Xenophobia, racism, and health in immigrant communities

[0:00:00]

RICK WEISS: Thank you, Josh. And welcome, everyone, to this SciLine briefing. A quick introduction for those of you who may not be familiar with SciLine – we are an editorially independent, philanthropically funded free service for journalists based at the American Association for the Advancement of Science. We connect journalists to scientists on deadline and make available a variety of kinds of credible, research-backed evidence for you to use in your news stories.

Among our services are media briefings like this one today. And today’s actually is the second in an ongoing series of briefings from SciLine that are focused on the health effects of racism in the United States. The topic of racism, of course, is inherently political. But what I think gets too often overlooked is that it’s also a topic that’s informed by a body of rigorously conducted social science research. And as journalists, you can – and indeed, I’d argue you should – be turning to and taking advantage of the findings of this science as you cover the issue of race in today’s news. Put differently, just because race is a topic on which people hold strong opinions doesn’t mean that the news should simply report on those opinions. There is an evidence base that is relevant here. And with public attention now drawn to the issue, there’s an opportunity for you to convey some of those findings more widely.

So to help you do that, we have today gathered three academic researchers with deep expertise in this topic. I’m not going to take the time to introduce them in full. Their bios are on the SciLine website. But we will hear first from Dr. Georgiana Bostean, a sociologist and associate professor of environment, health and policy at Chapman University whose research on population health has focused on Latinx and immigrant populations. Next, we will hear from Dr. Gilbert Gee, who is a professor in the department of community health sciences at UCLA’s Fielding School of Public Health. His research focuses on the social determinants of health inequities in minority populations. And he’ll focus here primarily today on Asian American populations. And then third, we’ll hear from Dr. Goleen Samari, who is an assistant professor and public health demographer at Columbia University’s Mailman School of Public Health. And she will describe what science is learning about how xenophobia and migration-based discrimination can impact health, with a particular focus on communities from the Middle East and North Africa. We’ll take questions after their short presentations. As Josh mentioned, please feel free to submit them even as the presentations are happening via the Q&A icon at the bottom of your screens. And with that, let’s just get started with Dr. Georgiana Bostean.

[0:02:55]

GEORGIANA BOSTEAN: Thank you so much, Rick. So I’m going to start by sharing my screen here. My name is Georgiana Bostean. And as Rick pointed out, I’m an associate professor of environment, health and policy at Chapman University. And I’m thrilled to be here today with this distinguished panel of scholars. We are going to be talking a bit about – in my presentation, I’ll be talking a bit about population health disparities and the role of the environment on health and health behaviors and how that ultimately translates into racial and ethnic health disparities. And I’m particularly excited to be on the panel with Dr. Gee today, as I did postdoc training in cancer prevention and control research at UCLA. And I am trained as a demographer and sociologist. So you’ll sense that bias throughout my presentation.

So I’ll start with asking you to think about what contributes to differences in health and longevity between different racial and ethnic groups in the U.S. So if we had to assign a slice of the pie to genes and biology, where might you put that? So the CDC estimates that a very small proportion is actually due to genes and biology. Health behaviors is often also smaller than what people think. Medical care – also a little bit smaller than what people tend to think. And the total ecology and social and societal context actually makes up over 55%, approximately, of population health differences. And this can come as a surprise to folks when they think about health. And we in America especially tend to think about health as largely about personal choices and health behaviors. But really, health starts where we are born and work and live and age.

And I understand that last week, you talked about structural racism in different institutions and how that impacts health. So I’m going to get straight into one of those today, which is our surroundings. So when – one component of our surroundings is the built environment. And in the built environment, we can think of things such as which retailers and services are available in different neighborhoods. And it probably doesn’t surprise you that we know that there is a greater density of unhealthy retailers, such as alcohol and tobacco retailers and fast-food retailers, in predominantly minority neighborhoods and lower socioeconomic status neighborhoods. And that tends to be the trend.

So does this actually impact health behaviors? Well, there is a large literature that suggests that, yes, the surroundings and the built environment do impact individual health behaviors. And one of the studies that I like to point to is actually a Google study within their offices. They teamed up with academics and changed the types of foods that were available and snacks that were available in the office. So they took M&M’s and put them in dark jars and further out of reach. And they took healthy snacks and put those further up front in clear jars. And they were able to change the office consumption patterns to increase healthy food intake and to decrease unhealthy food intake. This also translates, then, on our neighborhood level as well.

So given the really strong and well-established literature showing that lower socioeconomic status is associated with poorer health, people are often surprised to hear about what’s called the Latino health paradox – that Latinos, despite having lower-average socioeconomic status, tend to have longer life expectancy than native-born populations. But this advantage decreases among immigrants with time in the U.S. So here we’ll see a life expectancy graph. And you’ll notice that the first bar is the life expectancy for whites, then U.S.-born Mexican, then foreign-born Mexican, Puerto Ricans, island-born Puerto Ricans and Cubans. And you’ll notice that these immigrant groups have among the longest life expectancy. However, they don’t necessarily have healthy life – longer, healthier lives. So they may live longer but spend more years in morbidity and functional disability. And so here we can see that these lighter-colored gray bars show that foreign-born Cubans are advantaged, but all of the other groups are slightly disadvantaged in terms of functional life expectancy.

