Health in All Matters podcast
Series 2: If Not Now, When? | Racism: A 400-year public health emergency
Episode 6: Hope, Solidarity, and Perseverance
Airdate: January 7, 2020
Duration: 29:58

News Clip: “It’s such disturbing video: George Floyd handcuffed, lying on his stomach, with a police officer’s knee on his neck for nearly 9 minutes as he begs for breath.” 

Michael Joyce: I’m Michael Joyce, host of the “Health in All Matters” podcast from the University of Minnesota School of Public Health. We opened this second series of our podcast with that news clip. We knew George Floyd’s murder was a flashpoint and we knew we had to respond. We needed to listen and learn and acknowledge the urgency of addressing racism as a public health priority.

In this final episode of our series on racism as a public health emergency you’ll hear from two people who were instrumental in helping put this series together.  One is Tricia Alexander. She’s a Master’s student in our program with a special interest in both nutrition and human rights. The other is Kumi Smith. She’s an assistant professor in our division of epidemiology and community health with a strong passion for health equity.  Here’s Tricia ..

Tricia Alexander: His murder absolutely changed me. His murder was a modern-day lynching. I’ll admit I haven’t watched the video. I don’t have it in me to watch that video. Just hearing the audio I’m having a visceral reaction to hearing his voice. The realization that he knows he’s going to die. And so to watch that video for me would take me beyond the point of recovery. I think it would be self-inflicted harm.

His murder changed me in that I reassessed what I was willing to put on the line. What I was essentially willing to risk for human rights.

I had never been to a protest before and after George Floyd’s murder was the first time I went to a protest. And it was the protest in which a tanker truck drove through the highway as we were all just sitting there in a moment of silence.

Walking away from that moment I felt just so connected to people I didn’t even know.

That made me realize it’s not just a saying – you know, ‘human rights are for everyone’. In that moment I felt what it meant to live by those words. When you’re really in the fight, are you willing to have your actions back up those words? And seeing others live up to that made me rededicate myself to living up to that cause.

MJ: Did the global response surprise either of you? And what were your thoughts as it started to spread virally across the globe?

TA: It did surprise me. Because I felt this will be just another scenario where there’s some rage — outrage for a couple of months — and then we’ll all go back to normal. But then I realized there was no normal for us to go back to in the Covid-19 pandemic.

People didn’t have their everyday routine that they could just jump right back into. I think there was a lot of time to sit and think about this.

I do wonder if the pandemic created a scenario in which — regardless of your background — you were experiencing some sort of trauma. Some sort of stress with this pandemic. And to see another person lose their life life during such a tumultuous time, I think would ignite compassion in any human being

Kumi Smith: I too was surprised by the response and when I reflect back on it I think one of the reasons why George Floyd really hit home so much for us and folks around the world is because the pandemic had really distilled life down to what was so important: Your health and your life. And how important social connection is and how reliant we are on each other.

And I think it was just the absurdity of it. How are we all just fighting to stay alive, and to stay well during a pandemic, and how is that a black man is still having to die this way? When we know there is so much more that is important.

[Music Interlude]

MJ: Before we go any further in this conversation, I think we need to connect the dots between the mission of public health, and the health impacts of racism. So for you Kumi, what is the most clear and convincing argument that racism is a public health issue?

KS: Yeah. That’s both an easy and a really complex question that I think our field is really struggling with.

Maybe not all folks have an immediate understanding of what public health means. So to start from there I think of it as — contrasting with medicine, where it’s about the health of the individual — public health is about the health of populations.

And so if you look at health from a population point of view, it becomes pretty quickly obvious just how different we are from each other. But it’s in a very specific way. And those ways are essentially patterns.

So during this pandemic we’ve had to deal with: Why is Covid so much more lethal for people who identify as black or latinX? And when you think of police shootings: Why is it that the risk of being killed by a police officer is two-and-a-half times higher for young black men as compared to young white men?

So it’s not that being black is bad for your health. It’s that the pervasive racism in our system unfairly disadvantages some groups, and unfairly advantages some groups. But it does so based on how we look.

So what this really really tells us is that health conditions, and access to health care, are spread out across our societies in a really uneven way. And that racism is the driving force behind all these things.

So we in public health often talk about what we call ‘social determinants of health’ — things like housing, education, employment — and all of these are sort of your ticket to better health. And if there is a system that distributes these things unevenly, then that system is something that we in public health have to address and think about. And it is what fundamentally links public health to a system like racism, and obliges us to dismantle it in the name of public health.

