Our skin is the largest organ in the body, designed to shield and protect us from the elements of the outside world. Its color is determined by the amount of melanin produced by a specific cell in our body and the reaction to sunlight. Throughout history, however, many people have been deprived of fundamental rights and equitable opportunities because of the color of their skin. This is racism.
All. A short, simple word that carries amazing weight. This word is very intentionally included in the Lake County Health Department and Community Health Center’s mission statement, “Promoting the health and well-being of all who live, work, and play in Lake County.” There are many in our community unable to experience their fullest quality of life, held back by the systems that affect them. And if public health is not advancing the health of all, we are failing.
At our Health Department, we constantly and curiously seek out ways to improve the health of our community and our own operations. One simple quality technique is the “Five Whys.” Basically, you start at an initial problem and keep asking why, up to five times, to get to the root cause of the issue. Sometimes these are very simple internal processes and we try to find more effective ways of doing things. Other times, it is much more complex and requires long-term strategies and many partnerships.
Let’s look at an incredibly nuanced example. We’ll start downstream at the symptom level—African American residents in Lake County ages 45-74 are more than two times more likely to die of cardiovascular disease than our white residents. As we start asking why multiple times, we head upstream toward root causes. Asking why reveals immediate factors such as diet and physical activity… asking why again we see access to fresh food and safety… asking why again brings us to topics like employment and earning a living wage. When we keep probing further, we find multi-generational factors within systems such as criminal justice, housing, and education.
Let’s be clear—many of these upstream factors are rooted in racism that continues to permeate established systems in our society. For this reason, racism is a public health issue. We see Asian-Americans being taunted, harmed, and blamed over COVID-19 fears. We see challenges in health literacy, and we must strive to communicate in ways that resonate with a person’s language and culture.
I am proud of who we are and what we do at the Health Department, with our incredibly diverse workforce and our continued focus on health equity and addressing the social determinants of health. We have proudly supported our Inclusion and Diversity Council since 2002, our human resources team has been very intentional to broaden our reach to promote open positions, and last year we invested in unconscious bias training for our managers and employees.
Our work, however, is not done. Injustices continue to prevail, and health disparities continue to plague our communities. These disparities have been highlighted by the COVID-19 pandemic, and in response, we co-founded community task force groups with Latinx and African American community leaders to assist us with identifying and implementing solutions. We are in the process of finalizing a new strategic plan with a clear a commitment to go upstream and address the root causes that keep our vulnerable populations from improved health outcomes.
We are a leading Health Department in our nation and will continue to take whatever steps are needed to advocate for policies that improve health in communities of color, and to assure our employees are positioned well to address these challenges with humility and compassion.
We have come together in public health to prevent diseases that devastated lives; more than ever before, we need to address fundamental impediments to all experiencing a healthy life, including racism. These conversations can be difficult, but they are necessary. These conversations can feel awkward, but they are worth having. This is not the first time we have discussed this topic, and it won’t be the last.
A picture I found online this week sums it up well— “If you are tired of hearing about racism, imagine how tired people are of experiencing it.”
All my best,
Mark A. Pfister, MSES, LEHP
Lake County Health Department and Community Health Center