So much of this Latino health paradox is thought to be due to smoking and to selective migration patterns. And so colleagues and I have thought about how this might dissipate as we see changes in smoking. So smoking really has declined in all groups over the last decades. And so we are not sure whether this life expectancy advantage will be maintained. On the other hand, we also have vaping, which has become an issue among particularly youth. And uptake among Latino youth has also been pretty strong, with approximately 15% of Latino high schoolers having vaped in the last 30 days. So it’s unclear how these counteracting forces are going to work out. And as we have fewer immigrants to the United States and see more second-generation Latinos, we may see some of this advantage dissipate as well. And then finally, the counteracting force of obesity-related mortality – we see higher rates of diabetes-related mortality, for example, in these groups.

So one of the things that I am excited to talk to a group of journalists about is the fact that the choice of words matter. As Rick pointed out, the word racism is highly politicized, even though we know there is this large evidence base that, in fact, it is racism causing some of these health disparities. But I want to point to a Robert Wood Johnson study foundation from a few years ago that found in a study of over 3,000 Americans across the political spectrum – and it was a multipronged study with surveys and focus groups. They found that even when messages are true – so saying things like the – America’s not in the top 25 countries in life expectancy – even though that is a true message, people are less likely to believe what comes after that because they have this adverse reaction to that initial message. So leading with something that Americans tend to already believe is value-based – something like Americans lead the world in medical research and medical care – they’re more likely to believe everything that follows. And these are the exact phrases that they tested out.

So they came up with at least three things that we can do when talking about these social determinants and social factors in health, and that is framing it around how disparities affect everyone. And there are some studies that show that greater inequality affects not only the groups that are disadvantaged, but even advantaged groups compared to other countries with lower equality. The second thing is that presenting just the problems tends to turn people off – so thinking about the types of solutions that we can implement to address these. And one of those that’s been widely accepted is a health in all policies approach, thinking about how all sorts of different policies affect individual choices. And then, finally, using language that is colloquial and priming, using values that we already believe in – for example, the personal choice – that, yes, health is both about personal choice, but let’s think about how those personal choices are affected by the context in which we live.

So I want to leave you with this thought about the role of journalism in shaping the public’s understanding of health. This figure is actually from the U.K., but it applies – similar ideas applied to the U.S. as well that in news media articles – these black bars – you’ll see that the most commonly noted cause of health mentioned is behavioral. And so – and then the second most common is social. But what I’d like to argue is that we should always talk about behavioral in the context of social differences. For example, with smoking, we can’t just talk about the personal decision to smoke, but rather, this – how does the retail environment affect those decisions? How does receipt of coupons affect these decisions? – because we have large established literatures on that. So the takeaway is that we’d love to see the whole story of how health is patterned. So thank you so much, and I look forward to the Q&A.

RICK WEISS: Thank you for that very interesting and professionally helpful focus to get us started. Dr. Gee, I’ll turn to you.

[0:11:48]

GILBERT GEE: Right. Good morning. Let me get my slide deck up. OK. I’m really pleased to be here to talk to you about what research says about racism and health amongst Asian Americans. And although I have my opinions, my comments are based largely on what I’ve learned in doing scientific research over the past two decades. Today, I’ll first talk about how racism makes people sick. And secondly, I’ll throw out a second angle that you might want to consider that I think deserves some more reporting.

So let’s begin with the big picture, and I’m building on the previous presentation. We know that health is determined in part by your genetics and also by your health behaviors – things like diet and exercise. But it’s also about health care. And it’s also…

RICK WEISS: Dr. Gee, can I just interrupt real briefly? I think you’re in your notes mode, and you might want to put it into display mode.

[0:12:46]

GILBERT GEE: Oh, OK. Good. Let’s see. I don’t even have notes, so…

RICK WEISS: May not matter.

GILBERT GEE: Yep. Well, is that good now? Actually, let me try again.

RICK WEISS: There you go.

GILBERT GEE: All right. So health is behaviors, genetics. It’s also access to care. It’s also whether you live in supportive social networks. But it’s also where you live, work and play. It’s also your position in society. We know that people with more education and more income tend to be healthier than people with fewer privileges. And this is a pattern we see across many societies, including the United States. And of course, we have national state policies and the political economy and so forth that all determine our health. So the main point here is that health isn’t simply about your behaviors and your health care, but it’s also what the research has called social determinants. All these upstream factors play an important role in our health and well-being. And unfortunately, prejudice, racism, discrimination are part of these social determinants. And today – I want to mention that racism has many different ways that can affect our health and well-being. But today, I’m going to focus on one, which is stress.

We know that microaggressions, making assumptions about people, as well as major hate crimes, are stressful. And the thing about stress is that it contributes to wear and tear on our body, resulting in something that scientists call allostatic load. This can have effects in terms of weakening your immune system, causing failure of target organs and things like that. And stress, we know, is associated with things like even increasing your probability of catching the common cold. And so let me give you some research on this specific to Asian Americans. This is a national probability sample of Asians across the U.S. And what you see here are – the light blue bars represent Asian Americans who report very little discrimination. And as you get higher, darker blue bars, they’re reporting more discrimination. And what we have here as an outcome is DSM-IV criterion anxiety disorders. And you see here what we call a dose-response relationship. More reporting of discrimination is associated with more illness. And this isn’t controlling for things like gender, age and so forth. But it’s not just that outcome. We see this dose-response relationship for other things like major depressive disorder, heart disease, pain, respiratory problems and so forth.

