The CDC’s Response

The CDC responded to Leslie on 10/23/15 by email. However (no surprise) it was not by Dr. Frieden:

Dear Ms. Gregory,

Thank you for your letter to Dr. Frieden expressing concern about the national response to the impact of racism on health.  Indeed, there is a significant and growing literature on the impact of racism on health, and particularly among African Americans.  In our work to address health equity, we have adopted the Department of Health and Human Services (DHHS) definition of health equity which clearly speaks to “….valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities.”  Similarly, our engagement with Healthy People 2020 Social Determinants of Health topic area also includes “perceptions of discrimination and equity” as a social determinant of health.  We have convened scholars, public health leaders and practitioners, and community leaders to chart a course toward achieving health equity, and racism is consistently named as undermining the health of communities of color.  In addition, CDC supports government-wide policies to combat the effects of racial discrimination. These take the form of various Executive Orders (EO), which are targeted toward improving language access to services since 2000 (EO13166), increasing diversity and inclusion in the federal workplace since 2011 (EO 13583), and promoting the implementation of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards), to name a few.  Addressing racism has been a central feature of a number of CDC-supported health disparities initiatives. One such example is CDC’s Racial and Ethnic Approaches to Community Health Program (REACH) in Genesee County, MI that is “undoing racism” as part of its public health efforts to reduce infant mortality among African Americans. See “Undoing Racism Through Genesee County’s REACH Infant Mortality Reduction Initiative” in Progress in Community Health Partnerships: Research, Education, and Action. Spring 2015; volume 9.1: 57-63.

 As we have sought to understand the impact of race and racism on population health, the most important question is what is the role of public health in addressing racism. One of the most effective ways CDC can represent the relationship between racial discrimination and health outcomes is to highlight the persistent burden of racial and ethnic health disparities.  One way CDC has highlighted these disparities is through a periodic CDC Health Disparities and Inequalities Report – United States, which was first published in 2011, and was updated in 2013. This resource has been used to call attention to emerging and persistent disparities in health.

 Though we are engaged in efforts on multiple fronts to address the impact of racism, including research and surveillance, policy and partnerships, we recognize that there are limited evidence-based practices that we have identified to effectively disrupt structural racism. We welcome information about any strategies you or your organization have identified about what works.  Racism and racial discrimination in health is a societal issue as well as a public health one, and one that requires a broad-based societal strategy to effectively dismantle racism and its negative impacts in the U.S.

 Thank you for your efforts, as well as those of your organization, to raise awareness of the impact of racism on health.

 Sincerely,

Leandris C. Liburd, PhD, MPH
Associate Director for Minority Health and Health Equity
Office of Minority Health and Health Equity
Centers for Disease Control and Prevention
4770 Buford Hwy, Mailstop K-77
Atlanta, GA 30341
770-488-8343
770-488-8160 (FAX)

While we appreciated Dr. Liburd’s reply, these words rang a bit hollow. Isn’t the CDC supposed to create strategies and research if there is supposedly not enough “evidence-based practices”? What exactly is “broad-based societal strategy”? Isn’t the CDC in a very powerful position to both create definitions and respond to them?

We welcome your thoughts. Suffice to say, for us, the seed has been planted for declaring racism a public health crisis.

It's Time To Flip The Script.