Nov. 01 2019

Come Together

For far too long, our country has been plagued by health inequity. It's time for that to change.

This year marks the 400th anniversary of a critical moment in our country’s history, one that continues to shape public health to this very day. It was 1619 when the first Africans arrived at the colony of Jamestown, in what is now Virginia. They may have been indentured servants—neither enslaved nor truly free—but their landing paved the way for millions more who would be sold or born into bondage during the 246 years in which race-based slavery was widespread in the United States. In 2019, the nation continues to be haunted by the legacy of that arrival.

Ultimately, three articles of the Constitution would systematize slavery, establishing deep-seated inequalities that continue to play out in our economy, in our political leadership, in our housing system, and in the health of our citizens. Jim Crow laws may be more than 50 years behind us, but racial inequalities still make a life-or-death difference in our health.

In the United States, people of color bear a disproportionate burden of illness and death as compared to the white population. The U.S. Department of Health and Human Services reports that the death rate is generally higher for African Americans than for whites for heart disease, stroke, cancer, asthma, influenza, pneumonia, and diabetes, among other conditions. African Americans are three times more likely than whites to die of a pregnancy-related complication and nine times as likely to die from HIV. American Indian and Alaska Native populations, who share a history of persecution, have a higher prevalence of obesity, diabetes, and cardiovascular disease.

These disparities are often attributed to poverty. But even when controlling for poverty, the statistics are sobering: Blacks have worse outcomes than whites at every level of income and education. Research conducted at the Columbia Mailman School shows that African Americans who experienced racial discrimination were twice as likely to use illicit drugs or to take pain pills without a medical reason. Interestingly, the relationship was present only among blacks with income above 150 percent of the poverty line—more evidence that income is not an insulator from slavery’s long-term effects.

It can be difficult for some members of our public health community to talk about racial inequality because it opens up a conversation they feel ill-equipped to have. But it is important that we do so. There is some evidence that the effects of racism translate literally from generation to generation: In one study by researchers at the University of California in San Francisco, black women who reported chronic worry about racial discrimination had roughly twice the rate of preterm birth of women who did not constantly worry about it.

We cannot accept these inequities for future generations. Members of the public health community are in a unique position to mark the 400th anniversary of slavery with open conversation about its lasting impact. Progress against inequality has always been achieved when people join together. Ask yourself what role you and your coworkers and others in your community can have in righting the wrongs of the past and shaping the future. Think about how to observe the anniversary. Publicly tell a personal story of oppression and resistance if you have one. Post health inequality information on social media. Host a potluck dinner to bring together a diverse group to talk openly about racism and its effects. For ideas, refer to the starter kit available at www.400yearsofinequality.org. It was compiled by a team led by former Columbia Mailman School professor Mindy Fullilove, MD, professor of Urban Policy and Health at the New School in New York City. (She is also my colleague and ex-wife.)

The field of public health has invested great effort into helping individuals and communities redraw their health destiny. But undoing 400 years of inequality will require more than individual effort. We must band together if we are to eliminate the strictures and structures of dehumanization and inequality so that future generations are born with a truly equal opportunity for a healthy life.


Robert E. Fullilove, EdD, is the associate dean for Community and Minority Affairs, professor of Sociomedical Sciences, and the co-director of the Cities Research Group at Columbia Mailman School.


Columbia Mailman School Marks 400 Years of Inequality

“The quest for equity underpins all of the work we do at the School to raise the floor and ceiling of health for people worldwide,” says Dean Linda P. Fried, MD, MPH. “Observing this fraught anniversary is key to understanding how we arrived at our current unequal situation, and to making fundamental changes for the future.”Throughout the 2019-2020 academic year, campus events will allow the community to reflect on the 400th anniversary of slavery and learn how to combat the significant health and structural inequalities that persist in the United States.

Events kicked off in September with a roundtable, Framing our Struggles for Justice, featuring faculty who work with children, adolescents, and other vulnerable populations. On October 14, a community-wide, daylong Ecology of Inequality event featured film screenings, panel discussions, and guest speakers who explored the inequalities that exist today in our neighborhood and our nation, with a focus on building a more cohesive and just community and society. Throughout the academic year, Grand Rounds at Columbia Mailman School will be themed to align with the national observance of the 400th anniversary, with topics such as 50 Years Since Stonewall (November), 400 Years of Xenophobia (January), and Data Science for Justice (February). For complete event details, visit publichealth.columbia.edu/400years.