MJ: Looking back at episode one, remember? When we were debating whether or not racism is a public health emergency. I’ve always been curious what your thoughts were about that. Whether you bought that or not. If so, why? If not why?

TA: There’s so many ways in which it’s so clear that it’s a public health emergency. But I think it’s because I live in the body of a Black woman and experience what it’s like to navigate this world as a Black woman. So to me this was all common sense.

It’s understanding how racism impacts Black people’s ability to make life decisions.

And I think the best way I can frame this is through reproductive choices. Dr. Rachel Hardeman of the School of Public Health is doing research right now on how police violence is literally impacting Black women’s decision to have children.

I think it’s easy for us to understand this in other countries. We think about countries that are war-torn and what happens there when they are going through civil unrest. And I think that is happening here. And we are just choosing not to see it in the same way. There’s Black boys and girls, and women and men, who are going out into a war zone. And they have no guarantees that they will come home each day. Their life might be seen as only worth a $20-bill, like George Floyd. Or worth a bottle of orange juice like Latasha Harlins.

I think about all these scenarios in which black people must always be ready to fight, or flee, or freeze in order to make it home alive.

And if we can see that as an issue of democracy and human rights in other countries, why can’t we see that as an issue of democracy and human rights right here on American soil?

MJ: And it brings up the notion that a lot of us who are white we’re not sure how racism affects us. In a way we don’t know what to do with it. We’re uncomfortable with it. What are your thoughts? I’m eager to learn how you think racism does affect all of us.

TA: I want to start off that when I think about ‘racism affects all of us’ I don’t think of it in the sense that we are all equally impacted with the burden of racism. Because that’s not true. But how I think about it is in a couple of ways.

One way is self-compassion. In order to have compassion for self you have to have compassion for others. When you don’t see others’ suffering as similar to your suffering, I feel that’s so isolating.

And another way I think about racism affecting all of us is there’s always a hierarchy. So I think about how power is at the center  of all ‘-ism’s’, not just racism. And how when we can’t address the experiences of racism, I don’t see how we can address sexism, how we can address homophobia. I don’t see how any type of discrimination or prejudice can be addressed without addressing the roots of racism.

I think about that poem  ‘First They Came’ … “First they came for the Jews and I didn’t say anything because I wasn’t a Jew … Then they came for the socialists and I didn’t say anything because I wasn’t a socialist … and he ends it by saying … then they came for me and no one was there to speak for me.”

KS: I would totally agree with you. I think that the notion of racism as a social problem for a long time has been talked about as if this is about ‘uplifting’ Black, Indigenous and people of color. With this implied message that the target that we’re all trying to reach, the level we’re all trying to reach, is the standard of living and the wellness that white people experience.

I think that is why the idea of diversity and equity, or the idea of minority health, has often been championed by scholars of color, students of color; while the rest of academia or society might applaud those, they don’t participate in it. At least not until recently.

And I think it’s a pretty subtle shift but a profound one is to realize that  we’ve been thinking about racism as what we need to do to lift certain groups out of poverty, or out of certain neighborhoods, and so we fixate on exactly what you were talking about; which is their suffering and their deficiencies.

And the real consequence of that — aside from putting people in boxes and perpetuating stereotypes — is that I think it absolves those systems that created those hierarchies in the first place.

MJ: And it also, Kumi, sounds like a caste system.

KS: So many things that Tricia has been saying really bring to mind Isabel Wilkerson’s book, Caste, which is to talk about how caste systems are everywhere. In the book she specifically talks about caste systems in Nazi Germany, in India, and in the United States.

And she says each version relied upon the stigmatizing  those deemed inferior to justify

the dehumanization necessary to keep the lowest ranked people at the bottom. And the most chilling thing she points out about caste systems is that they endure because they are often justified as divine will; originating from sacred texts or the presumed laws of nature, or reinforced through the culture and passed down through the generations.

So when I hear that it makes me realize there’s a reason why I came up through my public school system never learning about these things. And whatever I might have witnessed or seen about the black American experience was handed to me as very matter of fact: that this is just how it is in America.  And I don’t see any adults around questioning it. So why would I?

And that’s how I think these systems — as Isabel Wilkerson says — get reinforced in the culture and get passed down through the generations.

So it takes a huge amount of effort to wake up and realize what has been handed down to us and how that mistake has been repeated time and time again. And that it’s going to take a momentous effort to break that cycle.

Fortunately our generation is not the first to know this and there’s been so much done before us. But there’s a huge amount of history, and thought, and philosophy that we need to learn.

