11 1

“When I first met Alvin, I was going through No one can say that Simmons died from the
some personal things with a child,” recalled virus because he was Black. But what is
his girlfriend Lisa Williams in a Democrat and beyond doubt is that the color of his skin
Chronicle profile of Simmons after his death. subjected Simmons to layers of systemic
“He used to send me things through disadvantage that put him, and his Black
Messenger, like uplifting songs. He’d send me neighbors, at a much higher risk for exposure
messages like ‘Hold your head up.’ ” to, and complications from, the novel
infectious illness. Racial bias in housing,
In his last days, when he was short of breath, education, employment and other social
he asked Williams to sing solo. determinants of health meant that Black
Americans were forced to the front lines of a
“He said, ‘I want you to do karaoke,’ ” global pandemic with fewer resources to
Williams remembered. “ ‘I can’t join. I want protect themselves, including being less likely
to hear your voice.’ ” to have sick leave, health care and jobs that

On March 17, 2020, Simmons, an

African American, lost his battle
with the mysterious new virus.
He was 54 years old. 1

In the months that followed, it

became clear that Simmons’ death was a allowed them to work from home.
harbinger of the toll that COVID-19 would
extract on communities of color. Nationally, Put simply: coronavirus does not discriminate
the COVID-19 death rate for the Black on the basis of race, but our institutions and
population was 2.2 times the rate for the policies do. COVID-19 racial disparities are
White population.2 In Monroe County, the not a mystery. “What we’re seeing here is the
disparity was even higher. African Americans direct result of racism,” says Dr. Camara
were 2.9 times as likely to test positive for Phyllis Jones, an epidemiologist and past
coronavirus as their White neighbors and 2.6 president of the American Public Health
times as likely to die from the disease.3 Association. “That’s the thing that is slapping

African Americans face much larger risk from COVID-19

Monroe County COVID-19 rates

Rates are age-adjusted and shown per 100,000 residents.

Data is from 3/1/2020 to 10/21/2020 for White non-Hispanic and Black non-Hispanic populations.
This analysis excludes records with unknown race and ethnicity (5% of cases; 1% of hospitalizations; 1% of deaths).
Source: Rochester Emerging Infections Program, Center for Community Health & Prevention, University of Rochester Medical Center

