For anyone who thinks Oregon — long regarded as a liberal, progressive state — was a welcoming place for Blacks and other minorities in the past, a recent webinar sponsored by Oregon health care organizations was a chilling wake-up call.

In June 1844, Oregon’s provisional government passed its first Black Exclusionary Act, with language stating that any Black person who set foot in Oregon “would be publicly whipped 39 lashes.” From that time forward, Oregon, like most states, amassed its share of white supremacist laws and practices that have fostered violence against Blacks and people of color.

“The violence continues because it’s sanctioned by pervasive institutional and systemic racism and power inequities, said Izzy Meda, the executive director of Familias en Acción in Portland. Meda was referring to the murder of George Floyd and the response to racial justice protests in Portland and around the country.

Meda recently moderated a discussion, sponsored by the Oregon Health Forum and cosponsored by the Oregon Nurses Association, about historic legislation introduced in Oregon at the end of May. The bill— HB2337— declares that “racism in Oregon has left a legacy of trauma from one generation to the next.” If the bill becomes law, Oregon will join 10 other U.S. states that have declared racism to be a public health crisis. According to Meda, the law offers the following remedies:

• Creates pilot programs testing the use of mobile health units
• Improves data collection
• Gives decision-making power to community members impacted by structural racism

Speakers at the May 20 webinar included Ebony Sloan-Clarke, the interim director of the Multnomah County Health Department; Leslie Gregory, a certified physician’s assistant and researcher who developed a protocol for addressing racism as a public health crisis; and Danaya Halla registered nurse working in maternal, child and public health and the founding president of the Alliance of Black Nurses Association of Oregon.

Flagrant disparities

Being able to name racism as a public health crisis is the first step to getting to its root causes, explained Sloan-Clarke. “So why now?” she asked reflectively. “White supremacy has shaped our work, our decisions and our policies, causing ongoing pain and trauma, harm and negative outcomes for our Black, Indigenous, and all communities of color.”

You only need to look at COVID-19 cases to see the flagrant disparities in health outcomes, she said: Black and brown people are three and four times more likely than white people to test positive for the virus.

Beyond COVID, the link between racism and poor health outcomes in the absence of buffers is crystal clear, she said. “There's considerable research that suggests that racism leads to toxic stress, and it has long-lasting physical [and mental health] effects.”

Toxic stress from racism, she explained, can lead to a cascade of chronic health conditions and coping behaviors including high blood pressure, heart disease, drug and alcohol use, overeating. (See this study in the Annual Review of Public Health on adversity, toxic stress and racism.)

The Oregon bill calls for mobile health units to be set up to address racial inequities in areas where residents have greater barriers to accessing health care. Leslie Gregory, a health care provider and one of the advocates who helped develop the bill, has experience working with mobile health clinics dating back decades. She assisted her mother, a nurse, who provided health care to Black community members in Ohio, where Gregory grew up. Mobile health clinics can help improve health outcomes by providing preventive health care and managing chronic health conditions, according to an article in the International Journal of Equity in Health.

Lives could have been saved

Gregory is the founder of Right to Health in Portland, which focuses on improving health outcomes. She said that if the Centers for Disease Control and Prevention had declared racism to be a public health crisis years back, when she and others were advocating for it, the death toll on Black and brown communities from the COVID-19 virus might have been different.

“Had that happened, the mobile units would have been in place, we would have been able to use them in the context of this current virus, and tens of thousands of lives, potentially [could have been] saved,” she said.

In 2015, Gregory wrote a letter urging the CDC to declare racism a public health crisis. The agency’s response, she said, was weak. (Read her letter and the response to it.)

This year, at the beginning of April, the CDC issued a press release in which it called racism “a public health threat” and outlined actions the agency would take to counter it.

Gregory said that the mobile health clinics would help communities of color to tackle the underlying health conditions that affect them disproportionally, such has high blood pressure, diabetes, and high cholesterol, and will screen them about stress associated with racism.

Racism masquerading as fact

Danaya Hall circled back to the history of white supremacy in Oregon. She noted that the 15^th amendment to the United States Constitution, which call for voting rights for male citizens of all races, was not formally ratified in Oregon until 1959.

Closer to her sphere of work, she said that it’s still possible to find examples of racist and inaccurate statements masquerading as facts in scientific and medical literature.

“In one of my classes, our textbook, which is an authority on women's health and midwifery, actually falsely states that anemia levels for Black women are different than for other women, which is absolutely false,” she said. “And so we've got a long way to go. We need to stop perpetuating this kind of false science. And again, declaring racism as a public health crisis is what's going to drive better studies that capture the specific needs of our historically degraded population.”

According to 2018 data, Hall noted, Blacks had the highest percentage of deaths from preventable diseases, such as diabetes and HIV, of any ethnic group in Oregon. But, she said, they’re the most insured of all ethnic groups in the state.

“It's a public health crisis in the sense that the outcomes for the most insured ethnic group are the worst,” said Hall in a plug for the legislation. “This discrepancy is really what we need to fix.”