My research joins a much broader conversation that’s been happening in science for many, many years, including reports published by the National Academies of Science, the National Institute of Health, the surgeon general and so forth. So the point here is that science is taking racism very seriously as not only a health and equity – that is not only an equity issue, but a health one as well. And certainly, COVID has amplified our attention on discrimination amongst Asian Americans. And here’s a paper, in case you want to read a little bit more about it, that we published recently in the American Journal of Public Health. As you’ve probably seen in many reports, Asian Americans are being targeted for hate crimes in relation to this pandemic. Now, you know, the past couple of decades of research has shown that general experiences of racial discrimination amongst Asian Americans is associated with illness. So it seems logical to anticipate that COVID-related discrimination, anti-Asian discrimination, would also be associated with illness. And research is just starting to emerge to show that very point. So here’s a study that was just published where they looked at Korean immigrants in the U.S., and they found that discrimination was, in their analysis, a more important predictor of distress than even income.

So now let me pivot just a little bit and talk about another angle related to the same topic. And it’s on something I call race adjustments, and I want to talk about it from two points of view. So the first is, think of this issue of judicial awards. So in other words, imagine a child is struck by a car, and now the judge has to decide how much to pay out to the parents. And the way they calculate the payout is basically anticipating, what are the anticipated future earnings of that child using actuarial science? And so let’s say we presume that the payout is a million dollars, right? But we also know that women make 75 cents to the dollar. And we know that Black women, for example, make around 65 cents to the dollar. So it’s very – it’s happened in the past where the judicial awards to a white male child is far greater than the award to – and I mean to the parents of, say, a Black child, right? And so this is one way where seemingly neutral decisions using mathematics and seemingly objective science can reap major discriminatory effects not only to families, but across generations.

Now, let me take another example of this same idea. So three years ago, a study was published using kids from the Bay Area. And they had to wrestle – the researchers had to wrestle with what to do with biracial children. And they decided to create a (unintelligible) decision rule whereby if a child was Black and Asian, the child was reclassified as Black only. If the child was Hispanic and Asian, they were reclassified as Hispanic, and so forth. And so the consequences of this were to essentially, in the research, make Asian Americans invisible. And not surprisingly, later in the paper – the same paper – they admitted that, our study overrepresents the Black and Hispanic community and underrepresents the Asian community. And so these are two examples of how researchers can make decisions that are seemingly neutral but nonetheless can have racialized impact and contribute to inequalities in that way. So to close, what this all means is that issues of race, racism, health and research are all intricately intertwined together. So I want to thank you for your attention, and I welcome your questions in the Q&A.

RICK WEISS: Thank you very much. Some great examples there. And we will turn next and last to Dr. Samari.

[0:19:24]

GOLEEN SAMARI: Hi, everyone. I’m going to just share my screen. There we go. So this presentation is actually a nice extension of what Georgiana and Gil were just discussing. So I’m going to conceptualize and discuss why Islamophobia is a public health issue as sort of a lens into one specific community that experiences racism and xenophobia. And it’s important to note that this work really builds on the legacy of anti-Black racism and health research that has been done in the field of public health for many decades.

So first, I think it’s important to set the context a bit. So this is a graph of hate crimes, of specifically physical assaults against Muslims from 2000, seen on the left, all the way to 2018, which is the last year that we have data. So hate crimes are clearly a dimension of health that result in fear, injury and death. So for this, the x-axis shows the years, and the y-axis shows the number of assaults, according to the FBI. And I’m happy to talk about sort of the validity of hate crime statistics in the Q&A if people are curious about that. But this graph really shows apparent associations between the current events and Islamophobic hate crimes. So in 2001, you see a yellow peak that I’ve highlighted there, and that really corresponds to the increase in anti-Muslim hate crimes after 9/11. Then you can see after that, the rates were fairly stable until about 2015, when the rhetoric of the 2016 presidential election started. So according to these data, you also see that assaults peaked in 2017, which is where you see that second yellow bar. This is sort of confirmed by other sources that collect these types of statistics. So the Council on American-Islamic Relations has now recorded over 10,000 anti-Muslim bias incidents from the June of 2014 to June of 2019, with the highest recorded in 2017.

I also want to point out while we’re here that discrimination on the basis of religion is only second to race for source of bias in discriminatory acts. So anti-Semitism is often at the forefront of the types of incidents that we see recorded. So the highest number of incidents are usually anti-Semitic in the religious categories. But these things trend together, so hateful events towards one community often beget hateful events towards another community. So whenever you see a rise in anti-Semitic or anti-Black racism, you also see a rise in Islamophobia.

