Addressing racism as a public health crisis: a starting point for dismantling current systems

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The whole world has changed since the NYC Health Department exposed Undesign the Redline in 2018, but the relevance of the project has only grown. The project, detailed in a recently released report, provided a concrete way for a local health department to engage with residents, community partners and government employees about structural racism. Since 2018, two events stand out. First, the COVID-19 pandemic, with its disproportionate impact on blacks and Latin Americans as well as Native Alaskans, American Indians, and Asian Americans. Then came the murder of George Floyd, which re-energized activism against police violence, bringing structural and institutional racism to the forefront of the international stage. Together, these triggered a collective consideration of racist policies. Yet it remains a challenge to move beyond the rhetoric and make visible in everyday experience how such policies work to harm health. The example of redlining clearly shows how a policy can create conditions in which universal threats of viruses, violence or other harm are deadlier in some communities than in others.

Created and curated by Designing the WE, a social impact design studio, Undesign the Redline is a traveling interactive exhibit exploring the antecedents and subsequent harms of redlining. It aims to promote understanding and opposition to the lack of public and private investment in the marked neighborhoods. From January to September 2018, staff from the NYC Health Department offered tours of the exhibit to city government employees, religious leaders, architects, city planners, health service providers, educators, students. and residents of the Bronx. The content of the exhibit included reproductions of the original color-coded maps of the Home Owners Loan Corporation (HOLC), a historical timeline of relevant organizational policies, practices and efforts, and actual applications of how the resulting disparities may be not designed. The New York Department of Health matched the selected panels with maps showing geographic disparities in New York City, such as high school graduation rates, asthma hospitalizations, infant mortality rates and l ‘life expectancy. Cards make a powerful visual statement. Almost a century later, today’s health burdens continue to follow the historic red line.

My colleagues and I humbly acknowledge that this was a difficult job as government employees. For staff who grew up in the South Bronx, the intersectional identities as government employee and community resident have created unique complexities and opportunities. We offer this work as a tangible example of how a local health service can engage in difficult conversations about structural racism among staff, partners and residents. Editing and Staffing Undesign the Redline brought Department of Health staff closer to the experiences of the people in the neighborhood we serve, showing how the government can change its approach to public health practice. We learned with our visitors.

The first lesson was that in today’s South Bronx, by many indicators, the definition of a troubled neighborhood reflects bad policies, not bad people. But perhaps more importantly, this project highlighted how divestment in some neighborhoods made disproportionate investment in others possible. For example, redlining has also simultaneously created neighborhoods with green and blue lines where banks have made mortgages and other long-term investments. We found ourselves, as government employees, participating in an honest dialogue that included people who were harmed by the redlining system and people who benefited from it. Some participants had experienced events detailed in the exhibition. Some had internalized the narrative that their communities suffered because of poor decisions by residents and challenged alternatives to personal accountability. These conversations were raw, at times strained, and mutually rewarding. At the end of a tour a resident thought about it, I experienced that !!!! Please tell the truth.

Our call to action for other local health departments and organizations is to join us in pointing to structural racism as the root cause of health inequalities and in making explicit the link between racist policies and practices and resulting health outcomes. This project had reverberating effects. A senior school staff member inspired his class to visit the exhibit after his attempt to broaden the discussion of the war on drugs to include identifying elements of systemic racism embedded in politics and intergenerational trauma unresolved drug use.

Difficult conversations need a starting point; a way of understanding that the goal is to take responsibility, not blame. This work begins with learning from and alongside those we serve, and speaking the truth. It is only from there that one can begin to undo the design of what has been built. To learn more, read our Practice Full Report, Making Injustice Visible: How a Health Department Can Demonstrate the Connection Between Structural Racism and the Health of Whole Neighborhoods in the September / October 2021 issue of the Journal of Public Health Management and Practice.

Author Profile Lauren Shiman Lauren Shiman is Director of Research, Evaluation and Planning at the Bureau of Bronx Neighborhood Health, NYC Department of Health and Mental Hygiene. She works collaboratively with a team of community engagement specialists and researchers to increase understanding of the local social, economic and structural conditions that create health in the South Bronx. Like that:

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