Michelle A. Williams is an epidemiologist and dean of the faculty at Harvard T.H. Chan School of Public Health. Jeffrey Sánchez, a former Massachusetts state representative, is a lecturer at Harvard Chan.

“I can’t breathe.”

That was the one of the final pleas uttered by George Floyd last week before he was killed by police officers kneeling on his neck and back — the same plea cried out by Eric Garner before he died six years ago in a police chokehold. These words have become a rallying cry for protests across the nation.

To those of us in the public health community, they are also a visceral reminder of a reality we have come to know all too well: Racism is a public health crisis.

Nowhere is that reality more gut-wrenching and visible than in the police violence that kills black Americans at nearly three times the rate of white Americans. It is also apparent in the legacy of slavery and discrimination that persists in modern medicine and across the many social determinants of health.

Indeed, it is cruel and somewhat ironic that some are now pointing to “underlying health conditions” as a contributing factor in Floyd’s death, which has been ruled a homicide. That line of explanation, of course, is intended to deflect blame from the officers whose actions ended his life — and goes against what millions saw plain as day on video.

But it also illuminates another way in which racism is deadly. Across the country, black Americans suffer from higher rates of diabetes, hypertension, asthma and heart disease than white Americans. They are more likely to be obese and get insufficient sleep, which can contribute to such health issues. The role of racism in these underlying conditions cannot be denied.

A growing body of literature shows that social determinants — otherwise known as the conditions in which we’re born and in which we live, work and play — are key drivers of health inequities. For generations, communities of color have faced vast disparities in job opportunities, income and inherited family wealth. They are less likely to have housing security and access to quality schools, healthy food and green spaces. All these factors undoubtedly undermine mental and physical well-being.

In addition to the consequences of structural racism, it is well-documented that racism itself is hard on a person’s health. Chronic stress caused by discrimination can trigger a cascade of adverse health outcomes, from high blood pressure and heart disease to immunodeficiency and accelerated aging. Evidence even suggests that the racism endured by black mothers contributes to the alarmingly high maternal and infant mortality rate. Look no further than Erica Garner, Eric Garner’s daughter, who at the age of 27 went into cardiac arrest following an asthma attack.

“I can’t breathe.”

The covid-19 pandemic has laid bare many of these inequities for the world to see. We’re now learning that Floyd tested positive for the coronavirus in early April, almost two months before his death. All told, predominantly black counties are seeing three times the rate of infection — and six times the rate of covid-related death — as white counties.

Black and brown Americans make up a disproportionate number of essential workers who have stayed on the job through lockdowns, and thus are at higher risk of contracting the disease. And when they do fall ill, they are more likely to receive worse care than white Americans do. That’s true even when controlling for socioeconomic factors such as income and education. And, of course, they are more likely to suffer from the underlying health conditions that can make this coronavirus deadly.

We see this in the striking link between long-term air pollution exposure and coronavirus deaths. Black Americans are 75 percent more likely to live near a polluting facility, such as a factory or a refinery. This in part explains why even before this pandemic, black children had a 500 percent higher death rate from asthma than white children.

Now, data from our school’s research show that a person who lives for decades in a county with high levels of fine particulate air pollution is 8 percent more likely to die from covid-19 than someone who lives in a place with just one unit less of such pollution.

“I can’t breathe.”

As James Baldwin wrote, “Not everything that is faced can be changed, but nothing can be changed until it is faced.” It is time to face this immutable fact: Systemic racism has had its knee on the neck of the African American community since America began. And all of us have a responsibility to acknowledge it and address it.

We have the tools to identify the many ways that decades of entrenched discrimination are hurting health and cutting lives short to this day. And we cannot let this moment and the growing call for justice fade without making those connections clear — and pressing for meaningful policy change.

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