So let me define Islamophobia a little bit. So Islamophobia is social stigma towards Islam and Muslims, dislike of Muslims as a political force and a distinct construct referring to xenophobia and racism towards Muslims or those perceived to be Muslim. So parts of this definition are really important because Islamophobia affects several different groups of people. So first, you have Muslims, right? But then you have this assumption about who is a Muslim based on how people look. So we call that category of people those who are racialized to be Muslim because of stereotypes and assumptions about racial identity. So Islamophobia, similar to other stigmatized identities, is really rife with stereotypes of Muslim Americans and Americans who look Muslim-like. Really, that’s equating a lot of populations who are from the Middle East or North Africa to being Muslim when there’s a lot of heterogeneity of religion within those groups. So in the U.S. Muslim population, there’s about 3.5 million Muslims, and over half of them are immigrants. But again, there’s a long history of Muslim migration to the U.S., and you have second- and third-generation Muslims in the population. So worldwide, the population of Muslims is really growing. And by 2050, you expect about 8.1 million Muslims, or 2.1% of the U.S. population. Importantly, though, this is a really racially diverse group of individuals. So in the U.K., you have Muslims primarily from the South Asian region. And then in the U.S., you have a really interesting mix of sort of white, Black, Asian – primarily South Asian – and Latino Muslims.

So you see at the top there’s sort of a bar chart of the U.S. – the racial and ethnic composition of the U.S. Muslim population. On the bottom, it’s the U.S. general population. So you see the blue is the white. The yellow is Black. The green is Asian. The purple is Hispanic. And then the turquoise color is other or mixed. And you can see that there’s quite a bit of racial heterogeneity within the U.S. Muslim population, even more so than you observe in the U.S. general population. So a lot of who is in that white category or – is what we consider to be sort of an invisible minority, which is the Middle Eastern and North African immigrants, because they are categorized as white because there is no other sort of census-defined racial ethnic category that captures immigrants from the Middle East. And so similar to what Gil was talking about in people sort of disappearing in the way that we collect data, that’s one group that often disappears because they’re categorized as white.

So research on Islamophobia and health to date shows some interesting findings. So in 2018, myself and my colleagues, we did a systematic search, and we looked at sort of what is the evidence based on Islamophobia and health. In total, we found 53 studies – only 53. So this is clearly an area where there is more research needed, and ongoing research efforts are encouraged. But there were consistent relationships between experiences of discrimination and poor mental health among Muslims and Muslim-like populations. Findings of worse mental health were really consistent across outcomes of psychological distress, paranoia, depression and anxiety. For physical health, the research was a little bit more limited, but there were some findings on coronary heart disease or poor self-rated health, which is correlated with poor physical health. And then a study on birth outcomes after 9/11 that showed that women with Arabic names in California were more likely to give – have preterm birth compared to women without those names. So there’s some physical health evidence.

There’s also a lot of evidence on barriers to access and utilization of health care. So as you would expect, discrimination on the basis of your identity is preventative in your ability to – it prevents you from seeking and getting health care. So in a recent study sort of unpacking this Muslim-like population, we really – my colleagues and I used seven years of National Health Interview Survey data and looked at the population of Middle Eastern immigrants in the U.S. And we found that among Middle Eastern immigrants, white respondents had 66% lower odds of delaying care and 84% lower odds of being rejected by a doctor as a new patient compared to nonwhite respondents. And similar to other studies of immigrant groups, we found that U.S. citizens had a 76% higher odds of visiting the doctor. So basically, identifying as nonwhite was very prohibitive of getting care.

So these have been touched on in the other presentations, but these are some of the pathways that which racism and Islamophobia affect health. So you have your individual pathways of stress. You have interpersonal pathways, interactions with providers and the health care system, other mechanisms – like these communities tend to socially isolate when they experience discrimination. What I want to draw our attention to today is a little bit of the structural pathways. So these are basically discriminatory ideologies and the structural features of institutions, policies and the media that can reinforce health disparities. So examples of these policies include immigration policy that contributes to structural inequity. We saw this really pretty clearly with the implementation of the Muslim ban in 2017. We’ve also seen this over the years with patterns of racial and religious profiling in the naturalization process to block citizenship of individuals from Muslim-majority countries.

We also see Islamophobic policies at the state level. So this depiction is an illustration by the Haas Institute at UC Berkeley that shows where anti-Sharia legislation has been introduced and enacted in the U.S. So the anti-Sharia movement really came to be in 2010 and aims to prohibit Sharia law from being considered or enforced in state courts. So the legend at the bottom shows you that the center number is the number of anti-Sharia bills introduced. And at the top right, the number includes the number of anti-Sharia bills that were actually enacted. And this depiction really is intended to show you how widespread policies are that aim to stop – strip Muslims of First Amendment rights and institutionalized Islamophobia.

So in the last minute, I really want to focus on the fact that the media can also shape the structural social environment in ways that affect Muslim American and immigrant community health. Negative media coverage of Muslims plays an active role in the social understanding of Muslims as, quote-unquote, “the enemy” and in perpetuating Islamophobia. The Media Portrayals of Minorities Project at Middlebury College published a report in 2019 that found that Muslims were disproportionately by far the most negatively portrayed minority in America today. They’ve looked at over – close to 3,000 articles – news articles – and they basically found that coverage of Muslims heavily focuses on foreign conflict, terrorism, law and order. And this means that stories centering on Muslims basically tend to reinforce the perception that there’s a correlation between Islam and violence. So it’s important to think about the fact that this coverage not only influences sort of our political debates, but it also impacts how we perceive people of different demographic backgrounds when we encounter them in everyday lives. And it ultimately impacts their health and well-being and the health of these communities.