1 2
 us in the face. Actually, it’s lashing us like
whips.”4 Real estate and lending practices limit access “It’s common to have racism without racists.”
to affordable, quality housing. Lower-quality
Over the past few years, overt racism has schools and biased treatment in the — DR. EDUARDO BONILLA-SILVA, PROFESSOR OF SOCIOLOGY, DUKE UNIVERSITY
reemerged in the public sphere through classroom result in inequitable educational
White supremacist ideology on social media experiences. Implicit bias among health care and practices that ensure African Americans professional lives. With collective action, we
and nationally televised gatherings like the providers leads to suboptimal treatment and equitable access to employment, education, can build a region in which race-based health
2017 Unite the Right rally in Charlottesville, lack of trust in the health care system. housing and the other social determinants of disparities are relics of a bygone era and
Va., that left one peaceful protester dead and Consistent exposure to demeaning racist health are not just good social policy, they wellness is a birthright for all.
19 others injured. stereotypes prohibits individuals from fully are essential investments in public health.
believing in themselves and realizing their
However, explicit racism is only the tip of the potential. All of us must find ways to drive such
iceberg. Most race-based discrimination in investments. Highlighted throughout this
21st century America is much harder to see Each layer of racism, directly or indirectly, report are actions for increasing equity that
because it does not require that individuals puts additional stressors on physical and each of us can take in our personal and
exhibit or embrace bigotry. mental health and makes it harder for people
of color to access resources that support
“Today, racial segregation and division often well-being.
result from habits, policies and institutions
that are not explicitly designed to The cumulative results are devastating.
discriminate,” explains Dr. Eduardo Bonilla- Despite our region’s proud history of anti-
Silva, author of Racism without Racists. slavery activism, today, policies and practices
“Contrary to popular belief, discrimination or that lead to race-based inequities are killing
segregation do not require animus. They Black residents in Rochester and the Finger
thrive even in the absence of prejudice or ill Lakes region at a rate that is indefensible.
will. It’s common to have racism without
racists.”5
Compared to White people, Black people in
our region face dramatically higher rates of
premature mortality from nearly every
About This Report
Systemic inequities are to blame. Centuries condition, including heart disease (133%
of discrimination, reinforced by exclusionary higher), diabetes (146% higher), cancer This report is the second in a series of health coalition members is included at the end of
suburbanization, have perpetuated two vastly (35% higher), and premature birth disorders equity studies produced since 2019 by this report.
different life experiences in the United States (218% higher).8 The breadth and depth of Common Ground Health, the health research
— “two the disparities and planning organization for the nine-county Since 2003, coalition members have
societies” as the reflect the
Rochester-Finger Lakes region. The Color of supported prior studies of health disparities
Kerner breadth and
Commission put depth of Health follows on the heels of Overloaded, an experienced by Black communities in our
it in 1968, “one racism’s impact extensive analysis of the tragic toll that region. Updated most recently in 2014, the
black, one white on the young poverty takes on residents’ health across our What’s Goin’ On report documented higher
— separate and and old alike. urban, rural and suburban communities. rates of illness and premature mortality
unequal.”6 And this among Black residents and called for
While many well-intentioned people may happens at tremendous cost to the region – The focus and recommendations in this report increased efforts to address social
believe that the country has moved beyond human and financial. were guided by the African American Health determinants of health as a central strategy
its racist past, economic and health outcomes Coalition. Convened by Common Ground, the for eliminating unfair and preventable health
of Black Americans tell a different story. By In the midst of this pandemic, most of the long-standing advisory group brings together inequities. The Color of Health takes the next
nearly every measure, the deck continues to world longs to return to normal. For Black community leaders and health professionals to step to put a spotlight on the many ways that
be stacked against people of color. residents of Rochester and the Finger Lakes
coordinate efforts to improve health for racism undermines the social determinants of
region, normal is the last thing needed.
The 2021 report by the Commission on Racial Reducing illness and early death for communities of color. This report builds on the health, and that dismantling systemic racism
and Structural Equity (RASE) found that communities of color is within our reach, but coalition’s proud history of providing is the key to any significant and lasting
these inequities are persistent and the science of health improvement is clear: community data and insight on African improvement in African American health
widespread in Monroe County and the City of community health is not determined primarily American health inequities to inform and outcomes.
Rochester. “While we found hardly any laws by biology or the medical system, but rather mobilize meaningful change. A roster of
in the City and County which created and by the social constraints in which we live.
sustained racist policies, we have found
practices and conditions... where people of Health equity strategy for Black residents
color are unable to fully participate and are must look beyond the four walls of the
implicitly or explicitly excluded from medical clinic or hospital and include what
opportunities that could enhance their happens in the classroom, on the way to
economic, social and mental health.”7 school, on the job and in the home. Policies
The Color of Health was supported by funding from Excellus BlueCross BlueShield
3 4
 measures of public health, higher rates of diseases. High blood pressure is linked to
violence in Black neighborhoods are the heart disease and is 21% more common
outgrowth of social and economic among Black adults.13
discrimination.
While blood pressure can be controlled and
In short, violence is a symptom of poverty, kept at safe levels through a combination of
explains Willie Lightfoot, Rochester city medication and lifestyle changes, Black
council member and founder of the Cut the patients have significantly lower control rates
Violence Initiative for teens. “At the end of (69% vs. 81% for White patients), exposing
the day, violence affects our entire them to greater health risks. This disparity
community,” he says. “It impacts everything persists across the socioeconomic spectrum.
and everyone.” Black patients in high socioeconomic status
areas have lower control rates (74%) than
Other major drivers of YPLL inequity include White patients in low SES areas (79%).14
premature birth, diabetes and cancer
(primarily lung and breast). The variety of The combination of higher prevalence, lower
these causes is a testament to how broadly control rates and other risk factors leads to a
health inequities are experienced across the Black rate of hypertension-driven preventable
entire Black community, including by babies, inpatient hospital stays that is nearly 6 times
who should be the hope for the future, not higher than the White rate. Unfortunately,
victims of discrimination. In fact, the Black asthma and diabetes show similar
premature mortality rate is higher for nearly disparities.15
every cause of death, with the notable
exceptions of suicide and drug overdose, Mental illness mirrors the disparities seen in
which are higher for the White population.12 physical illness. Black adults across the Finger
Lakes are over 50% more likely to report
Racial health inequities not only shorten lives, poor/fair mental health than White adults
they also diminish quality of life. Black (22% vs. 14%). Black residents also
residents of our region live with chronic identified mental health as their number-one
illness more often than Whites and priority when asked broadly about concerns
experience worse outcomes from these for their health and well-being.16

