Nevada Journal of Public Health (vol 18; 2021) 18 COVID-19 and Communities of Color: on COVID-19 and communities of color, Understanding the Impact of Racism on even here in Nevada. With this Public Health understanding, the article closes with potential solutions in the areas of policy, health care and COVID-19, public health, as well as future research opportunities. While Melva Thompson-Robinson, DrPH the solutions are not all encompassing, it Center for Health Disparities Research does provide a starting point for dialogue, University of Nevada Las Vegas planning, and implementation in which to [email protected] address the multitude of health disparities and health inequities that have always Johanna Adlam, PhD, MPH existed but systematically ignored either Center for Health Disparities Research intentionally or unintentionally. Regardless University of Nevada Las Vegas of intentions, it took a pandemic to be the moving force and catalyst for enlightenment Eboni Anderson, DHEd, MA, MEd, MSW as it relates to the determinants of health and A.T. Still University School of Osteopathic racism within communities of color. Medicine in Arizona KEYWORDS: COVID-19; racism; Daryl Traylor, MS, MPH, PhD(c) structural racism; communities of color Sinclair School of Nursing University of Missouri Introduction The summer of 2020 was filled with social Carolee Dodge Francis, EdD unrest amidst a global pandemic. The news School of Human Ecology broadcasts were filled with stories of deaths University of Wisconsin-Madison of George Floyd, Breonna Taylor, and Ahmaud Arbery. At the same time, across the United States, as well as Nevada, data Abstract was starting to clearly show that the As the COVID-19 pandemic spread across COVID-19 pandemic was hitting the U.S., communities of color shared an communities of color particularly hard. uneven burden of the disease. The ability to Questions started to rise about how we got understand from a public health perspective, here. One of the answers to this question the increase and devastating health effects was racism. Not just racism that happens and morbidity consequences due to COVID- between individual people, but structural 19 is alarming, but not unexpected based and institutional racism that have served as upon structural racism. In light of the recent the foundation of our country. declarations of racism as a public health crisis, the push to address the situations that In 2014, Camara Jones, MD, PhD, MPH COVID-19 has brought to bear is an was elected as President of the American imperative. This article defines the levels of Public Health Association (APHA). As an racism that exist, distinguishing between esteemed scholar of race and health, in intrapersonal, interpersonal, institutional, 2015, Dr. Jones launched an initiative at and structural racism. Redlining in terms of APHA’s annual meeting to begin to discuss the provision of home loans is used as an the impact of race and racism on public example of structural racism and its impact health (Ford, Griffith, Bruce, and Gilbert, Nevada Journal of Public Health (vol 18; 2021) 19 2019). Her work launched a movement Throughout history, racism has been a within APHA to examine the roles of and pervasive issue in the U.S. Race relations address race and racism on public health. and racism are intimately linked to historical Since then, APHA has produced webinar trends where the sociopolitical and series, statements, a book, and other economic conditions formed, and continues resources that explore these issues. (See: to form, racial divides. Racism has always https://apha.org/topics-and-issues/health- been a feature of life in the U.S., starting equity/racism-and-health) with the enslavement and genocide of Native American tribes and the trans- Additionally, in 2020, across the U.S., Atlantic slave trade (Edmondson, 1976; racism has been declared a public health Fisher, 2017). Racism was used as a means issue by various jurisdictions across 26 to justify the white exploitation of anyone different states, including states as a whole, who was deemed different or unworthy and counties, and cities, as well as by local became a vehicle to subjugate people of health authorities. Nevada has also been a color in the U.S. The notion of racism part of this movement. In June 2020, the required that people be placed into Southern Nevada Health District declared hierarchies (Jacques, 2003). The early racism as a public health issue (See: history of the U.S. saw people being https://www.southernnevadahealthdistrict.or classified into a hierarchical structure g/news-info/racism-is-a-public-health- (Roediger, n.d.). By eventually categorizing crisis/). In August 2020, Governor Steve humans by “race,” a new hierarchy was Sisolak issued a proclamation declaring invented based on what many considered racism as a public health issue (See: science (Roediger, n.d.). However, the https://gov.nv.gov/News/Proclamations/202 thoughts, ideas, and notions of race and 0/Racism,_as_a_Public_Health_Crisis/). In racism are considerably more complex and September and November 2020, the