Today is Juneteenth — a day that celebrates the abolishment of slavery in the United States. Almost 200 years later, protests surrounding police brutality against Black Americans have erupted across the country. Meanwhile, the coronavirus pandemic, which has been hitting African Americans harder than white people, continues. In our new weekly Facebook Live show focused on health in Appalachia, Kara Lofton interviewed Dr. Lauri Andress, a public health researcher, and Dr. Rachael Woldoff, a sociologist specializing in crime, race and community, about racism as a public health concern. This is an excerpt from that conversation, which can be found in its entirety here.
***Editor's Note: The following has been lightly edited for clarity.
Kara Lofton: How is West Virginia different about approaching public health than what we're seeing in other states?
Lauri Andress: That's a good question. I've been in West Virginia since 2013. And I've been asking that question and kind of looking at it. And, you know, the conclusion that I've reached is consistent with what a lot of scholars in public health think — that your health is shaped by where you are. Your health is shaped by an intersection with the place where you are.
When we strip away everything that makes up health, you have to look at the policies, regulations, history of that state, how they have approached employment, wages, keeping people safe in their everyday lives and professions. And when you add all that up together, at the end of it, you get population health. Health care only makes up about 20 percent of what makes us healthy. And so when you look at the history of West Virginia, and a lot of other sociopolitical factors, you're going to see worse population health in that state.
Kara Lofton: Well let me ask you guys this: West Virginia is a poorer state. There are in some ways many of the same sort of challenges that you would see for inner city African American folks in terms of poverty and access to health care and a lot of the things that can impact health. Is there an equivalency between white Appalachia and health and being Black in America and health?
Lauri Andress: Some of the research that I've done lately has looked at the gap in the infant death rate between Black women and white women, especially in West Virginia. And what we know at this point is that Black women, historically, have had a greater rate of infant deaths in the first year of their lives in white women.
And we see that particular statistic through time, no matter where we look, in whatever region of the country we are in. We also know that Black women can have a higher education level and a greater income than white women, and their infants will still die at a greater rate than white women. And so when we start looking at those factors, and we think about poverty... Black women and white women have the same opportunities to experience poverty in a state like West Virginia. But what they don't have an equal chance of experiencing in West Virginia is racism. And so there are public health scholars across the United States that are looking at racism, how it shapes the health of African Americans, minorities, people of color. Literally how racism gets under the skin to shape the health that we see at the end of the day. Racism has been declared a public health problem in the United States.
Kara Lofton: Why is it a public health problem? Like what makes racism a public health issue?
Rachael Woldoff: I think one of the big conversations that's happening right now around white privilege is white people not understanding what it's like to move through the world in systematic oppression and systematic racism in every institution, the police. Taking your children out and telling them to go have fun is not part of black existence. They're afraid of every single accepted control mechanism in our society that white people have accepted. For them, and I have a black daughter, we move through life worried about what will happen to our children, and so for African Americans, there is much stress and so much anxiety from the time they're very young.
Lauri Andress: So I want to take Rachael's examples, which are accurate and fantastic, and take them up to a higher level. So the first bucket is race and racism changes how you behave. The second bucket is race and racism shapes the opportunities and resources that you have access to, it limits opportunities and resources that you have access to, [such as] jobs, housing, education, laptops. And then the third bucket is that race and racism, long term, generational, happens over centuries in the United States.[It’s] your great-great grandfather, your great-grandfather, your grandfather. It begins to shape you at the cellular level. It gets under your skin. It changes your body at the cellular level through toxic stress. We call it weathering, sometimes they call it weathering or allostasis. Your body doesn't have the opportunity to relax and step back. So you're always vigilant, you're always under stress, chronic stress, from microaggressions, large aggressions, insults and pushback because of your race. And so we think that that gets under the skin and begins to change you at the cellular level. It's the flight or fight response where your body is always in a mode to take flight. Even when you sleep at night, your body never relaxes. And so we think that those are the three ways that racism shapes the health of black and brown people.
Rachael Woldoff: And so talking about it is like, “Oh, you know, I have black friends or I'm dating someone black or I have a black child, so there's not racism. You know, I don't have a Confederate flag,” those kinds of conversations. Those are sort of lower-level conversations about racism. And we're trying to elevate that to get people to recognize that racism is systemic. And it's built into our society. It's built into the criminal justice system. It was designed that way.
Lauri Andress: So, in defining racism, Rachael is right. You have to look at structures and systems and how they oppress the experiences and opportunities that people have. And then at the end of the day, you have this data that shows these inequities.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.