In the last many days, as a brown woman and mother to multiracial children, I have experienced outrage, sadness and anger. Simultaneously, as an epidemiologist and public health professional watching protests in the midst of a pandemic, I’ve felt concern that these gatherings will lead to the next wave of illness (which, as we’ve seen, disproportionately affects Black people).
But what I’ve experienced most of all is disbelief. Because I haven’t heard many currently elected political leaders ― the people who shape the legislative landscape of this country at the local, state and federal levels ― stand up with a real plan of action.
I’ve heard a lot of pontificating, but not solutions. What I long for is someone who will say, “I hear you, protesters, and this is what I plan to do.” Someone who could give people a glimmer of hope so they no longer need to protest and no longer need to congregate and transmit a virus that disproportionately affects communities of color.
And I don’t just mean solutions for police brutality itself (because there are a few politicians mentioning that). I mean solutions for the root causes as well. In public health, we talk about not just curing a disease, but preventing it from happening to begin with.
For example, if the disease we want to prevent is Type 2 diabetes, we work backward to a major cause of that disease ― obesity. And then we work backward to the causes of obesity ― poverty, limited access to healthy foods, little opportunity for exercise, etc. And we work on dealing with the consequences of obesity (treating diabetes) while simultaneously working on the root causes of obesity (improving access to nutritious foods in poor neighborhoods).
If only we would use a similar approach to the issues we are dealing with now. If the “disease” is police brutality and higher death rates among Black people, then we work backward to a major cause ― racism and implicit bias (the assumption that a person is likely to commit a crime simply based on their skin color). And working backward from there we get to a root cause (like socioeconomic inequality and lack of equal access to educational opportunities and white nationalism). In other words, we need to simultaneously work on curing the “disease” (stronger community oversight of police, for example) while also preventing the root causes (improving education and job opportunities and shifting stereotypes/cultural biases).
If there continues to be paralysis at the federal level, then I encourage states and local governments to take this on — not just to seek a Band-Aid for police brutality, but for longer-term strategies to reduce racism and socioeconomic inequality.
Now I know that lofty goals like changing cultural norms seem difficult, even impossible to accomplish, but we’ve done it before. Just think about smoking in the mid-1960s. Nearly half of adults in the U.S. smoked. Thirty years later, the number of adults who smoked was halved. And by 2018, only 13.8% of adults in the U.S. smoked.
How did we make such an enormous cultural shift? It was a multidisciplinary approach, involving the health care system, media, lawyers, policymakers and educators. Mass media blitzes on the dangers of smoking, laws banning smoking everywhere from airplanes to restaurants, anti-smoking education in schools, health care efforts to systematically promote cessation and a whole host of other strategies were deployed to shift public views, within a generation. And this is just one example ― there are so many others to learn from.
At the federal level, there should be a bipartisan, multidisciplinary committee of experts, including police officers, public health professionals, economists, policymakers, social workers, education experts, philanthropists and psychologists, to determine next steps. This is a group that could examine ideas from around the world for both curing the “disease” and preventing it. (For example, should school funding really be tied to property taxes ― doesn’t that inherently create inequality in poorer neighborhoods?). They could develop ideas for legislation at local, state and federal levels, and a concrete timeline for enactment. And they could identify actions that private companies, the media and even individual citizens could take to speed up norm shifts.
And if there continues to be paralysis at the federal level, then I encourage states and local governments to take this on ― not just to seek a Band-Aid for police brutality, but for longer-term strategies to reduce racism and socioeconomic inequality. And I urge philanthropic organizations to infuse much-needed capital into these multidisciplinary efforts, to enable them to succeed. I am not suggesting this approach would bring immediate answers to our problems. But at least it would move us beyond perseveration, toward solutions.
Tista Ghosh, MD, MPH is a physician trained in both internal and preventive medicine with a master’s degree in public health from Yale University. She received specialized training in epidemiology from the Centers for Disease Control and Prevention (CDC) and served in the U.S. Public Health Service. She is the former chief medical officer of the state of Colorado and was appointed (2017-2019) by the CDC director to the U.S. Community Preventive Services Task Force, a panel of national experts who review evidence and make recommendations to guide public health efforts across the country. (The views she presents here are her own and do not represent those of any current or former employer.)
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