How to get well amid deeply embedded inequities
In a virtual Wexner Center panel, Dr. Shawnita Sealy-Jefferson and others discuss systemic public health inequities and the tough work of moving forward
In many ways, the ongoing coronavirus pandemic has created unprecedented levels of social and economic upheaval. The death toll alone is horrifying and difficult to comprehend: COVID-19 has killed well over 500,000 people in the United States.
And yet when it comes to inequities in public health, the pandemic hasn’t revealed anything new. According to Dr. Shawnita Sealy-Jefferson, a social epidemiologist and assistant professor at Ohio State’s College of Public Health, the virus has merely exacerbated pre-existing realities. “People of color are disproportionately impacted — that's not new. Mistrust of the medical establishment — that's not new. We're seeing mass shootings and state-sanctioned violence in multiple ways, and that's also not new,” Sealy-Jefferson said. “These inequities that this pandemic is showing have been observable for 400 years.”
In a virtual panel discussion hosted by the Wexner Center at 7 p.m. tonight (Monday, April 12), Sealy-Jefferson and others, including artist Cameron A. Granger, artist Baseera Khan and the Kirwan Institute’s Kyle Strickland, will tackle the question, “How Do We Get Well?” (Autumn Glover, senior director of Community and Civic Engagement at the Wexner Medical Center, will moderate; previously scheduled moderator Dr. Amy Acton will no longer appear “due to unforeseen circumstances,” according to the Wex. RSVP here.)
The good news, Sealy-Jefferson said, is that the pandemic, along with racial justice uprisings from the spring and summer of 2020, have made inequities virtually impossible to ignore, and more people are speaking out in response. “With the calls for racism to be declared a public health crisis and all this social activism around Black lives matter and stopping anti-Asian racism, I think a lot of people are awakened who haven't been awakened to these issues in the past,” she said. “And that's a good thing. That's something different that this pandemic has ushered us into.”
The bad news is that society has a long way to go in addressing those inequities. “Seeing multiple municipalities declaring racism a public health crisis is a step in the right direction, but that's not enough. We need action. We need words and deeds,” she said.
As a social epidemiologist, Sealy-Jefferson approaches public health in an all-encompassing manner. “We’re trying to empirically document associations between systems of oppression — all of the -isms: racism, sexism, classism — and population health outcomes. … All of these multiple sectors are related and connected, and they are impacting health. You can't disentangle them, and I think that complexity is something that is hard to wrap your mind around,” she said. “We’re trying to focus on the question, ‘Who and what is responsible for these inequities that we see?’”
In answering these questions, Sealy-Jefferson is less interested in individual risk factors and personal behavioral decisions. “The choices people make are a function of the choices they have,” she said. “We're wanting to move the conversation in another direction, towards the root causes of inequities.”
Sealy-Jefferson studies how racism manifests itself in various ways at the neighborhood level, focusing on factors such as evictions and mass incarceration and how they relate to preterm birth, which is the leading cause for death for Black infants. From there, she seeks policy solutions that can help improve health outcomes. “Some of these policies, on the surface, they look like they don't do anything for health. They look like economic policy. They look like they don’t have anything to do with people's risk of having an infant death,” she said. “But we know that there's health in all of the policies.”
Still, a single policy won’t solve systemic problems that prevent society, particularly vulnerable populations and communities of color, from getting well. “It's going to take a sustained, thoughtful approach,” Sealy-Jefferson said. “If we do anything short of telling the truth about racism and actually documenting and figuring out all of the ways that racism shows up, and then systematically going across all of the parts of our society and doing the very uncomfortable, very hard work of dismantling it, it's not going to work. There is no shortcut. It took us 400-plus years to get here.”
Understanding and grappling with the long history of racism in the United States is crucial, said Sealy-Jefferson, noting the “How it started vs. How it’s going” meme can be a helpful way to frame these issues. “We can't possibly forge a path forward if we don't understand how we got here,” she said. “The inequities have gotten worse over time, and that doesn't make sense, because this country spends a lot of money on public health initiatives and medical technologies.”
The all-encompassing nature of the problem doesn’t let individuals off the hook, of course. In fact, it all begins with one person’s actions. “Where can you impact the negative consequences of racism on a day-to-day basis?” Sealy-Jefferson said. “I think everybody was created to do something of service to the world. If everybody just picked a problem and dedicated themselves to doing something about it, I don't think we would have so many problems. … Who are you? What are you created to do? What problem are you here to help solve?”
For Sealy-Jefferson, those questions aren’t abstract. They’re deeply personal. “I have an opportunity and an obligation because I am a member of the group that is disproportionately impacted by nearly everything. So this is my work. This is what I do for a living. But I'm also called to it because I have a Black husband. I have two Black kids. I don't get to opt out. I either am a part of the solution or I'm just taking it. And I'm not just going to take it,” she said. “I have epidemiologic tools that I'm able to use to fight injustices for the liberation of my community. … If not me, who?”