State health plan declares racism a public health crisis

A new state health report pinpoints racism as a public health crisis while also noting Illinois needs to improve in the areas of maternal and infant health, mental health and substance use disorders.

The broad goals are laid out in a draft of the State Health Improvement Plan, which will be finalized and presented to the Illinois General Assembly next year. The SHIP is part of Healthy Illinois 2028, a five-year plan outlining the major public health crises the state hopes to address.

After two years of assessment and planning, Healthy Illinois 2028 prioritized five major public health issues:

• Racism as a public health crisis.
• Maternal and infant health.
• Mental health and substance use disorders.
• Chronic disease.
• COVID-19 and emerging diseases.

The report found these issues consistently overlap and are all exacerbated by a lack of access to health care and wraparound services, the infrastructure of public health systems and racial inequities.

“It is essential to emphasize that disparities in health outcomes according to race/ethnicity have nothing to do with biology and everything to do with inequitable distributions of money, power and resources,” according to the report.

Several members of the public registered concern at virtual hearings last week about what was missing from the draft plan – including care plans for migrants and concrete actions to slow a rising number of overdose deaths in Illinois.

Public health advocates asked for the inclusion of data-driven responses. Previous SHIPs have included measurable goals including reducing rates of suicide and opioid overdose deaths, both of which have increased over the last decade, according to the Centers for Disease Control’s National Center for Health Statistics.

But Jennifer Epstein, deputy director of the Illinois Department of Public Health Office of Policy, Planning and Statistics emphasized to Capitol News Illinois that the report still is in draft form, and that specific metrics will be added to the plan during 2024.

Racism’s effect on health care

The draft improvement plan for the first time makes a point of listing racism as an overarching public health crisis in Illinois.

“Racism is both a cross-cutting issue and a standalone priority because it is at the root of many, if not all health issues,” Illinois Public Health Institute senior program manager Janece Gough said at the hearings.

IPHI was one of the entities that contributed to the draft under the guidance of the Illinois Department of Public Health and the State Board of Health. The report also was co-authored by staff from the University of Illinois Chicago’s Policy, Practice and Prevention Research Center.

Gough said continued stigma and discrimination from health care providers are among the barriers to equitable health care.

The plan aims to address inequities by forming an appointed advisory committee on racism in health care and building a more diverse health care workforce. This type of racism happens when health care workers hold racial biases against patients, whether intentional or not.

IPHI director Laurie Call said public health infrastructure needs serious strengthening to be ready for emerging threats, as evidenced by the COVID-19 pandemic. Climate change – and its health effects caused by air, water and land pollution – are included in those emerging threats, she said.

“We know that as climate change is expected to worsen, this will have many health consequences,” she said.

Call said eight local entities in Illinois – such as the Chicago Department of Public Health, the Peoria City/County Health Department and a Champaign school board – have already issued a formal declaration of racism as a public health crisis. According to the American Public Health Association, 19 other states have declared racism a public health crisis, including Michigan and Wisconsin.

During a hearing last week, Angela McLemore, who worked for years in hospital administration and now serves as executive assistant to state Sen. Mattie Hunter, D-Chicago, said she was supportive of the plan’s goals, but she emphasized the state will need to dedicate resources to make them a reality.

“I like what I have seen,” McLemore said. “In order to make the goals and objectives happen, you have to spend a lot more time on implementation, planning and we need to attach the money, manpower and materials necessary for each plan.”

Funding was a key concern for multiple other public commenters, including Creola Hampton, president of Black Leadership Advocacy Coalition for Healthcare Equity, or BLACHE, pronounced “black.” BLACHE currently has 19 organizations in its network from the west side of Chicago down to East St. Louis.

“The unfortunate dilemma is the Illinois Department of Public Health funding is so highly racially inequitable that it perpetuates racism being a public health issue,” Hampton said.

Hampton argued that when it comes to combatting HIV and AIDS, by which Black communities have been hit the hardest, there has been little funding sent to “African American-led organizations that have the enhanced cultural competency” and “the maximum degree of effectiveness.”

“The state is going to be leading saying that racism is a public health issue,” she said. “Then the state has to be actively involved and making sure that there is equitable funding going to African American-led organizations to do the work that needs to be done to negate the inequity of health.”

In response to media questions, IDPH spokesperson Jim Leach said the agency aims to partner with Black-led organizations around the state to reduce the “historic and present-day disparities” found with HIV.

“More than half of the HIV testing and risk reduction services delivered with IDPH grant funds were provided to clients who identified as Black/African American,” Leach told Capitol News Illinois in an email.

Healthy Illinois 2028 lists an infrastructure recommendation to “de-silo funding and eliminate inequitable funding.”

Requested additions

Although reducing overdose mortality was outlined as a priority goal in the previous SHIP, overdose deaths have continued to climb in Illinois.

The IDPH Opioid Data Dashboard recorded 3,261 opioid-involved overdose deaths in 2022 — a new record for the state.

The SHIP draft lists broad objectives including reducing the number of emergency department visits and increasing access to health care and wraparound services. It also sets a goal to “Increase funding to support the infrastructure development of the mental health and substance use disorder system.”

Absent from the report is any mention of licensed overdose prevention sites, something many addiction researchers and advocates for those with substance use disorders support.

“We really don’t have time to lose,” Chelsea Laliberte Barnes, co-founder of the Illinois Harm Reduction and Recovery Coalition, told the panel last week.

Overdose prevention sites, which are places where people who use drugs can get clean equipment and drug samples tested, present one major evidence-based strategy to reduce overdose deaths. Illinois has none but the issue was brought forward each of the past two legislative sessions by state Rep. La Shawn Ford, D-Chicago. New York is the only state with licensed overdose prevention centers, both of which are in New York City.

In countries with overdose prevention sites, like Canada, Australia and several European countries, no deaths have been reported at any of these centers.

“We’ve seen how much these types of interventions save money, they reduce costs from emergency services. They provide a direct link for people to access health care services, job training, food,” Laliberte Barnes said. “I would just like to really advocate for the addition of overdose prevention sites as a strategy for the plan over the next five years.”

She said overdoses are still rising “statewide — rural, urban, suburban, you name it.”

The draft report also doesn’t contain a plan of care for recent migrant populations that have arrived in Illinois in the last 15 months largely from the southern U.S. border.

As of Dec. 6, more than 27,000 asylum seekers have arrived in Chicago, with a majority arriving via buses from Texas at the direction of Gov. Greg Abbott, according to the city’s new arrivals dashboard.

Without proper medical attention and paperwork, the number of asylum seekers places a particular strain on public schools that need to address their physical and mental health needs.

Betzua Rubio, a nurse at Eli Whitney Elementary in Chicago’s Little Village, told the panel she was concerned for migrant children who are without paperwork such as immunization records.

“We are seeing the lack of implementation for medical providers to adequately provide medical orders,” including “asthma action plans, allergy action plans,” Rubio said at the hearings.

Rubio estimated that more than 100 migrant students have been enrolled at Eli Whitney and described her work as a bilingual school nurse as “nonstop.”

“We have been bringing administration vans for those children, but this is all work that we’re doing individually,” Rubio told Capitol News Illinois. “We’re not getting any help.”

Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of newspapers, radio and TV stations statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, along with major contributions from the Illinois Broadcasters Foundation and Southern Illinois Editorial Association.