Racism as a Public Health Crisis: A Cracked Foundations Costs

A note about foundations. Not the makeup kind – I’m talking about the literal concrete and steel that holds up buildings.

Because when we talk about racism as a public health crisis, we’re dealing with some seriously cracked foundations that everybody keeps trying to cover up with fresh paint and fancy furniture.

When you build a system designed to exclude, to discriminate, to deny care based on race – you don’t get stability.

You get cracks.

Deep, spreading, structural cracks that no amount of “diversity initiatives” or cultural competency training can patch over.

And those cracks?

They keep spreading through every level we try to build on top.

America’s healthcare system wasn’t just built separate and unequal – it was designed to maintain power over who gets care, who gets denied, and who gets to make those decisions.

We’re not talking about accidental oversights or unfortunate mistakes. We’re talking about intentional, systematic exclusion that created deep structural instability.

And baby, we got the receipts.

The Power of Legal Permission: How They Built Inequality By Design

If you think about power, it can be infinitely more destructive when it’s got legal backing.

When somebody can point to a law and say “see, we’re allowed to do this to you.” That’s not just discrimination; that’s state-sanctioned oppression. And in American healthcare? That power got baked into every level of the system.

The year is 1947:

A Black person could be actively dying outside a white hospital, and that hospital could legally say “not our problem.”

Think about that power dynamic. It extends deeper than individual racism, it was emboldened by Jim Crow laws and hospital segregation policies that made it legal to deny care. They had the law protecting their right to watch somebody die based on race.

Even the Hill-Burton Act, which funded hospital construction, allowed separate but equal facilities.

That’s not just cruelty; that’s systematic dehumanization with a legal stamp of approval.

When people talk about “medical mistrust” in Black communities like it’s some irrational fear, remind them: That mistrust was earned through generations of legally-protected abuse.

No trust was built in the first place.

When your grandma tells you stories about family members being turned away from hospitals, that’s not ancient history – that’s lived experience being passed down as survival knowledge.

These weren’t just individual choices made by racist doctors. This was systematic, institutionalized power over Black and brown bodies, written into law, built into hospital designs, and woven into medical education.

The whole system was architected to maintain control over:

• Who gets care
• Who gives care
• Who can access medical education
• Who has power over medical decisions
• And most importantly – who gets to make all these rules

When we talk about the GI Bill, we’re not just talking about denied benefits—we’re talking about denied generational wealth that could’ve changed health outcomes for entire family lines.

On paper, Black veterans were eligible for the same GI Bill benefits as White veterans.

In reality?

White veterans were able to use and enjoy those benefits for homeownership and education, allowing them to flourish in suburia after the war.

But for Black vets?

Racist banks and local VA offices blocked Black vets from securing home loans and accessing education, forcing many into underfunded schools and redlined neighborhoods, where hospitals were scarce or nonexistent.

That redlining wasn’t just about housing – it was about systematically controlling where people could:

• Live
• Work
• Learn
• Receive medical care
• Build community resources
• Create generational wealth

And here’s the part that really makes this system diabolical: They didn’t just deny resources – they blamed communities for not having them.

Like pushing somebody into the deep end and then criticizing their swimming technique.

These weren’t random acts of racism. This was calculated, systematic engineering of health inequality.

They didn’t need to put cracks in the foundation – the very act of building a system on exclusion and control guaranteed those cracks would form and spread.

Modern Symptoms of Historical Disease: How Past Power Creates Present Pain

The Tuskegee Syphilis Study wasn’t just about watching Black men die from untreated syphilis – it was about a system that saw Black bodies as expendable test subjects rather than human beings deserving of care.

And that mindset? It didn’t end with Tuskegee.

Look at Henrietta Lacks.

They took her cells without consent, built a multi-billion dollar research empire off them, and her family couldn’t even afford the treatments developed from her own genetic material.

That’s not just medical ethics – that’s medical exploitation wearing a lab coat.

