Institutions that deliver healthcare and conduct research must prove themselves good neighbors to the communities they serve, say Anika Hines and Lisa Cooper

When natural disasters happen, humans show up. Our newsfeeds are populated with storm victims who gather together the remnants of what they have left to help those who fared worse. Passersby have run towards the wreckages of automobile crashes in the hope of retrieving survivors. Beachgoers have formed human chains to rescue swimmers drawn out too far by the current. It feels innate. A shared tragedy seems to remind us that we’re all made of the same set of complementary organ systems that lie just beneath the organ system most often used to categorize people—the skin.

This was true on 25 May 2020—the day that George Floyd was arrested for allegedly passing a counterfeit $20 bill. In broad daylight, those on the scene and those who could bear to watch the footage days later saw an expressionless police officer kneel nonchalantly, hands in pocket, on the neck of an immobilized, unarmed man for longer than nine minutes. It was ghastly. It was outrageous. It was the worst fear of Black parents who advise their children on how to interact with the police. George Floyd called out to his mother. Human hearts heard and broke as his pulse slowed. This was a crime against humanity—an unnatural disaster. 

In an ongoing pandemic, the murder was even more appalling. Despite looming political infighting in the US about the legitimacy of the pandemic’s threat and the best response to it, we collectively cheered on healthcare workers, checked on our neighbors, and mourned lives lost. We took care of each other by wearing masks and staying socially distant. We bonded over video conferencing gaffes and dance routines that filled the time of which we suddenly seemed to have so much. The world seemed smaller. We paid attention to what we may have previously overlooked. We acknowledged the need to address inequities driving the disparate impact of covid-19 on people of color. In the face of this common “enemy,” SARS-CoV-2, there was a sense of connectedness that made us feel we were more alike than different. As it turned out, we cared about the same things—mainly, the health and wellbeing of our loved ones. 

Scholars describe collective efficacy as the linkage of mutual trust and connectedness, or social cohesion, and the willingness to intervene for the common good or social control.¹ Ironically, the latter concept, which is often a response to deviant behavior, includes the effectiveness of informal mechanisms by which residents themselves achieve public order outside of police regulation. On that day, within that community, the police officer was the deviant. Bystanders intervened—pleading on the victim’s behalf, empathizing with him, and even calling the police on the police. Grounded in humanitarianism, global residents then used their collective efficacy to police the police. Protests ensued. Individuals and institutions began to hold each other, and themselves, to account. A recent international report, for example, called the US’s systematic killing of unarmed people of color by the police without punishment crimes against humanity, which the US could face charges for in the International Criminal Court.²

Science and healthcare are no exception to social injustice and the devaluing of the lives of Black, Indigenous, and other People of Color—both are microcosms of our broader society. We see racism in the disparate health outcomes across chronic conditions^{3 4} and in shorter life expectancy rates.⁵ These differences in morbidity and mortality may be explained by higher levels of chronic stress experienced by people of color.⁶

Interpersonal and structural racism, including unfair disadvantages in housing, employment, education, healthcare (even in access to life saving covid-19 vaccines), and the justice system, are culprits of poor health for Black, Indigenous, and other People of Color around the world.^7-9 Yet, it was not George Floyd’s underlying health conditions possibly acquired via accumulated stress—autopsy revealed an enlarged heart—but a blatant act of physical oppression that ultimately took his life. Racism effectively “others” Black, Indigenous, and other People of Color, underestimating their capacity to feel pain and eroding their humanity. 

Moving forward, institutions, including those delivering healthcare and those conducting research, must prove themselves good neighbors, demonstrating shared values with the communities they serve. Among those values is a fundamental commitment to protecting human life against both the screams of police brutality, the moans of structural inequities, and the whispers of racial microaggressions.

However, the policies and practices of institutions are carried out by the individuals who lead and work within them. Scientists and health professionals can rectify bruised relationships between the power structure and historically marginalized communities by fostering genuine human-to-human connections with patients, community members, and each other. We can leverage our wealth of resources and social connections to advocate on behalf of the communities we study and serve and to hold our institutions and our local and national policy makers accountable, as did George Floyd’s neighbors, including a jury of 12 citizens.

As a scientific community, we can use our collective knowledge to advance solutions. Individually, and together, we must rely on our humanity as a guidepost to inform our actions, not only in the face of disaster, but on a daily basis. 

Anika Hines is an assistant professor in health behaviour and policy at the Virginia Commonwealth University School of Medicine. Twitter @DrAnikaLHines

Lisa Cooper is a professor of medicine and health, behaviour and society at Johns Hopkins School of Medicine and Bloomberg School of Public Health in Baltimore, Maryland, and directs its Center for Health Equity. She is the author of the forthcoming book Why Are Health Disparities Everyone’s Problem? Twitter @LisaCooperMD

Competing interests: none declared.

References

1. Sampson RJ, SW Raudenbush, and F Earls. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science, 1997. 277(5328): p. 918-24.
2. Commission, I., Report of the International Commision of Inquiry on Systemic Racist Police Violence Against People of African Descent in the United States. 2021: https://inquirycommission.org/website/wp-content/uploads/2021/04/Commission-Report-15-April.pdf.
3. 2019 National Healthcare Quality and Disparities Report. December 2020, Agency for Healthcare Research and Quality: Rockville, MD.
4. United States. Congress. House. Committee on Government Reform. Subcommittee on Criminal Justice Drug Policy and Human Resources., Racial disparities in health care : confronting unequal treatment : hearing before the Subcommittee on Criminal Justice, Drug Policy, and Human Resources of the Committee on Government Reform, House of Representatives, One Hundred Seventh Congress, second session, May 21, 2002. 2003, Washington: U.S. G.P.O. : For sale by the Supt. of Docs., U.S. G.P.O. Congressional Sales Office. iii, 180 p.
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6. Geronimus AT. Understanding and eliminating racial inequalities in women’s health in the United States: the role of the weathering conceptual framework. J Am Med Womens Assoc, (1972), 2001. 56(4): p. 133-6, 149-50.
7. Razai, M.S., et al. Mitigating ethnic disparities in covid-19 and beyond. BMJ 2021;372:m4921.
8. Omotoso KO and SF Koch. Assessing changes in social determinants of health inequalities in South Africa : a decomposition analysis. Int J Equity Health, 2018. 17(1): p. 181.
9. PAHO, Just Societies: Health Equity and Dignified Lives., in Report of the Commission of the Pan American Health Organization on Equity and Health Inequalities in the Americas. 2019, PAHO: Washington, DC.