[Music Interlude]

MJ: Tricia. As a student about to become a public health professional: What’s your plan personally for confronting racism in your professional life?

TA: I look at addressing racism in my professional life with the same amount of passion and necessity as I do in my personal life. Because the two I don’t think can be separated.

I think it’s a characteristic of white supremacy when we try to be ‘objective’ about this work professionally or academically. Because we can not be truly objective about something that is extremely personal and emotional. One main thing that comes to mind is recognizing the humanity of the other.

I think about Loretta Ross. She is one of the founders of the reproductive justice movement. I attended one of her virtual lecture series and she talked about how her mentor said you can not ask others to show up with love and kindness if you can not do the same.  She said ‘of course I can do that.’ And then he said can you do it for someone who is a KKK member? And that for her was huge to think about. How do we show up with love and kindness for people who blatantly hate us for reasons that are beyond our control.

By ‘othering’ people we can justify within ourselves that there’s something that makes them less of a human. But the moment we begin to recognize the humanity of the other as our own, that’s just a different level of engagement and intentionality in combating racism. It’s not about helping, it’s about solidarity.

MJ: And this brings up the issue of solutions. Because it makes me wonder where public health as a discipline might have the biggest impact. More importantly, what’s realistic and do-able if public health wants to step in here?

KS: I think public health has a really important role to play in anti-racism and dismantling structural racism because we hold such strong evidence in our hands that it exists. And I think holding it up for the public to examine — to give them unequivocal evidence that it’s there — is a really powerful role that we can play.

Dr. Ibram Kendi’s book ‘How to Be an Anti-racist’ is really making the rounds right now and I think one of the really key things that he talks about is that people often mistake racism as a matter of hatred and bigotry and ignorance. He says it’s not really those things or changing individual minds, it’s really about confronting the system that we’ve all found ourselves a part of, and using the tools that we have available to dismantle that system and to lay the groundwork for a new one.

On top of that … I think what has really come to light in the past few years is that researchers and academics and people who practice public health also have some of the greatest leverage over making policy changes that really need to happen to make these differences.

So we really do have a moral, also a professional obligation and ability to implement a lot of the important change that we’re reacting to right now, both with Covid and the post-George Floyd era.

[Music Interlude]

MJ: Elevating missing or unheard or marginalized voices. We hear a lot about the need for it.

But not so much about how it can be done. Again, does public health have a role here? In terms of elevating these missing or unheard or marginalized voices? What do you think, Kumi?

KS: What I think our field needs to do is to first educate ourselves about who is already doing this important work of anti-racism in the public health field. Who is already out there.

Then I think what public health needs to do is invite those folks to the table and give them a platform.

But we must be careful not to do it in a way that ‘tokenizes’ them or marginalizes them. Because that’s been happening for a long time. And the ways that a lot of activists have told us to be careful of that is to compensate folks for their time. Be ready to take seriously their suggestions for structural change. And avoid making excuses that something they are suggesting is just too hard. Because by saying that you’re really minimizing the injustice or struggle they’re trying to describe to you.

A final important thing is for us to focus on diversifying who is active in our field of public health. Who are our researchers, our study participants, our community partners, our students?

And when we want to diversify, that’s a very noble goal, but I think what can often end up happening is that our field will sort of pluck the few black, indigenous, and people of color who are active at the top and then we sort of hire and recruit them away.

But what we don’t necessarily do is invest in the pipelines — the younger ages and earlier stages of education — where we really need to start fostering the next generation of scientists and doctors and activists. And these are the people who are going to make our public health workforce in the future. And are going to make the workforce, and the responses that we create, reflect the diversity and the values of the people that we serve.

MJ: How about you Tricia? When you graduate from this program and become a public health official. How would you like to see public health, as a discipline, help elevate those missing and unheard voices?

TA: I think something very pragmatic that the field of public health could do is broaden what it believes is its area of practice. And by that I mean we have an understanding of the social determinants of health being someone’s access to food, someone’s access to housing – all of these different areas. And I hope to see public health lean in more and push a little bit more into working more collaboratively with folks in these fields. Working interprofessionally, and saying: “We might be the field of public health but you won’t limit us to only addressing diseases.” Until it becomes the norm and  part of the framework  for public health to be engaging in education policies,  and all these different areas that affect people’s health.

Entrenching ourselves in community to the point that community members know: “there’s so-and-so from the department of public health. They come to our community garden, they come to our block parties, they know my kid’s school and their needs.”  I think it’s really that personal connection that requires time.

