Public health is a diverse discipline. Here at Yale School of Public Health, we have researchers working on every aspect of the field, from basic laboratory science to evaluating the implications of social and economic policies on health outcomes. As protests have broken out across the country in the wake of the murder of George Floyd by a police officer in Minneapolis, Minnesota, many have joined the marches, which have become a larger crusade against racism and white supremacy in American life.
Some in public health may see the protests simply through the lens of the continuing SARS-COV2 pandemic as a source of disease transmission, others see the protests as central to public health as police violence and the health disparities among African Americans in the United States result in tens of thousands of excess deaths per year. Perhaps the truth is somewhere in the middle. The protests around the country will likely lead to new SARS-COV2 infections, but the rationale for these marches is pro-public health and many in the crowds are making real efforts to protect themselves and others around them.
As a faculty member in the Department of the Epidemiology of Microbial Diseases, it’s very easy to collapse public health to a story about pathogens and their hosts. But we’ve known for a very long time that what we now call the social determinants of health are powerful forces that can determine health risks and outcomes. As early as the 17th century, John Graunt, suggested that overpopulation and squalid conditions accounted for Londoners’ poor health and frequent bouts with infectious diseases like plague, “London, the Metropolis of England, is perhaps a Head too big for the Body, and possibly too strong,” Graunt wrote. As scientists, we also sometimes forget the role of social mobilization in the birth of our own discipline. The American Public Health Association was born in 1872 out of “sanitary crusades” and their revival-style conventions to improve living conditions and keep people safe from epidemics.
In public health, we talk often about competing risks, where someone is exposed to more than one mutually exclusive hazard, the prospect of death from different causes. COVID-19 is a pandemic ravaging communities of color, but the virus of racism in America has been with us since 1619 and its health effects are enormous. We don’t get to choose the time in history in which we live and today, we face multiple, overlapping public health crises. Should we tell the protesters to go home, the risks of SARS-COV2 are too great? That would probably work as well as just asking nicely for the cessation of police violence or our president to stop provoking violence and racial discord.
We have competing risks, competing challenges, competing responsibilities. We have to try to minimize the harms across the board for communities of color in the United States, that means working hard to battle SARS-COV2, but it also means realizing that the protests, which are already achieving some success in getting police departments to consider or establish new restrictions on use of force, may be an important public health intervention in and of themselves. We cannot stop the protests and I’ve made the case that the benefits associated with them could reshape the lives of communities here in New Haven and around the country for the better. As public health experts, we can “meet communities where they are at,” and if they are protesting, help them protest safer, by wearing masks, eye protection, keeping to a small group of friends rather than mingling in the crowd, bringing hand sanitizer with them, washing their hands or even showering when they get home, seeking testing for COVID-19 and self-isolating if they can.
This is not March or April, we’re not in the same kind of lockdown and even with a resurgence of virus across the country, it’s unlikely we’re going to convince anyone to resume the strictest of social distancing we saw back then. States have re-opened and closing them down again would be difficult if not impossible to do. This isn’t because of the protests gave the wrong signal to Americans that the all-clear had sounded, as some have suggested. It’s because the president will, like he did in March, April and May, keep banging the drum to keep everything open regardless of what public health experts think.
Whether it’s protesting, taking a trip to Las Vegas, sending your kids back to school, all of this is going to be done now in the context of harm reduction. We can’t eliminate the risks facing us, but we can blunt the force of what we now can expect to greet us in the months, and perhaps years, ahead.
Gregg Gonsalves, Ph.D., is an assistant professor at the Yale School of Public Health and co-director of the Global Health Justice Partnership.
This is part of a series of essays by Yale School of Public Health faculty, alumni and students on the issues of race and racism in the United States following the killing of George Floyd and the ensuing protests against police brutality throughout the United States. We remember, too, Ahmaud Arbery, Breonna Taylor, Rayshard Brooks and countless Americans who came before.