Part of the Series After the Raid

The root causes of health disparities lie in policies and practices that distribute power and resources such as housing, education, employment and health services inequitably. For example, law enforcement agencies—including police and Immigration and Custom Enforcement (ICE) officers—disproportionately target, surveil and perpetrate state violence against communities of color. Ample research shows that the unjust government practices associated with the enforcement of immigration policies, the war on drugs or the criminal legal system damage health and reduce life chances for entire marginalized communities, playing a key role in creating health disparities.

The paradox here is that the government and taxpayers are funding both the state violence that causes these public health problems and the public health attempts to address them. While hundreds of billions of dollars fund unjust state violence practices, public health agencies are directing a fraction of their limited funds to the alleviation of the very health disparities caused by this state violence. In few instances is this paradox clearer than immigration enforcement. As our public health research shows, government-funded immigration enforcement is not only damaging to the individuals who are its targets, but to their families and communities as well. In this series, we highlight ed the way in which home raids are likely to influence the presence of post-traumatic stress disorder (PTSD) and trauma symptoms. Public health agencies will ultimately fund the interventions to address these negative health effects, such as PTSD. Given this paradox, what do we as public health researchers and practitioners do about future health equity work in the United States?

Public health programs addressing health disparities and inequities should be dedicating at least as much vision, creativity and funding to tackling root causes—including state violence—as they do to interventions that help communities cope with the resulting inequities. Many (but certainly not all) of the existing programs addressing health disparities insufficiently highlight unjust state violence as a key root cause of health disparities and thus refrain from taking the steps to address it. This means that too often “health equity”/”health disparities” work focuses downstream from the root causes like state violence.

For example, the US provides after-school programs for youth whose families have been ripped apart by mass incarceration and offers free pre-natal care to immigrant mothers who are anxious about getting deported. However, these are stop-gap measures, and we have yet to fully grapple with the complexity of dismantling these government-funded root causes and identifying evidence-based root causes interventions. Despite the good intentions of upstream-minded public health professionals, the current financial, political and creative restraints often limit our capacity to actually intervene upstream. We stop short of the advocacy and activism needed to dismantle these unjust systems. This is where future health equity work needs to focus.

We suggest four steps to make this possible:

If the public health industry is serious about eliminating health disparities and inequities, we will need to make significant changes in the coming years. The foundation laid by preeminent scholars and public health practitioners has given us the social epidemiological data and community-based participatory tools to take this next step. Now it’s on us — the current public health workforce — to make the hard and difficult push to create a “public health of consequence” that plays an important role in framing state violence and racist policies as health issues and undertaking interventions to dismantle them.

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