“Do No Harm” Amidst Cycles of Structural State-Sanctioned Violence and Adverse Pregnancy Outcomes

“Do No Harm”

Amidst Cycles of Structural State-Sanctioned Violence and Adverse Pregnancy Outcomes

On April 11, 2021, hardly 11 months after the murder of George Floyd sparked a global uprising anchored in Minneapolis, four Brooklyn Center police officers murdered Daunte Wright less than 10 miles from 38th and Chicago. Wright—one of 1,054 people killed by police in the United States in 2021—was Black, 20 years old and a father. In the immediate aftermath of his murder, hundreds flocked to the city, convening on a lawn situated between the Brooklyn Center Police Department (BCPD), and a small, two-story apartment complex. Within hours, BCPD unleashed brutal crowd control tactics, kettling protesters and firing tear gas that quickly ballooned around the apartment building, exposing residents and Brooklyn Center community members residing within blocks of the BCPD. The coming days saw news reports of Brooklyn Center residents moving to hotels, with the help of a community-led mutual aid group, to shield their families from flash bangs and chemical irritants, photos of toddlers pressed against the window, watching chaos unfold from behind a film of gas. While less than 7% of Minnesota’s population is Black, Brooklyn Center, a first-ring suburb whose population is majority nonwhite, is 31% Black. Within census tract 202, which includes the BCPD, more than half of renters are Black. Eviction filings in Brooklyn Center between mid-September and mid-October 2022 fell well above the national average, by as much as 121% in some areas. Median household income in census tract 202 is $52,000 annually, 31% below the statewide median. One in five

By Yusra Murad and Kene Orakwue, MPH

households lives under the poverty line (annual household income of $27,750 for a family of four). Myriad instruments of structural racism — police violence, residential segregation, criminalization, and poverty — converged on the lawn outside the BCPD. Policing and property ownership in the United States are inseparable from their brutal origins of colonization, land theft, enslavement, and exploitation, and thus inseparable from one another. Researchers at the University of Minnesota’s Center for Antiracism Research for Health Equity (CARHE) and others have found the crowd control tactics deployed by the BCPD, including less-lethal weapons and firing tear gas, to be harmful for health. That this hazardous and traumatic police response, on the heels of yet another murder of a Black man by police, occurred in a predominantly Black, low-income, renter neighborhood is no coincidence, but rather a microcosm of past and present systematically arranged violence. As the field of public health looks deeper into the intersection of police contact, neighborhood context and health outcomes, physicians must understand racism, housing policy, and carceral expansion as mutual reinforcers, and central drivers of poor health. There is no shortage of research suggesting that the vestiges of racial covenants and redlining are very-much alive in our cities, although modern-day tactics to maintain racial segregation and protect white property interests go by different names: surveillance, policing, gentrification, and eviction. Each of these tactics has documented impacts on our physical and mental health. In a recent study of almost three million births across

Yusra Murad Kene Orakwue, MPH

5,924 counties, evictions were associated with increased odds of low birth weight; and the association between living in a county with a high eviction rate and low birth weight or preterm birth (birth occurring before 37 weeks gestation) was strongest for Black women.* Evictions are concentrated in low-income neighborhoods, where families earning poverty wages become severely-cost burdened, forced to make choices between rent, nutritional food, childcare and health care. It is in these neighborhoods that research suggests police-related death rates are highest. It is no surprise, then, that in a study of Black women’s perspectives on structural racism across the reproductive lifespan, “housing,” “law enforcement” and “policing Black families” were identified as three of nine major domains of structural racism. The downstream effects of arrest and incarceration are often catastrophic and generation-altering, creating permanent challenges for renters in getting approved for housing, pushing families deeper into poverty and highly policed and surveilled neighborhoods, reigniting the vicious cycle. These cycles of violence churn from generation to generation. In 2021, one in 11 Minnesotan babies were born prematurely. Black women were twice as likely to have