So as reporters, I would really encourage people to – so challenge prejudice and debunk outright lies. Be careful who you give a platform to, and provide context for the events that you cover. Improve your understanding of Islam and all its diversity, as I hope you have begun to today, and really cultivate relationships with members of the community. And lastly, I just want to say you have to choose your words carefully. When you use phrases like Islamic terrorism, you’re implicitly conflating two concepts and further perpetuating Islamophobia. So with that, I want to say thank you, and I look forward to the Q&A.

[0:30:43]

RICK WEISS: Thank you, Dr. Samari. A fascinating presentation, a great summary from all three. I want to remind reporters at this point that, first of all, the slides from these presentations will be available on the SciLine website starting probably by tomorrow, so you can review those. And there are references at the end of some of these decks (ph) that can help you dig further. In the meanwhile, if you have questions, please hover down at the bottom of your screen over the Q&A icon, and you can submit your questions that way. And I’m going to start right off the bat with a question for Dr. Bostean. This is from Sheila Eldred (ph) at the Sahan Journal in Minneapolis. Can you explain what you meant when you said that the Latino health paradox may be due in part to selective migration patterns?

[0:31:32]

GEORGIANA BOSTEAN: Yes, great question. So – and this is true in immigrant health paradox more broadly. I think I touched on the fact that there – this has been observed in other developed countries with other immigrant groups that immigrants tend to be healthier than the native-born populations in those areas. And we think that this effect may be, at least in part, due to who is able to migrate and who is physically healthy enough to endure that journey. Migrants tend to be younger than – on average than the overall native-born population. And that leads to different patterns when you think about what it takes to migrate.

And we see this playing out with the subgroup differences among Latinos, for example, among Puerto Ricans. They’re technically not migrants, right? They are U.S.-born and citizens at birth. However, we see really different outcomes for island-born Puerto Ricans and for U.S.-born Puerto Ricans. And then we see different patterns from – for Puerto Ricans from other groups such as Mexican immigrants because Puerto Ricans are able to come and go as they please to the mainland, whereas the migration process for Mexican immigrants looks very different.

[0:32:45]

RICK WEISS: Great. Thank you. A question here for you, Gil, and I think for – actually, others may want to weigh in on this. How does the wording of the 2020 census questionnaire address or exacerbate the problems with racial and ethnic categorization that you discuss?

[0:33:04]

GILBERT GEE: Oh, wow. Yes. So the census – how they categorize racial groups is, you know, regulated by Directive 15 from the Office of Management and Budget. And it’s really sort of this political document more than anything else on what groups do we believe to be in existence. And if you look at the history of racial groups in the census, races come and go. So for example, I think it was in 1830, Mexican was a race. In 1840, we took that away. And then later on, we brought that back, for example. So, you know, there’s all these back-and-forth. And so for example, in the – in 1997 – prior to 1997, Asians and Pacific Islanders were considered to be one single group. And you often hear API kind of, you know, said together. But actually, Pacific Islander community groups said – you know what? – we’re really not that much like Asians. We actually have a lot of differences. And so they actually lobbied to become a separate race. So suddenly in the year 2000, in that census, a new race group emerged. And we’re having similar conversations on whether people from the Middle East should become a separate race. So how we think about races varies a lot.

The way the census has done it, you know, there’s the five race groups, but then they also have this sort of unusual way of thinking about Latinos – right? – where basically they said, hey, if you’re – we have these race groups, but then you can also be Hispanic. And Hispanic is considered a cultural category based on language, i.e., Spanish. But when you think about countries like Brazil, where other languages like Portuguese are being spoken, it doesn’t completely make a lot of sense, or at least there’s some slippage there. So it matters in terms of the race groups that we have.

And again, it’s – race is more of a political label than anything else. If you look at the history of the census, another example of that is we used to collect race purely by visual inspection. So somebody would look at you and say, you look Asian, or, you look white, or, you look Black, and they would just check it off. But we know that when we look at people, that’s actually fraught with a whole bunch of measurement error, you know? People make mistakes all the time. I’ve had people come up to me and say, oh, are you Chinese? Are you Filipino? Are you Mexican? Are you American Indian? People have said that to me, right? And so just by looking at somebody, there’s a lot of error. Now the census doesn’t do it by the census enumerators looking at you. Now they do it based on self-report. And so how we measure race has also changed over time, and this is also changing in the literature as well. So does that get at the heart of your question?

[0:35:52]

RICK WEISS: That provides a lot. I’d like to actually turn this over to the others as well and see – I think you each might have something to say about the way the census handles things. Georgiana, can I ask you to chime in there?

[0:36:05]

GEORGIANA BOSTEAN: Yes. Dr. Gee covered most of the bases, I think, but I wanted to point out, specific to Latinos, that there was an effort to make that a separate race group in this census, and it just didn’t pan out. There was no response. So probably, hopefully by the next census, we’ll see more nuance. But as he pointed out, race is a social construction. It’s just ongoing, changing based on the political climate for groups. But from a data perspective, the more nuance that we have, the better it is. So knowing – as we’ve pointed out – I think all of us had this embedded in our presentations – it matters not just what this broad category is, but what your ancestral background is, what the country of origin, if you have a migration history, is. So the more specific we can get, the better it is from a scientific perspective.

