Lets Talk About Racism

In March of 2020, when then-Mayor Bill DeBlasio announced that the New York City Police Department would be responsible for enforcing mandates related to the raging COVID-19 pandemic, Seth J. Prins, MPH ’10, PhD ’16, had a bad feeling. “We saw anecdotal reports in the media that most of the people being arrested or given summonses were Black,” says Prins, assistant professor of Epidemiology and Sociomedical Sciences.

Sure enough, once data became available, Prins and his research team found that ZIP codes with a higher percentage of Black residents had significantly higher rates of COVID-19–specific court summonses and arrests, even after researchers took into account what percentage of people in each area were following social distancing rules. The team’s findings suggested that tasking police with enforcing mandates may have contributed to overpolicing of Black communities and the harms that result. Living in a neighborhood with a high rate of police stops has been associated with elevated rates of anxiety, post-traumatic stress, and even asthma. Prins and his colleagues found that pandemic policing mirrored the discretionary nature of the city’s stop-and-frisk program, which was deemed unconstitutional in 2013 due to racially discriminatory practices.

“It was a sick irony,” he says. “Not only did the policy increase close contact with police, who had incredibly low vaccination rates and often weren’t wearing masks, but also the people arrested were taken to crowded jails, where transmission rates were extremely high, and then sent back to their communities, which were already experiencing disproportionately high rates of coronavirus.”

His team’s report is one of several highlighting the ways in which the COVID-19 pandemic brought to the fore the long-standing effects of racism on public health, with findings of far higher death rates in this country among people of color. The Centers for Disease Control and Prevention declared racism a serious public health threat in 2021, following decades of research supporting the idea that structural racism is a significant driver of the social determinants of health, impacting everything from where people live and where their children go to school to the quality of the air they breathe, the food they eat, and the healthcare they receive. In recent years, Columbia Mailman School researchers have published numerous studies that underscore the persistent and devastating effects of racism on public health and illustrate the ways in which historically marginalized groups experience deep-seated health inequities that lead to higher rates of diabetes, hypertension, obesity, asthma, and heart disease, as well as a shorter life expectancy.

In her course titled The Untold Stories in U.S. Health Policy History, Heather Butts, JD, MPH, assistant professor of Health Policy and Management, guides students through an examination of policies that have embedded structural racism in healthcare over several decades. Among them is redlining, a racially biased mortgage-appraisal policy dating to the 1930s that led to food deserts (and the adverse health impacts that result) and other environmental adversities. More recently, research has shown that pulse oximeters are less effective on people with darker pigmentation. Throughout the COVID-19 pandemic, “You had Black and brown people going to their doctors and saying, ‘I’m having trouble breathing,’” she notes. “The doctor says, ‘The oximeter says your oxygen level is 96, you’re good to go.’ Meanwhile, that’s not an accurate reading.”

By continuing to probe the less obvious ways in which these historic mindsets continue to affect society, the researchers hope to contribute to a conversation whose ultimate goal is true health equity. Ami Zota, ScD, MS, who recently joined the School, has published research linking elevated levels of endocrine-disrupting chemicals in the bodies of Black, Asian, and Latinx women to products, such as skin lighteners, hair straighteners, and fragranced feminine care products, that reinforce Eurocentric beauty norms. Discrimination based on hair style and texture has been directly traced to a lack of access to economic opportunity.

When discussing her work, Zota, like Prins, points to the structural racism behind the findings. While we might not typically think about the social context that drives definitions of beauty, Zota says, “environmental exposures are determined by upstream factors like racism.” In 2017, she wrote about the disproportionate use of feminine care products among Black women and noted a link between douching and the legacy of slavery in this country. “White slave owners created a social construction of race and highlighted phenotypic differences to basically say that those of African descent were sub-human,” she says. While skin color and hair texture were obvious components of that, she says, odor also figured in. “Smells related to sexual and reproductive organs were further used to hypersexualize Black women who were enslaved”—and used as a rationale for sexual exploitation. “The idea that the body and home should smell ‘clean’ became a value that was passed down and a pathway to social and economic mobility,” says Zota.

She also noted a subtle racism in some of the responses she got from the media covering the work. Some reporters asked her why, if the OB-GYN community had discouraged douching, Black women were still engaging in the practice. “They took the approach of vilifying the user,” she says.

