The U.S. continues to create policies and systems that deny opportunities to or abuse specific groups, which harms all Americans, according to presenters at Monday’s General Session on “Policy-Mediated Violence: A Threat to Health.”

Angela Blackwell, David Richards, Mona Hanna-Attisha, Tony Iton“We have to come to grips with the reality that the inequities we see, the racism we see, do not reflect a broken system,” said presenter David Williams, a professor of public health and chair of the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health. “Instead, they reflect a carefully crafted system functioning as planned, successfully implementing social policies, many of which are rooted in racism. They are not accidents.”

These deliberate choices are known as “policy violence.”

“We are having a reckoning with racism right now,” moderator Angela Glover Blackwell, founder in residence of PolicyLink, told the more than 600 attendees. “Everybody across the country is recognizing we have to come to grips with the institutionalized, the structural, the baked-in racism that we are experiencing the impact of right at this very moment.”

While attention to police killings of Black Americans has increased in 2020, people need to also acknowledge the everyday policies that harm people, said presenter Tony Iton, senior vice president of healthy communities at the California Endowment.

The damaging effects that a purposeful lack of policy can create has never been more evident than during the pandemic and the country’s growing number of deaths and infections, he said.

“COVID-19 has moved like a heat-seeking missile into Black and brown bodies throughout this country. …We know this is producing enormous trauma in the lives of these populations,” he said. “We live in a society that manufactures social vulnerability. We put people in harm’s way routinely, and then we act surprised when they get harmed, like by COVID-19 or Hurricane Katrina or a foreclosure crisis or HIV/AIDS.”

Williams continued to explain how inequalities in the U.S have been created through choice and policies. “I think of segregation as the ‘secret sauce’ that has created racial inequities in the United States,” he said.

There is not one major city in the U.S. where white and Black people live under equal conditions, Williams noted, citing a study showing that even the worst urban conditions that white people live under are considerably better than the average situation for Black residents.

However, racism not only harms the people it’s directed at, but the entire country, Iton said.

“Racism has a lot of collateral damage,” he said. “When you build a system around racism, it ends up having all of these unintended consequences in the larger population.”

Angela Glover Blackwell and Tony ItonThe lack of universal health care is an obvious example, Iton said. This affects middle-income people when they have a catastrophic event, have a child born with a disability, or lose their job and employer-based health insurance. That, in turn, creates enormous inefficiencies and an economic drag on the system because employers and unions have to focus on health care issues.

In addition, Iton contended, deaths of despair (drug overdose, suicide, alcohol-related disease), which have increased among middle- and low-income white people, are another outcome of racism.

“Those are directly collateral injuries as a result of policy that fails to essentially embrace a sense of social solidarity across groups,” he said.

The effects of policy violence are often seen in the nation’s children, said presenter Mona Hanna-Attisha, a pediatrician who helped expose the drinking water crisis in Flint, Michigan. (During Monday’s session, Hanna-Attisha was also honored with the 2020 Fries Prize for Improving Health for exposing the water crisis, motivating national changes in community water management, and reducing racial and ethnic disparities in child health.)

“It’s too often in the bodies of our children, and in their blunted potential, that we witness a failure of policies to respect science, to promote public health and to eliminate inequities,” Hanna-Attisha said. “To me, this is criminal.”

Mona Hanna-AttishaShe pointed to the lack of policies addressing child poverty, gun violence and environmental racism, particularly the threat of lead poisoning

To overcome policy violence, she said, the U.S. needs to: provide living-wage jobs; fund, desegregate and improve education; untie health insurance from employment and institute universal health care, free of racial disparities; and strengthen environmental regulations.

“These are the society policy-level things that we can do to make sure that our children grow up in resilient places, rather than burdening them with the necessity to be resilient themselves,” she said.

At the same time, Americans need to acknowledge and talk about the nation’s racist past and present, Iton said.

“This notion of truth, healing and reconciliation is central,” he said. “We can’t go forward the same way that we’ve come. We have to understand how we got to where we are; we have to tell the truth.”

Williams added, “We cannot be silent. We cannot be indifferent. We are in a moment of national reckoning, and we have to take advantage of this opportunity.”

Photos, from top: speakers Angela Glover Blackwell, David Richards, Mona Hanna-Attisha and Tony Iton; Blackwell and Iton; Attisha. Photos courtesy The Nation's Health.