[0:37:01]

RICK WEISS: Goleen, anything to add there? I mean, you focused a lot on religion, but it’s something that often gets, as you’ve put it, racialized.

[0:37:09]

GOLEEN SAMARI: So I’ll just build on what Gil was saying in that the Middle East – measurement of the Middle East category has been really fraught – whether to do it or not do it. It was almost added to the 2020 census. So there was this big community push to add it. But I think it’s also important to think about what these communities themselves want. And a lot of members of the Middle Eastern and North African community do want to be able to be racially identified on instruments and tools like the census. And then there’s a subset that, because of the discrimination and because of the experiences of discrimination, they prefer to conceal their identity and they prefer to be in that white category because it feels safer to them. So we actually have to think a little bit about how these things are circular and how people feel about them. And so it’s a complicated narrative and question, actually.

[0:38:06]

RICK WEISS: Got it. And, Goleen, actually, we have a question here directed to you from Chris Young at KCUR Radio in Kansas City, asking, along a similar timeline as the hate crimes against Muslims chart that you showed, were there congruent conflations in the media, as you referenced, to Islamic terrorism, or were those perceptions consistent in U.S. media coverage over the last 20 years?

[0:38:33]

GOLEEN SAMARI: No, there is definitely – I think the time period is based on current events. So around 2001, you had a lot of the 9/11 coverage and the terrorist – excuse me – narrative really taking off at that point. It was a narrative that predated September 11, but it really sort of took off in the media around that time frame because of the coverage of events. And then again, with the introduction of the Muslim ban narrative in the presidential campaigns in 2015, you again saw this sort of depiction of Islamic terror sort of widespread in the media as justification for bans on immigrants from these countries. And it does correspond to – the coverage really does – I mean, it’s a correlation, and we can look at associations further, but it really does. There are increases in hate crimes when there are – is more media coverage of certain groups. So – and you can see it with the anti-Asian discrimination that’s occurred in the time of COVID. There’s been a huge uptick in anti-Asian hate crimes as well.

[0:39:43]

RICK WEISS: Thank you. Question here that I think all three of you could address. This is from Sarah Lai Stirland. She’s at KALW Radio in San Francisco. She says several legislators around the country have declared that racism is a public health crisis. A recent example in my area is Santa Clara County. Has any state or local government around the country actually done a good job of making policy changes to make such a declaration more than a publicity stunt? What should journalists be asking to make these declarations effective or mean something? And lastly, are there specific policy recommendations you would give to county, city or state that has made such a declaration? Gil, this starts closest to your neighborhood, maybe, so I’ll start with you.

[0:40:35]

GILBERT GEE: Sure. And, actually, let me take a moment to share a slide real quick. Oops. Wait. Sorry. Let me try one more time. I keep getting the wrong thing. One more – one last time. Otherwise, I’ll just talk this through. You know what? Let me just – let me just – oops. OK. Let me just try one last time. There we go.

All right. Let me give you a little analogy. So – and let me preface this. You know, I started looking at, you know, racism and health 20 years ago in my dissertation. And at that time, if you were to talk about racism as a public health issue, people would basically look at you like you were stupid because, you know, at that time, when people were talking about race, they were basically saying, you know, race differences are actually not really true. They’re actually economic differences, and you should just be looking at social class, and you’re kind of barking up the wrong tree. And so to me, it’s kind of a weird moment in time when, you know, lots of places are talking about structural racism. And so for me, that’s a very interesting moment.

OK, so this picture I have in front of you is called a buckyball. OK, so it’s – essentially, it’s a soccer ball made out of carbon atoms, OK? Now imagine that each of those little black dots – you know, those carbon atoms – are a social institution. So one dot is health. Another dot is policing. Another is medicine. Another one is housing. OK? All right. So we know that social institutions are connected together. We know that they’re connected together. Now let’s go back to thinking about a soccer ball. When you have a soccer ball and you kick it, the ball momentarily deflates. You get a little dent in the ball. But then the ball essentially reverts back to being a sphere, right? Same thing if we think about our civil rights interventions. You know, we poke at one institution. We poke at housing or we poke at education, and we get a momentary deflection. But what we haven’t attended to are the interconnections across these institutions. So in other words, if we do a civil rights intervention on policing, the courts might have their back. That’s the bonds that are connecting these institutions together. The reason why a buckyball like this is very stable or why a soccer ball is stable is because all the other connections are essentially taking up slack when there’s some force applied to it.

So coming back to the question about health departments, I think it’s amazing the health departments are – and legislators and others are kind of saying that, yes, you know, racism is a public health crisis. But if we only think about single institutions without thinking about the structure as a whole, I think that we will have a couple of small successes, but we won’t change what I call the equilibrium of inequality that we have in our society. Even after 1960 – after the 1960 civil rights movement, we’ve made some progress, but we still have a heck of a lot of inequality in our society. It’s because we haven’t looked at all these interconnections.