These weren’t just isolated incidents of unethical research. They were symptoms of a system that saw – and still sees – Black and brown bodies as resources to be used rather than people to be healed.

Fast forward to today, and watch how those historical power dynamics show up in modern health outcomes:

• Black mothers dying at 3-4 times the rate of white mothers
• COVID-19 hitting communities of color harder while resources flowed to whiter, wealthier areas
• Life expectancy gaps of 10+ years between neighborhoods that were redlined and those that weren’t
• Indigenous communities facing life expectancies 5.5 years shorter than the national average

This ain’t coincidence – it’s compound interest on historical oppression.

The Residual Damage: How Historical Design Creates Modern Health Disasters

The concept of toxic inheritance…

When you design cities to concentrate pollution, poverty, and stress in specific neighborhoods, you’re not just affecting one generation – you’re programming health disasters that echo through decades.

Bodies Under Siege: The Physical Toll

Walk through any formerly redlined neighborhood and you’ll find a perfect storm of health hazards:

• Lead paint peeling off walls because nobody funded replacements
• Asthma rates through the roof from industrial pollution
• Food deserts where getting fresh vegetables is harder than finding designer drugs
• Medical facilities that disappeared faster than Blockbuster stores

When nearly 12% of children in former redlined areas show elevated lead levels, that’s not just about old paint – it’s about how systematic disinvestment turns neighborhoods into health hazard zones. Your ZIP code shouldn’t determine whether your child’s brain develops properly, but here we are.

Look at diabetes rates in Latinx communities – 66% higher than white Americans. The system wants to blame this on “genetics” or “lifestyle choices,” but let’s be real:

• How you gonna eat healthy in a food desert?
• Where you gonna exercise when your neighborhood ain’t got no green spaces?
• Who’s got time for preventive care when you’re working three jobs with no health insurance?

Minds Under Pressure: The Mental Health Massacre

Dr. Arline Geronimus calls it “weathering” – and in her groundbreaking work, she shows how the constant stress of racism literally ages Black bodies faster.

Like a house facing endless storms, the constant battering of systematic racism creates premature wear and tear on both body and mind.

This weathering effect isn’t just metaphorical. Dr. Geronimus’s research shows it’s literally programming early death into Black bodies through:

• Accelerated aging at the cellular level
• Higher blood pressure
• Increased heart disease risk
• Compromised immune systems
• Heightened risk of premature death

When we talk about policing and health, for example, we need to understand something about institutional evolution.

Systems don’t just appear – they grow from existing power structures.

Modern policing emerged from various 18th and 19th-century institutions focused on “maintaining social order and property interests.”

Modern policing doesn’t just harm communities—it erodes public health.

From the stress of over-policing increasing Black Americans’ risk for heart disease to the trauma of police violence shortening life expectancy, the connection is clear: you can’t be healthy when you’re constantly under siege.

When COVID Hit: The Pandemic Exposed Every Crack in the Foundation

When engineers want to find structural weaknesses in a building, they apply pressure and watch what breaks first. This is called a pressure test.

COVID-19?

That was America’s biggest public health pressure test in recent memory, and baby, did it expose every single crack in our foundation.

Remember how I said you can’t paint over structural damage?

When the pandemic hit, all that fresh paint got washed away real quick, showing exactly how deep those historical cracks run:

Black and brown communities weren’t just getting hit harder – they were getting demolished while the system acted surprised. But there was nothing surprising about:

• Essential workers (disproportionately people of color) being forced to choose between their health and their rent
• Multi-generational households in historically redlined neighborhoods becoming virus hotspots
• Communities with pre-existing conditions (thanks to environmental racism) facing higher death rates
• Healthcare deserts suddenly becoming COVID deserts

When they started tracking COVID outcomes by race, they acted shocked at the disparities. Like they couldn’t connect the dots between:

• Communities forced into crowded housing by historical redlining
• Neighborhoods with higher rates of respiratory issues from industrial pollution
• People working frontline jobs without the luxury of “working from home”
• Areas with limited healthcare access suddenly struggling to get testing

Black and Indigenous Americans were dying at nearly twice the rate of white Americans. Latino communities saw hospitalization rates three times higher than white Americans.