So pervasive is structural racism that it affects the temperature of the air circulating within our homes. Diana Hernández, PhD, associate professor of Sociomedical Sciences, has documented how racism has resulted in both segregation and a lack of investment in housing among certain populations, with enduring implications for physical and mental health. Hernández is a sociologist who conducts much of her research in the South Bronx, where she grew up in Section 8 housing. She has found that people living in poverty and people of color are more likely to live in energy-inefficient homes (such as those with poor insulation), despite consuming less energy overall. Energy insecurity—the inability to meet basic household energy needs—is associated with poor sleep, mental strain, and respiratory illness. Affected households might cope with the lack of heat by using ovens, stoves, or space heaters to warm their homes (exacerbating the risk of fire and contributing to respiratory problems), and by wearing coats and extra layers of clothing indoors. They might spend their days in bed, tucked under blankets and quilts, and forgo food, medicines, and other necessities. Hernández tells the story of one woman who sent her kids to school with holes in their shoes so that she could afford to keep the lights on at home.

Though the energy crisis of the 1970s and ’80s led to the implementation of some programs that address home-energy insecurity, only about 1 in 5 eligible Americans actually obtain benefits. In addition to a lack of awareness about where and how to access help, people with limited incomes face administrative burdens, from having to take time off work and pay for transit to submitting documents verifying identity and need. Energy insecurity also tends to be internalized in a way that other issues aren’t, says Hernández, and is often interpreted as a personal failure. “There are ways people navigate the food landscape—by visiting food pantries or accessing Supplemental Nutrition Assistance Program benefits, for example—that are not available when it comes to energy,” she says, a situation that can affect social relations. In managing the shame and stigma associated with a lack of heat or power, many will keep friends and relatives at a distance.

Prins, whose early-career work in the policy realm spurred him to ask bigger-picture questions about racism and our country’s drug policy, has written extensively about the school-to-prison pipeline, a set of practices that make it more likely for some adolescents to be criminalized and ensnared in the legal system than to receive a quality education. The phenomenon gathered steam in the 1990s, part of a trend that saw the government cut spending in welfare, education, and housing while investing in systems of surveillance, punishment, and incarceration. “There are over 10 million students in the United States who go to a school that has a police officer but no nurse, counselor, social worker, or guidance counselor,” Prins says. Out-of-school suspensions have more than doubled over the past 40 years, and these policies have been borne disproportionately by adolescents of color, which is directly related to the preponderance of Black people in the nation’s criminal legal system.

Many Columbia Mailman School researchers have had the satisfaction of watching their work translate into real-world change. Zota testified before policymakers in California, Washington, and elsewhere as they considered regulations on beauty and personal care products, for instance, and saw the Toxic-Free Cosmetics Act, which bans the use of 24 hazardous ingredients from personal care products, passed in 2020. (Eighteen states, including California and New York, have also passed laws banning discrimination based on hair style and texture in the workplace and in schools.) A write-up in The Washington Post about Zota’s research into the presence of harmful chemicals in fast food led Sen. Dianne Feinstein of California to take the issue on and spurred Rep. Raja Krishnamoorthi of Illinois to petition the Food and Drug Administration (FDA) about it.

The wins can be gratifying, but Zota and the others acknowledge that, like racism, entrenched interests including Big Pharma, Big Food, and other industries can obstruct the work getting done. For example, thanks in part to the trailblazing research of the Columbia Center for Children’s Environmental Health, Congress instituted a federal ban on seven phthalates in levels exceeding 0.1 percent in toys and children’s products. But the dangerous chemicals can still be found in clothing, shower curtains, detergents, shampoos, and other products. Zota points to a lack of enforcement mechanisms for various consumer protection laws and to a dearth of funding for implementation. Last year, she published a paper looking at the effects of phthalates on learning and attention among children and recommending their elimination from food contact substances, only to see the FDA rule soon after that the petrochemical industry could continue using the most common phthalates—and leaving out any mention of health concerns in its decision. Facing challenges related to climate change, she noted, the industry appears to be digging in when it comes to the production of plastic.