So, for me, my recommendation is as you’re thinking about writing up stories about health departments and things like that, the question for me is, who else are they talking to? What other institutions are – is the health department working with the police department? Is it working with the judicial system and the education system? If not, I don’t think we’re going to see long-lasting change. We may see small changes here and there, but in the big picture, I think the ball will stay a ball.

[0:44:36]

RICK WEISS: Great analogy – very helpful. Thank you, Gil. Georgiana or Goleen, anything you want to add about these efforts to take stabs at the problem through legislation?

[0:44:51]

GOLEEN SAMARI: I’ll just second what Gil has said and say that it absolutely has to be systemic. And so the right questions are, how are these sort of institutions working together? So we’ve seen a lot of, like, you know, people put into positions of diversity, equity and inclusion and this acknowledgement of racism as a health problem, but sort of what does that mean for the system? And is the system going to change is – has yet to be seen and requires a lot of sort of communication across sectors.

[0:45:29]

GEORGIANA BOSTEAN: So I will third what the others have said. I touched on this health-in-all-policies approach, and I think that gets at the issue that all of the different sectors affect health in some way, and racism is embedded within these different institutions. In things like fair housing rules, we just, in July, saw a fair housing rule changed and the definition of fair housing changed at the federal level. So states and localities can take measures to address things like residential segregation, which we know affects, then, educational outcomes and, you know, transportation access and all sorts of things that ultimately pattern health. So addressing them in isolation will only make one of the other dominoes fall. We really need to think of these pieces together across different sectors. And I think that then requires us making the case to people that health isn’t just behavioral, that it’s structural – it’s impacted by these structural factors – and that to change health for the better for everyone, we need to change these institutions.

[0:46:52]

RICK WEISS: Let me throw in the moderator’s prerogative herein and ask, is there any institution or level of government that actually encompasses or addresses all of the sectors of society that you’re saying need to be addressed simultaneously, you know – but let me say it – short of a revolution? You know, how does a society really change so many things in coordination? Is there an institution that can do that right now? Gil, I see you nodding. I’ll start with you.

[0:47:29]

GILBERT GEE: You know, in my mind, it’s the Supreme Court because – you know, I mean, and the court is a really interesting phenomenon, right? If you think about when the Constitution was signed, we had no idea that people would live as long as they live today, right? And so if you think about the court, there are no term limits on the court. But maybe back a couple hundred years, if we said – you know what? – people could live to be in their 90s, and they could be shaping policies across multiple generations, they might’ve thought, hey, maybe we could, you know, put some limits on some of this.

But what’s important here, though, I think, is the courts have been changing their minds and how they interpret things. And I think, in my mind, paying close attention – so when the court says, hey – you know what? – a corporation – I forget the exact phrase, but when a corporation – corporations, in some instances, are just like people. Now, that’s a really profound interpretation because now, suddenly, it’s you as an individual person versus another person, but that person is a corporation. Who’s going to have more power and more influence – right? – and more sustained influence over time. That’s one thing.

The other thing is the courts have changed their interpretation, in some ways, on how we think of discrimination, right? So if you think about it, there’s kind of, like, two ways – there’s a lot of different ways, but I’ll talk about two ways we can think about discrimination. One is how most Americans think about discrimination, which is based on racial animus, right? So, you know, there’s something – I don’t like your kind of people, and so there’s some kind of motivation for me. And because of that, discriminatory prejudicial motivation – that I do bad things to your group – and so a very common way we need to think about – that we have been thinking about it is that, oh, well, when some group, like, you know, claims discrimination based on gender on race or age or whatever it is, you’re stuck with the burden of proving that the perpetrators had some kind of animus against you. That’s a really tall burden. That’s a really hard bar. And a lot of times, we can discriminate without any animus. And that’s why I gave the example of the payouts to the families of children, right? There’s no – like, whoever the actuarial is who is calculating those payouts to the families, they don’t have to have any kind of gender or race bias at all. All they have to say is – you know what? – on average, women make less money, so it makes sense that we just allocate less money to women – you know, to parents with girls, right? But that reinforces inequality across generations.

So the other way we can interpret what discrimination is is, regardless of having some kind of animus, some kind of prejudicial intent, we see that the outcomes are unequal. And that’s a different interpretation. And the courts have been moving further and further away from those kinds of interpretations. So to me, if we can – so that kind of gets at really the heart of a lot of different institutions where they kind of battle, like, well, there’s some discrimination, but can you prove it? Maybe it wasn’t discrimination. Maybe it was just an economic issue. Or this just happened, and this is how we normally do business, and this all makes sense because it’s just logical. You know, women make less money, so we’re not discriminatory against women. That’s just how it is. So we want to think about different ways we can consider what’s discriminatory. And because the Supreme Court is, in some ways, the final stop for how we think about a lot of things, to me, if we had to pick one institution, that’s the institution I personally would pick on.

[0:51:27]

RICK WEISS: That’s a super interesting perspective. Thank you. Unless anyone else wants to address how we can do all this at once, I have one other question I’ll throw in. But does either of you…

[0:51:38]

GOLEEN SAMARI: I’ll just chime in really fast to say that there could be a national coordinated strategy. Like, for example, we should have those types of strategies for other health crises like COVID-19. And so you see a lot of different entities come together – or should come together for pandemic response. And if we really start to think about racism as a sort of epidemic that’s gone on for so long and think about it, bringing this coalition of people together for that type of – that scale of national response, I think it could be effective.