And when vaccines rolled out? Wealthy, whiter zip codes got first dibs, while Black and brown communities had to fight for access.

The virus might have been new, but the pattern? That script was written generations ago.

Breaking Ground on Better Systems: Beyond Band-Aid Solutions

Think about renovations…

At some point, you gotta stop patching walls and admit you need a whole new building.

Because when your foundation’s this cracked, no amount of “diversity initiatives” or cultural competency training is gonna fix the structural damage.

System-Level Reconstruction

Redesigning Medical Education from the Ground Up

Not just adding cultural competency modules, but completely reimagining how we train healers. We need medical education that:

• Centers community health experiences and knowledge
• Teaches the history of medical racism and its modern impacts
• Requires rotations in underserved communities
• Values cultural wisdom alongside clinical skills

So that we produce healthcare providers who understand health in context, not just bodies in isolation.

Rebuilding Funding Models

Instead of punishing hospitals for serving poor communities, create funding structures that:

• Reward preventive care and community health improvements
• Provide extra resources to historically underfunded areas
• Support community health workers and cultural healers
• Invest in local health infrastructure

So that a community’s health resources reflect their needs, not their property values.

Power Redistribution

Fixing these cracks isn’t about tweaking the same broken system—it’s about shifting power. Because for too long, healthcare decisions have been made about communities without being made by them.

If we want real change, power has to flow back to the people most impacted. That means moving from community ‘input’ to community control—where people don’t just have a seat at the table, but the ability to build the damn table themselves.

From Community Input to Community Control

Stop asking communities to advise on decisions already made. Instead:

• Put budget power in community hands
• Create community-led health boards with real authority
• Fund community organizations directly
• Support indigenous healing practices

So that communities can build health systems that actually serve their needs, not just fulfill grant requirements.

Cultural Authority, Not Just Competency

Move beyond teaching providers about culture to:

• Hiring healers from the community
• Supporting traditional healing practices
• Funding community health knowledge creation
• Validating multiple approaches to wellness

So that communities can access care that aligns with their values, not just tolerates their presence.

The Foundation We Need: Moving from Survival to Justice

Every crack we see in public health today started with a choice.

A choice to build systems that protected some lives while treating others as expendable.

A choice to concentrate power in institutions that were never meant to heal everyone equally.

A choice to keep painting over problems instead of fixing their roots.

Here’s what hits different: We’re not just fighting against a broken system – we’re fighting for the right to build something entirely new.

Something that doesn’t just patch holes but fills every community with the resources they need to thrive.

Because let’s be real – we’re not asking for equality anymore.

We’re demanding transformation.

We’re not interested in getting a slightly better seat at a broken table. We’re here to build a whole new house.

Think about what becomes possible when we stop accepting crumbs of progress and start demanding whole loaves of justice:

• Communities controlling their own health resources
• Healing practices that honor cultural wisdom
• Health systems that prevent harm instead of just responding to it
• Power flowing to those who’ve been historically denied it

Next time somebody suggests we can’t afford to rebuild our health systems, remind them:

We can’t afford not to.

Because every dollar we spend maintaining broken systems is a dollar stolen from our children’s futures.

Every band-aid solution we accept is another crack we’re passing down to the next generation.

So yes, we need to look at racism as a public health crisis.

We’re not just fighting against racism in public health – we’re fighting for a future where your ZIP code doesn’t determine your life expectancy.

Where your skin color doesn’t predict your maternal mortality risk.

Where seeking healthcare doesn’t require proving you deserve to live.

The foundation is cracked, fam.

But we’re not here to patch it anymore. We’re here to break ground on something stronger, something built for everyone’s survival, something worthy of our communities’ power.

Because at the end of the day, this isn’t just about health – it’s about justice.

And justice? That’s not something you request. It’s something you build.

Block by block. Community by community. Until the whole damn system is transformed.