The Multnomah County Board of County Commissioners declared racism a public health crisis on April 8, the latest step in a decade-long effort to address health inequities and disparities in access to quality education, employment, housing, and healthcare.
The resolution reaffirms the Board’s commitment to advance racial justice and health equity initiatives across the County; champion the continued integration of equity-related practices into the County’s policies and procedures; and support the implementation of a public health approach in policy development within each department.
Already, the County has doubled down on its anti-racism work through Preschool for All, the Transforming Justice Initiative, shifting funding to culturally specific providers in the SUN system, the Climate Justice Initiative, the adoption of the Community Health Improvement Plan, centering racial equity and prioritizing BIPOC communities in ending and preventing homelessness, and addressing COVID-19.
With this declaration, the Board joins 170 local governments around the country in declaring racism to be a public health crisis. The resolution, sponsored by Chair Deborah Kafoury, was prepared by the County Health Department and supported by a panel of County staff and presenters from community-based organizations.
Advocates for the resolution said that acknowledging the role that racism plays in determining health outcomes is a critical step that should lead to directing more resources to address inequities. Panelists provided many examples of how racism impacts the health of county residents. One of the most powerful was shared by Timur Ender, a member of the Multnomah County Public Health Advisory Board (MC-PHAB).
“Life expectancy in Multnomah County varies by up to 20 years by ethnic group,” he said. “That can be the difference between a person ever knowing their grandchildren or not.”
In introducing the panel, County Chair Deborah Kafoury noted that “the concept of racism as a social determinant of health is not new to Multnomah County. We know that the neighborhoods we live and work in, our access to transportation, stable employment opportunities, the kind of education we are offered, the ease or difficulty with which we can access healthcare, and even our risk of being victimized by harmful, sometimes fatal policing policies and practices — all these factors affect our health and are social determinants of health.”
“It is appropriate for the County to call out racism as a public health crisis and to act to address it,” Chair Kafoury continued. “As a public health authority and the largest provider of safety net services in the state, Multnomah County is uniquely positioned to create the conditions that contribute to people’s health by actively identifying where systemic racism is hurting individuals and our community at large, intervening where we can to stop it, and redressing those harms using the tools available to us.”
Ebony Clarke, interim director of the County’s Health Department, explained why the resolution was being proposed now.
“The past year has been a time of racial reckoning across our country,” she said, noting the thousands of protests that followed the police killings of unarmed African Americans, including George Floyd and Breonna Taylor. Further, the COVID-19 pandemic highlighted the inequities in health outcomes based on race.
“By adopting this resolution and naming racism as a public health crisis, this board is committing to an approach that will be utilized across the entire county, not just in the Health Department,” Clarke said.
Multnomah County Public Health Director Jessica Guernsey noted the County’s ongoing efforts to address health inequities based on race. Those range from the Community Health Improvement Plan (CHIP) to recent efforts to lead with race on the County’s COVID-19 response.
The resolution notes racist laws and policies in Oregon and the country that led to health inequities. Guernsey acknowledged that public health agencies had contributed to those inequities by withholding care and ignoring whole communities. She also said that there is an urgency to act now to combat inequities in health outcomes.
“Two years ago we reported to you on the leading causes of death in the county that highlighted racial disparities. Our 2020 data shows that the disparities are getting worse, partially as a result of COVID-19.”
Leslie Gregory, founder and director of Right To Health, was one of the community advocates who supported the resolution. A physician assistant, she is also an advocate for Oregon House Bill 2337, which would declare racism a public health crisis in Oregon.
“Going out into the community to provide services is the key,” she said. “We must act with a sense of urgency and use evidence-based data. We need action and funding and transformational new approaches,” such as mobile community-based health services.
Jenny Lee, deputy director at the Coalition of Communities of Color, said that the resolution should lead to new investments in public health. She applauded the County’s leadership on a number of fronts that will support public health in Black, Indigenous and other communities of color. Funding culturally specific health services, passing Preschool for All and the Supportive Housing Services bond are all important, she said. Equally important is improving data collection so that it is culturally appropriate and can identify disparities, such as during the pandemic.
Ender, the MC-PHAB member, talked about the connection between race and exposure to violence.
“Violence is not random,” he said. “It’s driven by policy decisions, from a lack of sidewalks to inequities in the justice system.” He noted that African American pedestrians are overrepresented in pedestrian fatalities in the county because they often live in communities that lack sidewalks.
Ben Duncan, the County’s chief diversity officer, recalled his start at the organization 17 years ago when he saw racial disparities as a community health worker.
“My job was to visit homes with children with asthma. I saw families that live next to freeways, with exposure to lead and mold. I had the privilege to work with community-based groups struggling to make real policy changes for those who were impacted. This is an opportunity to boldly state and then boldly act to do the reparative work needed.”
Brianna Bragg is a program specialist who works with the Native American and Alaskan Native communities for the Health Department. She noted that Native Americans have twice the infant mortality rate as the majority community and the highest death rate from COVID-19 nationally. Her work with Indigenous families in the County’s Future Generations Collaborative gives her hope that disparities can be reduced.
Charlene McGee manages the Health Department’s Racial and Ethnic Approaches to Community Health (REACH) program, which aims to reduce health disparities in the African American and African immigrant communities. She shared that research has shown that racism has a toxic effect on the health of people of color, leading to negative health impacts, from high blood pressure to weakened immune systems.
There is also a link between the global climate crisis and health disparities due to race, said Tim Lynch, a senior policy analyst with the County’s Office of Sustainability. He noted that the resolution states that “the threats of the climate crisis, like poor air quality, extreme heat and flooding, fall disproportionately on frontline communities of color.”
Each county commissioner reflected on their own experiences before voting to support the resolution.
“As an emergency room doctor, I often get to see the bigger picture of how our systems fail people, especially the toxic and damaging impacts of systemic racism,” said Commissioner Sharon Meieran. “I’m proud and humbled to support this resolution today.”
Commissioner Jessica Vega Pederson said, “As we were listening to the presenters today, I couldn’t help thinking of my grandmother Vega, who was the mother of nine children and grew up in poverty with a lack of access to health care. She suffered from diabetes and had her first stroke at 62. Those disparities contributed to her health problems at an early age and impacted her quality of life for decades. We need to continue to make upstream investments to address racism, from preschool to having safe sidewalks in low-income neighborhoods.”
“At this time, as we all witness the trial for the murder of George Floyd, I think this may be one of the most important things that this board votes on,” said Commissioner Lori Stegmann.
In closing, Chair Kafoury noted the importance of the moment and the challenges that lie ahead.
“The disparities in social conditions that different communities face are stark, egregious and persistent. But they are not intractable or inevitable, especially when this County is fully committed to doing our part to confront them head on.”Commissioner Susheela Jayapal was absent.