Racism is killing black people. It’s sickening them, too.

June 4, 2020 at 4:27 p.m. EDT

Michelle A. Williams is an epidemiologist and dean of the faculty at Harvard T.H. Chan School of Public Health. Jeffrey Sánchez, a former Massachusetts state representative, is a lecturer at Harvard Chan.

“I can’t breathe.”

That was the one of the final pleas uttered by George Floyd last week before he was killed by police officers kneeling on his neck and back — the same plea cried out by Eric Garner before he died six years ago in a police chokehold. These words have become a rallying cry for protests across the nation.

To those of us in the public health community, they are also a visceral reminder of a reality we have come to know all too well: Racism is a public health crisis.

Nowhere is that reality more gut-wrenching and visible than in the police violence that kills black Americans at nearly three times the rate of white Americans. It is also apparent in the legacy of slavery and discrimination that persists in modern medicine and across the many social determinants of health.

Indeed, it is cruel and somewhat ironic that some are now pointing to “underlying health conditions” as a contributing factor in Floyd’s death, which has been ruled a homicide. That line of explanation, of course, is intended to deflect blame from the officers whose actions ended his life — and goes against what millions saw plain as day on video.

But it also illuminates another way in which racism is deadly. Across the country, black Americans suffer from higher rates of diabetes, hypertension, asthma and heart disease than white Americans. They are more likely to be obese and get insufficient sleep, which can contribute to such health issues. The role of racism in these underlying conditions cannot be denied.

A growing body of literature shows that social determinants — otherwise known as the conditions in which we’re born and in which we live, work and play — are key drivers of health inequities. For generations, communities of color have faced vast disparities in job opportunities, income and inherited family wealth. They are less likely to have housing security and access to quality schools, healthy food and green spaces. All these factors undoubtedly undermine mental and physical well-being.

In addition to the consequences of structural racism, it is well-documented that racism itself is hard on a person’s health. Chronic stress caused by discrimination can trigger a cascade of adverse health outcomes, from high blood pressure and heart disease to immunodeficiency and accelerated aging. Evidence even suggests that the racism endured by black mothers contributes to the alarmingly high maternal and infant mortality rate. Look no further than Erica Garner, Eric Garner’s daughter, who at the age of 27 went into cardiac arrest following an asthma attack.

“I can’t breathe.”

The covid-19 pandemic has laid bare many of these inequities for the world to see. We’re now learning that Floyd tested positive for the coronavirus in early April, almost two months before his death. All told, predominantly black counties are seeing three times the rate of infection — and six times the rate of covid-related death — as white counties.

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