I think public health is slowly starting to see it’s not enough to just come in and do a study. And it’s not enough to come in and do a study and leave the tools with people. Right? I think personal relationships go a long way.

And that’s a big personal choice that people have to make.  How much am I willing to use my role as a public health official, not only to get funding and research – which is important – but actually become a part of these communities and know their day-to-day struggles.

[Music Interlude]

MJ: I think a common refrain that happened after George Floyd was this anxiety that we all sort of  felt that George Floyd was not … well, hasn’t been … the last black unarmed person to die at the hands of police. So the fact that we know it’s still coming means that we know that this work is important, that it’s unfinished, and that it’s going to be ongoing.

So there’s this question of stamina. How do we keep fighting? And not take our eyes off the ball. And at the same time it’s very emotionally distressing and stressful. There’s so many personal emotions caught up in it.  So I think the question is: How do you both honor those emotions (and not ignore them)  but then how do you harness them to make for sustained, directed, intentional work in this anti-racist journey?

KS: I look for role models. I take a lot of strength from knowing how long this journey has been going on. Long before I was born.  And how long it will go on after I’m gone.

And there are so many role models out there.  But one person who I really look up to … I did my graduate school in North Carolina where I learned about Reverend William Barber who’s nationally famous now … who’s done a lot of really great talks about anti-racism.  Something he often talks about is what he calls a ‘3rd reconstruction.’ And what he means by that is there were these broad multiracial, multi-religion, multi-class coalitions that have come together in the past in American History to rebuild society under this anti-racist paradigm.

He describes the first coming right after the civil war. The second one coming after Brown vs. Board of Education, and now we need a third one. And the point though, is that we don’t need a 3rd one because the past reconstructions were inadequate or somehow flawed, but it’s because they actually were successful, and that’s why we need another one.

So at the end of his sermons he often shouts out: “It’s movement time again” and you’re like ‘Oh my gosh! It is! And I get to be part of this one!”

So that’s what I find so motivating is that this path has been walked before. There are many who have been doing it for a long time. And if they tell you that they can do it, I can’t see any reason why I can’t either.

MJ: As I listen to you it keeps going through my head that: Yes, this is a public health issue. We’ve established that. It’s a moral issue. It’s a human rights issue. It’s an issue of justice. It’s so basic. But it’s also basic in humans to be tribal. So basic in humans to identify an ‘other’. And we’ve got a long way to go. Do you think we can get there?

KS: How long can we really wait? How bad does it need to be before we all realize that this is a moral issue. And that we are all standing, categorically, on the wrong side of history if we’re not doing something. 

And it’s a story that Isabel Wilkerson relates in her book Caste, and it’s a description of Nazi Germany and a photograph of a whole row of people ‘heiling’ in unison as Hitler goes by in a motorcade. And she points out in the photograph there is actually one person in the crowd who stiffly with his arms folded into his chest and he is refusing to salute.

And the thing that she says about this person is that everyone around him is tragically, fatefully, and categorically wrong. And in that moment only he could see it.

At that time he could not know the murderous path to hysteria around him and what it would lead to. And that’s because this is before any of the concentration camps had started. But she says he had already at that point seen enough to reject it.

I think that’s a great illustration of just because you can’t see how profound and immoral and sinister a lot of what is happening is now, it doesn’t mean it’s not happening and it doesn’t mean that where we are now is OK.

TA: Hope is so important to all of us. Without hope there’s really nothing.  And  if I did not feel a sense of hope in this work, I would not be able to keep going in it.

More importantly I think about how fun it can be. I understand this is heavy stuff. This is painful stuff. And I think we need to bring joy in to this work. I often say I laugh to keep from crying sometimes. As much as there is to be hopeless in this work, as much as there is to feel down about, there is so much to feel joy and happiness about.

Another reason I think it’s possible is looking back at all the things that were deemed impossible.  I’m sure at one point people thought slavery would never end. I’m sure at one point people thought segregation would never end. Although slavery and segregation continue today in different ways. Not to discredit that.  I would say that the fact that I’m on this podcast with you all would have never happened 100 years ago. We would never have been able to be in the same room.

So I think looking back at all of the points of joy that we take for granted because we live  in the ‘-post’ of it. We are the future generation that so many folks in the past talked about. And we take that for granted.

Yeah.  It is possible. It is absolutely possible to achieve this change in society that is committed to anti-racism, that’s committed to human rights.

[Closing music]


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