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Structural Racism:  Introduction


In 2020, the American Public Health Association issued a policy statement declaring structural

racism a public health crisis or emergency. Subsequently, local and state leaders in 30 states have issued

similar statements, according to data collected by the APHA. Five of these statements were issued by

governors or legislatures on behalf of the state at large, while other statements were issued by governing

boards at the county and local levels. Specifically, sixty-five local entities, including mayors, city

councils, town councils, and local health departments, have declared racism a public health crisis or

emergency. Eighty-seven statements have been issued by county-level agencies, including county

commissions and county boards of health.


Within North Carolina, boards of commissioners and/or public health departments in nine

counties (Buncombe, Cabarrus, Chatham, Durham, Mecklenburg, New Hanover, Orange, Pitt, and Wake)

have issued declarations.


As of March 7, 2021, the following states have issued at least one declaration at the state, county

or city level: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa,

Kentucky, Maine, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New

Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Vermont,

Virginia, Washington, West Virginia, and Wisconsin.


Draft Resolution


WHEREAS data demonstrate that Black and Brown communities exhibit poorer health outcomes,

including higher rates of maternal and infant morbidity and mortality; higher rates, earlier onset, more

rapid progression, and lower survival of chronic disease; and lower life expectancy;


WHEREAS Black and Brown communities are more likely to experience inequities in the social

determinants of health, including access to adequate housing and nutritious food, reliable transportation,

good quality education and jobs; exposure to gun violence; overrepresentation in the criminal legal

system; exposure to environmental toxins in air and water; and overall quality of life;


WHEREAS Black and Brown communities are shown to experience chronic stress associated with

personally mediated racism and implicit bias in their everyday lives, which undermines mental and

physical health;


WHEREAS Black and Brown communities, experience less access to medical care, including lower

levels of insurance coverage; maldistribution of medical resources; restricted access to available services;

and provider bias, which undermines quality of care even though it can be unconscious and unintended;


WHEREAS the COVID-19 pandemic has disproportionately impacted Black and Brown communities,

in terms of adequate information, prevention, detection, access to vaccinations, treatment, disease

severity, and mortality as well as resulting higher rates of job loss, economic hardship, hunger, and



WHEREAS institutional policies and practices need not be explicitly or intentionally racist to have

stronger negative impacts on Black and Brown communities (Equal Rules + Unequal Situations =

Unequal Outcomes);


WHEREAS the negative impact of racial disparities persists across all socioeconomic levels;


WHEREAS these disparities reflect the negative repercussions of historical racism and the racist

structures inherited from that history that continue to exert a differential impact on Black and Brown

Americans, including but not limited to lower wages for equivalent work; discriminatory lending;

restrictions on home purchase; educational systems emphasizing neighborhood schools with funding

linked to property taxes; and distrust of the medical system grounded in the lasting effects of historical

trauma (e.g., Tuskegee study; eugenics, sterilization practices);


Be it resolved that the Association of North Carolina Boards of Health (ANCBH) will


(1) Recognize that inequity associated with race and racism is a public health crisis and advocate for

policies that will demonstrably improve health conditions in Black and Brown communities.


(2) Advocate for efforts to expand understanding of how racism affects both individual and population

health and to provide tools for dismantling institutional and personally mediated racism, including

implicit bias.


(3) Focus on enhancing organizational effectiveness by: (a) Assessing internal policy, procedures, and

goals to ensure that racial equity is a core element in all organizational practice; and (b) Working to create

an inclusive organization by identifying specific activities to increase diversity across the workforce and

in leadership positions.


(4) Build and solidify alliances and partnerships with organizations that have a legacy and track record of

confronting and fighting racism and encourage partners and stakeholders to recognize racism as a public

health crisis.


(5) Develop a consistent methodology for data collection, reporting, and analysis relevant to race to

ensure transparency in publishing of reports and to inform recommendations to decision-makers.


(6) Call on policymakers, businesses, schools, and other community leaders and institutions to begin

taking the necessary actions to address persistent discrimination in housing, education, employment,

health care, and criminal justice that ultimately leads to poorer health outcomes among Black and Brown





Bailey, Zinzi D., Justin M. Feldman, and Mary T. Basset. “How Structural Racism Works – Racist

Policies as a Root Cause of U.S. Racial Health Inequities. New England Journal of Medicine. 2021.



Evans, Michele K. et al., “Diagnosing and Treating Systematic Racism.” New England Journal of

Medicine 2020. 383:274-276.


Williams, David R., Joycelyn A.  Lawrence and Brigette A. Davis. “Racism and Health: Evidence and

Needed Research. Annual Review of Public Health 2019. 40:105-25.


Love, Bayard and Deena Hayes-Greene. The Groundwater Approach: Building a Practical

Understanding of Structural Racism. The Racial Equity Institute, Greensboro, NC.

In North Carolina:


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