T Black people die earlier regardless of socioeconomic status

Years of potential life lost rate

African American families struggle with levels, the Black population has a 38% higher
reprehensible rates of chronic illness, mental premature mortality rate.9 †
distress and premature mortality. Even
among those with high incomes and Heart disease is the top cause of premature
advanced education, Black people in our mortality within our region’s Black population
region face an unfair burden of disease and and is also one of the largest contributors to
die earlier than their White neighbors. the racial disparity in years of life lost. Nearly
one quarter of the total disparity is driven by
Just how much earlier is captured by a the Black rate of premature mortality from
measure called Years of Potential Life Lost heart disease, which is more than double the
(YPLL). This mortality metric places a larger White rate.10
weight on the deaths of younger people by
estimating the additional years a person Homicide, the other leading cause of the
would have lived had they not died before premature mortality disparity, steals years of
the age of 75.* Black residents regionally life from Black men at a rate that is 25 times
have a 67% higher rate of YPLL than their higher than the rate faced by White men.11
White counterparts. Although this gap has This shocking racial disparity is not
decreased since 2000, the inequity remains inevitable. Decades of research shows that, All rates are age/sex-adjusted and shown per 100,000 residents
large. Even at the highest socioeconomic similar to heart disease, diabetes and other Source: NYSDOH Vital Statistics for Finger Lakes nine county region 2015-2017; Analysis by Common Ground Health

5 6
 Homicide
Homicideand
andheart
heartdisease
diseasedrive
drivehigher
higherrates
ratesofofpremature
premature
mortality
mortalityfor
forBlack
Blackresidents
residents
Years
Years
ofof
potential
potential
life
life
lost
lost
rate
rate Breakdown
Breakdown
ofof
disparity
disparity

All All
rates
rates
areare
age/sex-adjusted
age/sex-adjusted andand
shown
shown
perper
100,000
100,000
residents
residents
Source:
Source:
NYSDOH
NYSDOHVital
Vital
Statistics
Statistics
for for
Finger
Finger
Lakes
Lakes
nine
nine
county
county
region
region
2015-2017;
2015-2017;
Analysis
Analysis
by Common
by Common
Ground
Ground
Health
Health

The
Thebreadth
breadthandanddepth
depthofofthese
theseinequities
inequitiesisis The
Theresults
resultsare
aredevastating
devastatingfor forsosomany
many
striking
striking– –nearly
nearlyevery
everyhealth
healthmetric
metricisis individuals,
individuals,their
theirfamilies
familiesand andourourregion’s
region’s
significantly
significantlyworse
worseforforour
ourregion’s
region’sBlack
Black entire
entireBlack
Blackcommunity.
community.AsAsMartin MartinLuther
Luther
population.
population.AndAndwhile
whilehealth
healthoutcomes
outcomesare are King
KingJrJrdeclared:
declared:“Of “Ofallallthe
theforms
formsofof
particularly
particularlypoor
poorfor
forlow-income
low-incomeBlack
Blackpeople,
people, inequality,
inequality,injustice
injusticeininhealth
healthisisthe themost
most
the
thedisparities
disparitiespersist
persistacross
acrossthe
the shocking
shockingandandthethemost
mostinhuman
inhumanbecause
becauseit it
socioeconomic
socioeconomicspectrum.
spectrum. often
oftenresults
resultsininphysical
physicaldeath.”
death.”17 17

Black
Blackcommunities
communitiesface
facemuch
muchhigher
higherrates
ratesofofhospital
hospital
visits
visitsfor
forchronic
chronicconditions
conditions