City of furtive than this. The following section North Las Vegas and Clark County, further defines racism and the level at which respectively, issued similar proclamations. racism operates. The purpose of the article is to provide a Levels of Racism foundation for the discussion of public Race and racism are products of one’s social health, racism, and COVID-19 in Nevada. thought and the promotion of one’s own This article will define racism and relate self-interest. Jones (2018) explained, racism to public health and COVID-19. “Racism is a system of structuring Where appropriate, Nevada specific opportunity and assigning value based on examples will be provided. The article will the social interpretation of how one looks end with potential solutions that can be (which is what we call “race”), that unfairly implemented across the public health disadvantages some individuals and spectrum. We hope that the discussions that communities, unfairly advantages other are triggered by this article will lead to individuals and communities, and saps the continued and focused efforts to eliminate strength of the whole society through the health disparities and promote health equity waste of human resources” (p. 231). This in Nevada and throughout the country. explanation asserts the fact that the power, privilege, and advantages that are inherent in The Historical Context of Racism non-communities of color, and the disadvantages associated with communities Nevada Journal of Public Health (vol 18; 2021) 20 of color, remain in existence and continually example, messages about one’s own abilities adapt over time (Griffith et al., 2007). For and intrinsic worth have the tendency to be many years, communities of color have negative in nature. Jones (1999) received several different facets of metaphorically used flower boxes, seeds, inequitable treatment due to being placed at and the gardener to explain the relationships the bottom of the proverbial racial status between the different levels of racism, and it hierarchy. Whereas, non-communities of illustrated what happens when the gardener color have experienced a myriad of social (the structural system) is not concerned with privileges, advantages, and benefits by equity. Her work also demonstrated what simply being members of the dominant race. happens when one level of racism is addressed and adequately dealt with Different levels of racism are interwoven accordingly. into U.S. society. Jones (1999) formulated a theoretical framework, which categorizes From a more practical standpoint, many the three levels of racism. They include different types of racism involve oppression, institutionalized, personally mediated, and which are based on a hierarchical level and internalized racism. Institutionalized racism include the personal and interpersonal, is defined as the manifestation of material institutional, and structural levels. Personal, conditions, structural barriers, and an or the individualized level of racism, is an unequal access to power (Jones, 1999). For issue that exists within that particular example, receiving access to appropriate individual (Felder, 2020). The individual health care or a quality education fall under holds negative perceptions about his or her the category of institutionalized racism. own, or another individual’s race, ethnicity, and/or culture, which can be an inadvertent, Conversely, personally mediated racism, unconscious bias that the individual which is defined as individual-level possesses. This perception is also known as prejudice and discrimination, whether it is xenophobia. An occurrence of racism intentional or unintentional (Jones, 1999). between two different individuals is known Prejudice means differential thoughts and as interpersonal racism (Felder, 2020). feelings about the abilities, motives, of Circumstances of this nature often involve a others based on their race. According to victim and a perpetrator. This demonstrates Jones (1999), prejudice is what most people the myth of meritocracy where some think of when they think about racism. individuals believe that if one works hard Personally mediated racism may be and makes the sacrifice, then they, too, will manifested as intentional or unintentional be successful. No consideration is given thoughts and/or actions (Jones, 1999). Some that members within communities do indeed of these actions, when directed towards work hard, yet do not achieve success other cultural or ethnic groups, may because many issues that impede a person of manifest themselves as a lack of respect, color from being successful. Racism is one suspicion, devaluation, and/or dehumanizing of the reasons for this issue. Thus, society is behaviors (Jones, 1999). apoplectic when it comes to addressing this area of racism. Also, a denial of racism Internalized racism are the types of exists. For example, when two babies are privilege-based systems and societal values, born, they both have equal potential or the which causes one to reflect on and devalue same abilities; however, they are not given one’s own sense of racial identity.