Across the U.S., there have been 256 declarations of racism as a public health crisis. The city of Boston’s 2020 executive order was one of the few declarations to actually specify an action plan.

Tuesday’s APHA 2022 session “Racism as a public health crisis: From declaration to action” drew a packed room, engaging many attendees who were in the process of drafting their own region’s declaration of racism. Declarations of racism are resolutions, formal statements and executive orders that acknowledge racism as a public health crisis or emergency. They often recognize the historical foundation of racist policies and declare racism a driver of inequitable outcomes. 

APHA compiles information on these declarations in an interactive storytelling map and accompanying analysis. Session moderator Tia Taylor described these statements as necessary for the healing that precedes transformation.

“We recognize (these declarations) as an important first step toward action,” Taylor said. “But without strategic actions, resources and systems of accountability, these declarations can seem very performative.”

Lonias Gilmore explained what she learned after analyzing 60 declarations and conducting interviews with 18 public health leaders. She found that administrative reforms and training were the most common activities performed in response to declarations of racism, with funding remaining scarce in many situations. Even funding provided to jurisdictions for social justice and health equity work often still does not go directly to communities, Gilmore said. 

A caveat to her analysis was that it was difficult for Gilmore to determine whether the government was partnering with organizations run by people of color and whether their actions directly served communities of color. 

“We don’t want this to be a performative declaration. We want the community to hold us accountable,” said one senior public health official interviewed for Gilmore’s project.

Boston’s anti-racism action

Triniese Polk, director of the Boston Public Health Commission’s Office of Racial Equity and Community Engagement, shared the actions taken by the city of Boston after releasing its declaration. 

On June 12, 2020, Boston’s then-mayor Martin Walsh signed an executive order declaring racism an emergency and public health crisis. The order referenced statistics on racial health disparities faced during the COVID-19 pandemic, pointing to systemic racism and preexisting inequities. The rate of COVID-19 cases reported for Black Boston residents was 268.8 per 10,000 compared to 89.8 per 10,000 for white residents.

The Boston declaration committed to a partnership with the BPHC to undertake eight key strategies, ranging from developing a “Boston Health Equity Now” plan with the city’s COVID-19 Health Inequities Task Force, to guaranteeing access to data for equitable policy and practice development. 

As opposed to other forms that these declarations can take — including formal statements of opinion by legislative bodies or simple proclamations — executive orders issued by local mayoral offices govern action by the “force of law,” Gilmore said.

Walsh transferred around $3 million from the Boston Police’s overtime budget to the BPHC in support of work that assesses and addresses the impact of racism on the lives and health of Boston residents. Taylor singled out Boston’s declaration as one of the few to “actually specify a distribution of resources.”

Gilmore explained that while implementation plans, timelines and actions may still be happening, these commitments were not embedded in most declarations, making it difficult to evaluate progress. 

After the Boston declaration’s release, the BPHC used an equitable community engagement framework to learn from staff and residents — including the Racial Health Equity Advisory Committee — to figure out how to tackle racial injustice. 

“While I was reviewing responses, I couldn't help but share my 94-year-old grandmother’s voice in my head who always says, ‘Triniese, mind your own business and sweep your own front porch before you go try to sweep somebody else’s,’” Polk said. 

Polk directed the Office of Racial Equity and Community Engagement to implement antiracism in “every corner” of its operations. Formerly named the Office of Health Equity, the specification of racial equity and community engagement in the new title allowed the health commission to be more intentional in how it addressed racial inequities, according to Polk. The BPHC instituted an anti-racism policy that set forth action plans to confront institutional racism. 

Actions have included implementing a budget equity tool now used by all departments to prioritize funding for equity neighborhoods and populations. Departments are required to incorporate community voices directly through participatory budgeting that targets communities of color and other marginalized communities — such as frontline staff — who should have a voice in the budget process. 

“Institutional and structural racism does not create itself,” Polk said. “Policies, practices and environmental cultures are created by people, people with power. And I know this because I’m a person with power and privilege. Without a shift in how we use our individual and institutional power, racial inequities will continue to persist.”

The new equitable procurement policy addresses inequitable economic investment in the small and local business sector. It requires city departments to obtain records when seeking goods and services above a particular amount. At least one of those quotes must be from a certified underrepresented business enterprise, which are Black or Brown-owned businesses in Boston.

Professional development plans were updated with anti-racism training that teaches public sector employees how to identify and counter implicit unconscious bias in decision-making and how to collect breakdown data. According to Polk, the staff will be held accountable through the creation of racial equity action plans and the inclusion of pre- and post-training requirements. 

The local government’s job descriptions now have anti-racism and racial equity duty requirements. To decrease incidence of implicit and unconscious bias in hiring, the city is piloting the use of diverse interview committees in tandem with standard equity questions and scoring rubrics. Race-based employee resource affinity groups have also been established, with their first official Juneteenth event happening in 2022, hosted by the city’s Black Employee Network.

Polk admitted that as a team, the BHPC still had a lot of work ahead: addressing pay inequities, rolling out a race/ethnicity/sexual orientation data collection standard across the entire organization and more work to identify how best to serve vulnerable communities in Boston. Polk wants the city to be more outward-facing so community members can hold the city accountable — her team is currently working on a plan to distribute resources outward to Black and Brown communities in a way that hasn’t been done before in the city. 

“My fight against racism is both personal and political,” Polk said. “My family were once recipients of the resources that I advocate for in my daily work. My professional success and generational first aren’t a result of my ability to pull myself up by my bootstraps. Instead, (it is) a direct result of access and opportunity.”