With COVID-19 having a disparate effect on Washtenaw County's Black residents, particularly in the 48197 and 49198 ZIP codes, local residents are increasingly describing racism as a public health issue.

The issue has notably received recent recognition at the government level. The Ypsilanti City Council passed a resolution June 4 declaring "racism a public health crisis in the nation" and resolving to institute policies that promote equity, justice, and health in communities of color. But like many people of color, Ypsilanti resident Cherisa Allen has been living with racism as a public health issue her entire life.

"I remember being pregnant at 17 with a set of twins, and the doctor just assumed I was on Medicaid," Allen says. "He saw someone young and Black and having twins and tried to rush me out of the hospital, saying Medicaid would only cover a few days. I told him it was a good thing I wasn't on Medicaid."

Racism touches all of the social determinants of health – factors that have an effect on people's access to healthcare and their health outcomes, from education level to the neighborhood they grow up in to the kinds of food they have access to.

"As a social worker, I talk about mental health and the effects of stress," Allen says. "You become stressed because of a lack of education, which leads to a lack of job opportunities, which means lack of food in the home, which means people are in the home fussing and fighting as stress leads to unnecessary arguments. If it becomes too overwhelming, protective services steps in, and a child may end up in foster care. Systemic racism has a snowball effect on our community."

Declaring racism a public health crisis

Jimena Loveluck, health officer with the Washtenaw County Health Department, says recognizing there are different "levels" of racism that play out in society, including on the individual level, is an important first step.

"In public health, the focus is on structural racism that comes from policies and systems, particularly as they impact health outcomes for different communities," she says. "We've seen for years, well before COVID-19 came, that we had significant health inequities in Washtenaw County. At the health department, we've made addressing these inequalities part of our ongoing mission and strategic work."

Part of that effort to address inequalities has involved creating a Community Voices for Health Equity Team, with members representing different segments of the county, from Whitmore Lake to Superior Township to the south side of Ypsilanti. The team members gather information about what communities need and relay information and resources from the health department to their communities.

Allen serves as the team member representing the South Side of Ypsilanti.

"We talk about things we can do in each community and how we can come together," she says. "One good thing we learned is that the South Side has a lot of resources within walking distance, but we still don't have a grocery store. We still have to go out of our city limits to get to a grocery store."

Community efforts to fill that gap have included members of the Community Voices team providing financial support for a gardening project at Parkridge Community Center. Hope Clinic has also created a free farm stand for the community to access. Billy Kangas, director of community engagement for Hope Clinic, also notes lack of fresh foods as a problem in a city with a high percentage of residents of color.

"That's one reason we started the farm stand, because if you don't have access to [a vehicle] there's no way to get to a grocery store without taking a bus," he says. Providing a farm stand next to Hope Clinic means that area residents don't have to rely on packaged food from the local liquor store or gas station, he says.

Stress, trauma have long term impact

Racism's other effects on health aren't as easy to address as creating a farm stand, though. The stress and trauma caused by living in a racist society have a large impact as well, leading directly to worse health outcomes for racial minorities.

"In Washtenaw County, we certainly see that. Look at life expectancy," Loveluck says. "We know, based on data from 2017, that there is a 10-year difference in life expectancy between Whites and Blacks, with Whites living 10 years longer. If you're Latinx, there's even more of a disparity. They're looking at an average life expectancy of 59, as opposed to 66 for Blacks."

Kangas says many of Hope Clinic's clients are immigrants, and trauma and fear sometimes keep them from accessing the food and care they need to stay healthy. He tells the story of a client's family whose mother was visiting from out of the country and ran out of a prescription.

"She couldn't get back home and she didn't have insurance, so the choice was to go without life-saving medicine or raise the money [to pay out of pocket]," Kangas says.

Luckily, Hope was able to get her access to a physician and a prescription, but many undocumented immigrants are too afraid to seek medical attention, he says.

"Then the issues fester until critical medicine is done at the emergency level rather than at a primary care level," Kangas says.

Trauma and stress also impact the local African-American community. Allen says she feels that Black women experience a "double whammy," needing to buck gender-based discrimination as well as racial discrimination. She says that in the past, sometimes she would say the same thing as a White colleague and get labeled an "angry Black woman" while the colleague was listened to and congratulated.

"In the workplace, we want to be validated, and oftentimes, we have to do better. We have to stay later, get up earlier, and take on extra jobs so we will be validated," she says. "All that stress is put on us to do better [and] give 120% when nobody else is giving more than 90% but getting paid more than me."

Alisha Spencer, a Community Voices team member who represents Sycamore Meadows in Superior Township, says she's often stressed about her two sons growing up.

"A couple years ago, I never thought that right now I'd be sad and not wanting them to grow up," she says. "African-American boys are often treated the wrong way, even in the school system. I don't want them to learn to hate. I want them to love everyone."

Allen has many of the same worries about her college-aged son. She says she calls him frequently and reminds him to be mindful about who he hangs out with and that he's taking care of his own health.

"With George Floyd and Tamir Rice and so many other Black men whose lives were taken, it's stressful as a Black mother with a son in college," she says. "I worry about him. Talk about health – this is stressful, going to sleep at night and hoping you don't get that call in the middle of the night."

Loveluck says that while the COVID-19 pandemic has changed the way the health department interacts with the public, the department's focus is unchanged.

"I think our staff see on a daily basis the impact of these health inequities, but particularly in the current time with COVID-19, issues around law enforcement, violence, the death of George Floyd and other Black and Brown people," she says. "Our staff is also very much reflecting on our role in public health and very much wanting to recommit to this fight for health equity and really looking at racism as a public health issue."

For more Concentrate coverage of our community's response to the COVID-19 crisis, click here.

Sarah Rigg is a freelance writer and editor in Ypsilanti Township and the project manager of On the Ground Ypsilanti. She joined Concentrate as a news writer in early 2017 and is an occasional contributor to other Issue Media Group publications. You may reach her at sarahrigg1@gmail.com.