RICK WEISS: Great analogy.

[0:52:20]

GEORGIANA BOSTEAN: I’ll also chime in that the higher you go, the more effective the policies are because of preemption laws in particular. Even though we all often say, think global, act local, sometimes local ordinances can be preempted by state law and so forth, so it really requires a larger and broader systemic approach. That said, if you are working in local communities, that’s a place to start, right? We don’t want to go so high that people think, well, I have no influence over the Supreme Court. But you do. Vote, right? But nevertheless – so, yes, starting top-down, I think, is a far more effective strategy.

[0:53:07]

RICK WEISS: Great. I’ve got one last question. It’s directed to you, Georgiana. It’s – does our understanding of social determinants of health explain racially disparate impacts of the COVID-19 pandemic?

GEORGIANA BOSTEAN: Does our understanding of social determinants…

RICK WEISS: Right.

GEORGIANA BOSTEAN: …Change – or impact COVID-19?

RICK WEISS: Does it explain the differences between racial impacts of COVID-19? Yeah, I think as opposed to biological differences and…

[0:53:37]

GEORGIANA BOSTEAN: Yes. So absolutely. We – so I think there are two things to be said. First, that we see – we’re in Southern California here. We see disproportionate impact on Native Hawaiian populations and Pacific Islanders and also among Latinos. And there are social factors that contribute to that, including household size and the types of occupations that people are in. And these are exactly the social determinants that Gilbert also pointed to that affect health.

I’ve also seen that people make this – have this bias about it being a personal health decision. And so when they see statistics about obesity being a risk factor for COVID-19, they say, well, you know, obesity is a personal choice. If people engaged in healthier behaviors – and anecdotally, I’ve had phone, you know, conversations with folks in Southern California who say, well, you know, why are people living in such large households? If they weren’t living in these really large households, they wouldn’t be spreading it to all sorts of people – right? – not contextualizing why we see these differences in social factors, and part of it being socioeconomic – the large part of it being socioeconomic status.

[0:54:54]

RICK WEISS: All right. Thank you for clarifying that. At this point, we’re just about at the top of the hour, so I want to give each of you just a half a minute or so to wrap up, maybe give our reporters on the line here a take-home message or something. You know, if they’re going to walk away with one idea, what do you hope it will be? And I will go back through the order and, Gil, start with you. Actually, that’s not the order, but anyway, go ahead. Order on my screen.

[0:55:27]

GILBERT GEE: You know, actually, I wanted to take my topic and flip it around a little bit. One thing that’s really been a silver lining this year for me is the immense coverage. So I want to actually thank all the reporters out there because in the past, Asian Americans and other communities have essentially been invisible in the media. And when there was maybe some bit of news, it’s kind of been one and done. But now there’s been this sustained coverage of anti-Asian discrimination and discrimination against many other communities. And I just wanted to actually thank the journalistic community for that because most of the time, the Asian community is rendered invisible.

RICK WEISS: Great. Thank you. Goleen, I’ll go to you next.

[0:56:18]

GOLEEN SAMARI: Sure. So, yeah, thank you to the media, for sure. There’s been a lot more coverage of discrimination and racism, and that always helps, actually. One thing that I always think about in terms of my sort of mission as a public health professional is that as I observe these experiences of Muslim Americans or immigrant communities, racial minorities, immigrants at large, and I actively seek to sort of counter all forms of discrimination, xenophobia and othering and related intolerance in order to actually expose the power structures that generate them to foster more inclusive societies and to foster health justice. And if we all sort of independently take on that framing, I really do think that we can move this fight forward. So thank you.

RICK WEISS: Great. Georgiana?

[0:57:12]

GEORGIANA BOSTEAN: Yes, thank you. So journalists have one of the toughest jobs in this current climate. And so I echo that sentiment, and I think you all play an indispensable role, really, in shaping the public narrative and the discourse. And so not to add one more thing to the plate, but as I close, I think though we’ve learned and we’ve seen that evidence is no longer enough, that science is no longer the end point – right? – the thing, the truth, and so we have to think about how to communicate the truth that we’re getting from science in a way that the public will be receptive to and policymakers will be receptive to. And I struggle saying this as a sociologist, that I – you know, I think it should be clear. The evidence should speak for itself. But we see that it doesn’t. And I think journalists then have a really big role in being able to communicate in a way that will convey the truth behind the data that we’re working with. Thank you.

[0:58:22]

RICK WEISS: Fantastic. I want to thank all three of you for a very enlightening discussion today that I think is both intellectually interesting and helpful and also practically, on a professional journalistic scale, very helpful. So thanks for that. For the journalists on the line, I want to remind you as you log off today, you will get a prompt for a very short three-question survey. It takes a half-minute. It’s very helpful for us if you go ahead and take the minute to fill that out. So thank you for doing that. A reminder that you can come to SciLine when you need help getting connected to a scientist or to research-backed scientific evidence. Look at our website at sciline.org. Follow us on Twitter – @RealSciLine. And thank you all for attending, and we’ll see you at the next SciLine media briefing. So long, and thanks to you all.