Some progress is being made where the school-to-prison pipeline is concerned. Prins points to pilot programs in New York City that use restorative justice practices in schools to deal more holistically with disciplinary issues and that train teachers to be less discriminatory when applying discipline. But such measures can only go so far. Truly addressing the structural issues behind the school-to-prison pipeline, Prins says, will require a fundamental shift, one where social services are redirected from punishment to prevention. Similarly, he says, addressing mental health and substance use issues related to exploitation in the workplace shouldn’t be about offering underpaid and overworked people seminars on work-life balance. Policymakers should be looking at things like enforcing overtime laws and making it easier for people to unionize.

Systemic change will likely come about only once different questions start getting asked—and different people ask them. In 2019, Zota, whose parents hail from rural India, created Agents of Change in Environmental Justice, a fellowship aimed at amplifying the voices of environmental health scientists from marginalized backgrounds. The program’s move to Columbia with Zota’s arrival complements the work of RISE (Resilience,  Inclusion, Solidarity, and Empowerment), a peer mentor program launched at the School in 2018. These days, Zota says, most of the people shaping public perspectives in the environmental health field are older, male, and white, but the members of her program—which works with the nonprofit Environmental Health News to amplify research and engage with the public—offer different lived experiences. “Whether you’re talking about climate justice or environmental justice, if you’ve grown up in one of the communities that is hardest hit, that is going to shape how you view the problem and how you view solutions.” Participants in Agents of Change write essays and produce podcasts and videos. Graduates, including at least four Columbia Mailman School alumni, already have been invited to give talks at the National Institutes of Health and the National Academies of Sciences, Engineering, and Medicine.

A new initiative capitalizing on the expertise of Epidemiology professor Mary Beth Terry, PhD ’99, will tackle systemic health problems among historically marginalized groups in a revolutionarily holistic way. In January, Terry was named director of the Center to Improve Chronic Disease Outcomes through Multi-level and Multi-generational Approaches Unifying Novel Interventions and Training for Health Equity  (known as COMMUNITY). While the citywide center has roots in public health, it incorporates representatives from cardiology, oncology, neurology, nursing, and general medicine and draws expertise from across Columbia University. The goal is for the Columbia researchers, working with colleagues from Cornell, NewYork-Presbyterian, Hunter College, and the City University of New York, to engage with the communities Columbia Mailman School serves, particularly the Black and Latinx communities, across several diseases at once. Whereas most research programs get their funding through a connection to individual diseases, the aim here is to break down silos and focus on more comprehensive interventions.

Terry calls this new initiative the realization of a 20-year dream shared by the entire team, whose members have wanted to work together, given the common antecedents to many chronic diseases. “This new funding focuses on developing and validating interventions as we have so much descriptive epidemiology already,” she says. “These data have existed for decades. We need scalable, successful interventions.”

Terry notes that community health workers, who tend to have large networks and inspire trust, will be central to achieving health equity. They are already part of a program focused on improving outcomes for people juggling multiple chronic diseases, including a sleep program recently launched in the Latinx community in Washington Heights. A Harlem project will rely on community health workers engaging with churches to identify candidates for colorectal cancer screening, as the guidelines recently changed in response to a surge in diagnoses among young Black men. Terry expects the combined initiatives, which are led by her Columbia colleagues, to improve health and help build the evidence for the cost-effectiveness of community health workers, and ultimately to fund them better.

Hernández, too, sees leveraging community networks—in her case, within reimagined multiple-unit housing—as a way to bridge gaps in public health. Practitioners have long worked in gathering places such as churches, particularly in Black communities, to get public health messages across. “In some ways,” she says, “sharing an address can be more of a connection point than sharing faith. There are so many things that can be done to think about meeting people where they are, reducing barriers, and reaching populations that are quote-unquote hard to reach.”

Researchers affiliated with the COMMUNITY Center will continue the work that Columbia Mailman School has long undertaken with community organizations such as the Harlem-based WE ACT for Environmental Justice—work that centers the concerns of people of color. Like Zota’s fellowship, COMMUNITY involves an educational element, including training the next generation of new investigators who are interested in combating the health inequities of chronic diseases. This deliberate passing on of knowledge is critical. “To me, structural racism is not having the mentors you need to move up the ranks,” says Butts. As an African American with degrees from three Ivy League universities, Butts stands as a living example of the change she and her colleagues all believe is possible.

Jocelyn C. Zuckerman is the author of Planet Palm: How Palm Oil Ended Up in Everything—and Endangered the World.