a preterm birth baby as compared to their counterparts. This has dire consequences: preterm birth can lead to a range of complications, including underdeveloped organs; breathing, vision and hearing problems; and long-term conditions such as cerebral palsy. Research infers that chronic exposure to stress, namely structural racism and anti-Black racism, leads to inequities in adverse birth outcomes. A recent study conducted by CARHE’s Dr. Rachel Hardeman found an association between living in highly-policed neighborhoods and elevated odds of preterm birth, particularly for Black pregnant people. Importantly, Hardeman et al. concluded that because neighborhoods with more Black residents were more likely to be policed, “the higher incidence of PTB among Black pregnant people than white pregnant people may be attributed to racialized exposure rather than a differential effect of police contact between racial groups.” Another study concluded that any encounter with law enforcement, positive or negative, was associated with increased medical mistrust. Repeated interaction with law enforcement is detrimental to the lives of Black people. The long-term sequela of chronic stress resulting from persistent exposure to structural racism has devastating intergenerational effects. When high levels of stress contribute to an array of maternal health disparities, such as preterm birth, Black children are at increased risk of adverse health outcomes, creating a lifetime and generational cycle of weathering and worse health statuses. Preterm birth and low birth weight also generate exorbitant costs: one study estimated the excess cost associated with babies born prematurely in 2016 was $25.2 billion. Racism leads to health and economic inequities, and is a function of white supremacy. Physicians and healthcare providers have long considered themselves absent from this cycle of place-based structural racism, exploitation, violence and poverty, up until the point of clinical intervention. In recent years, the field of medicine has embraced the concept of social determinants of health; physicians are quick to note the effect of housing, environment, and income on patients’ health outside the four walls of the clinic. But unapologetic willingness among physicians to name structural racism as the fundamental root cause—and commit to disrupting it in day-to-day practice—is nascent yet. It is not enough for physicians to step forward at the point of preterm labor, or the great many complications that may follow, and make hollow statements about “ending health disparities.” To intentionally ignore the structural conditions that enable such deleterious outcomes for Black birthing people is an act of great harm, a direct violation of the first oath every physician recites. A healthy Minnesota, where all people cannot just survive but thrive, is possible. It is imperative for physicians, who hold the responsibility of caring for us at our most vulnerable moments, to understand the breadth and depth of community-centered investments that are needed. A significant proliferation of public housing, with rent capped at 30% of income, is crucial in lessening the magnitude of eviction and displacement affecting working-class families. Racialized policing that prioritizes property over health and well-being will exacerbate racial inequities in preterm birth and other health outcomes, and represents one of the most pressing public health issues of our time.

Yusra Murad (she/her) is a PhD student in Health Services Research, Policy, and Administration at the University of Minnesota School of Public Health. She is also a research assistant with the Collaborative on Media & Messaging For Health and Social Policy. Her research interests are at the intersection of housing, health care and journalism, with a focus on how media narratives can and must contribute to the ongoing work of establishing housing as health care; identify structural racism as a driver of the housing crisis and subsequent poor health outcomes; and ultimately compel policy change that is grounded in collective well-being. Yusra received her Bachelor of Arts in Psychology and Global Health from the University of Wisconsin–Madison. She was previously the health policy reporter at Morning Consult. She can be reached at: murad011@umn.edu.

Kene Orakwue, MPH (she/her) is a reproductive justice and health equity scholar. She is currently a Health Services Research doctoral student at the University of Minnesota–Twin Cities. She is also a research assistant at the Center for Antiracism Research for Health Equity (CARHE). Kene’s research focuses broadly on racism, maternal health, and their intersections. She strives to apply her findings to real-world initiatives to improve the outcomes of Black birthing people.

Kene received her MPH with a concentration in Health Policy & Management, her B.S. in Public Health Sciences with a focus area in Global Women’s Health, and a certificate in Reproductive Health, Rights & Justice from the University of Massachusetts Amherst. She is also a Mama Glow Doula Trainee. She can be reached at: orakw005@umn.edu.

References available upon request.