State Legislation to Declare Racism a Public Health Crisis and Address Institutional Racism

August 12, 2020 | Melissa Lewis, Cassandra Thompson

The movement to address racism through policy change in the U.S. is receiving significant political support at every level of government. Government institutions are acknowledging the systemic oppression of people of color that persists in the United States and elevating racism as an urgent public health emergency comparable to other public health crises.

At the local level a growing number of cities and counties are issuing declarations. Public and private institutions, school districts, and business leaders are joining the charge to advance racial equity and to support policies declaring racism a public health crisis. At the federal level, a national resolution was introduced in Congress declaring racism a public health issue and leading national health associations ASTHO, APHA, AMA, and AAP issued statements in solidarity with these efforts.

At the state level, governors and legislatures are also taking actions to raise awareness of the impacts of racism on health outcomes, to reverse the damage of racist polices, and to promote policy change to prevent the negative effects of racism and discrimination on future health outcomes. Research shows that persistent exposure to racial discrimination may result in premature aging, poor health outcomes, and increased prevalence of certain chronic diseases. For example, Black Americans are more likely to have or die from certain chronic diseases, such as asthma, diabetes, and heart disease than white Americans and have a shorter life expectancy than the rest of the U.S. population. These racial disparities are tied to historical racist policies such as redlining and Jim Crow laws, and a legacy of disinvestment in communities of color.

Below is an overview of state level efforts to declare racism a public health issue, establish political bodies and procedures to assess the disparate impact of current policies on populations of color, and implement policy changes to ensure that future policies are enacted with a racial equity lens.

Governors in Michigan, Nevada, and Wisconsin issued executive orders declaring racism as a public health crisis requiring immediate action and allocation of resources. In addition, governors in North Carolina and Vermont issued executive orders establishing task forces or councils to implement strategies and policies to eliminate racism in several systems including the public health and criminal justice systems.

In July, the Minnesota House of Representatives passed HR 1 declaring racism a public health crisis. The resolution calls on the state to dismantle racism by studying existing policies, supporting initiatives that advance equal opportunity, and ensuring that public safety is administered equitably. Several states have introduced resolutions declaring racism a public health crisis—Michigan SCR 27 and HCR 25, New York J 3206, Ohio SCR 14 and HCR 31, and California SCR 92. These resolutions would commit the legislature to creating working groups, reviewing current policies with an equity lens, and developing strategies to reduce racism.

Other states have introduced legislation to investigate and/or address institutional racism by creating task forces, commissions, offices, and committees. These bodies would be tasked with investigating, studying, and evaluating racism and current policies; making recommendations; organizing amending policies; and bringing awareness to these issues. New Jersey introduced two sets of companion bills (A 2327, S 1662, A 711, and S 322) that would create two task forces, the Task Force on Institutional Discrimination in Health Care and the New Jersey Reparations Task Force. The purpose of these task forces is to study and evaluate the reasons for unequal healthcare outcomes and to research and develop reparatory proposals and recommendations to address the generational harms caused by the institution of slavery.

Massachusetts introduced companion bills H 1440 and S 2823 that would establish a commission on structural racism to review policies and make recommendations on reducing the number of people of color in the criminal justice system, a policy change that may have a positive public health impact. Black Americans and Hispanics make up the largest percentage of incarcerated individuals, and parental incarceration is linked to poor health outcomes across the lifespan including depression, substance use disorder, suicide, and chronic disease. Massachusetts also introduced HD 5124 that would establish the Truth and Reconciliation Commission to study institutionalized racism in Massachusetts and to recommend solutions to advance social justice and improve race-based policies.

Some states are introducing policies aimed at addressing the history of institutional racism. New York introduced companion bills A 10319 and S 8209 that would establish the Office of Racial Equity and Social Justice to plan and coordinate changes in policy, allocate state resources in an equitable manner, and to implement the state’s racial equity and social justice plan. In the North Carolina House of Representatives a resolution, HR 1233, would establish the House Select Committee on Combating Systemic Racism to study issues related to combating systemic racism in education, health, housing, criminal justice, economics, and government operations. Nebraska introduced LR 449 that would require the state to conduct an interim study on systemic and institutional racism and make recommendations to improve systems for people of color.

Public health agencies are well-positioned to lead, galvanize change, and foster collaboration across government sectors, stakeholders, and community organizations to advance racial equity and improve public health. There are many ways state officials can promote and adopt executive and legislative policies that move beyond pronouncements and commit to concrete action, such as forming taskforces, enacting meaningful policy change, and strengthening data collection capacities to evaluate and support a policy’s effectiveness.

Moving forward, states can sustain these efforts by allocating funds to programs with a stated goal of eradicating racism. The inclusion of a racial equity lens in policies, practices, cultural norms, and public health programming will work towards combating institutional racism and ultimately improve health outcomes for all citizens. ASTHO will continue to track legislative and executive action on this important public health issue.