II n nhis
and
hisgroundbreaking

disparities
groundbreakingresearch
andcivil
civilrights
disparitieswere
rightsleader
weredriven
drivenby
researchmore
leaderW.E.B.
W.E.B.Du
bysocial
morethan
DuBois
thana acentury
Boisdeclared
centuryago,
declaredthat
socialinequality
inequality– –not
ago,sociologist
thatracial
sociologist
racialhealth
notbiology.
biology.
1616
health

Scientists
Scientistshave
havesince
sinceproven
proventhatthatnonogenetic
genetic populations.
populations.19 19

ororinherent
inherentbiological
biologicalcondition
conditionexplains
explainsthe the
broad
broadandandextreme
extremehealth
healthdisparities
disparities While
Whilerace
racedoes
doesnot
notexplain
explainoutsized
outsizedhealth
health
associated
associatedwithwithrace
raceininthe
theUnited
UnitedStates.
States. disparities,
disparities,racism
racismdoes.
does.20 20
A Agrowing
21 21
growingbody
body
Race
Raceisisa asocial
socialconstruct
constructwithout
withoutbiological
biological ofofmedical
medicalandandsociological
sociologicalresearch
researchprovides
provides
significance.
significance.Genetic
Geneticstudies
studiesshow
showthatthatfar
far clear
clearevidence
evidencethatthathowhowpeople
peopleare areperceived,
perceived,
Source
Source
(hypertension
(hypertension
andand
diabetes):
diabetes):
NYSDOH
NYSDOHSPARCS
SPARCSInpatient
Inpatient
Data;
Data;
Finger
Finger
Lakes
Lakes
9 county
9 county
region
region
(2011-2015)
(2011-2015) more
moregenetic
geneticvariation
variationoccurs
occursbetween
between treated
treatedand andable
abletotoaccess
accessresources
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because
Source
Source
(asthma):
(asthma):
Age/sex-adjusted
NYSDOH
Age/sex-adjusted
NYSDOH
analysis
SPARCS
analysis
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Outpatient
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by Common
by Common
Data;
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Ground
Finger
Ground
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Health
9 county
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region
region
(2013-2015)
(2013-2015)
individuals
individualswithin
withina apopulation,
population,thanthanbetween
between ofoftheir
theirrace
racehas
hasa areal
real– –andanddangerous
dangerous– –
77 88
 The reality is that the broadest-reaching effects of racism are not from
The Four Levels of Racism hurtful words or the actions of bigoted individuals, but rather from public
policies and business practices that lead to racially disparate outcomes.

many forms and whether intentional or not, of being Black? Even in 2020, I have to run
creates a gauntlet of barriers that makes it faster, further, carry a heavier burden and do
very difficult for the Black community to it with a smile on my face.”
thrive. As Wade Norwood, CEO of Common
Ground Health, puts it, “What is the high cost

Racism negatively impacts all of the social determinants

of health for the Black community

impact on health. Hundreds of studies show a disparate outcomes – whether intentional or

relationship between racial discrimination and not. In his book, Racism without Racists,
poor physical and mental health, and Eduardo Bonilla-Silva explains: “Whereas for
researchers are illuminating many of the most whites racism is prejudice, for most
pathways by which racism degrades health.22 people of color racism is systemic or
23
institutionalized.”

Racism is a complex force that is

experienced on four levels:
structural, institutional,
interpersonal and internalized.24
Each of these layers creates
obstacles that make it much
harder for the Black community
to live long, healthy lives.
Discrimination limits access to employment,
Americans may be tempted to believe that housing, nutritious food, health care and
racism is no longer an oppressive force. other social determinants of health.
Although “Whites Only” signs and other forms Additionally, exposure to racism is a chronic,
of in-your-face discrimination are now illegal, toxic stress that has a weathering effect on
racism remains embedded in American the mind and body.25 Through these varied
culture and institutions. The reality is that the and reinforcing mechanisms, racial
broadest-reaching effects of racism are not discrimination is the driving force behind
from hurtful words or the actions of bigoted large physical- and mental-health inequities.
individuals, but rather from public policies
and business practices that lead to racially The overarching problem is that racism, in its
9 10
 S tructural racism is so persistent and devastating because it is not
something that individuals and institutions choose to do, rather
it is embedded in our social, economic and political systems.26
Although the civil rights movement brought policies to make investments in their
an end to certain explicit forms of neighborhoods and community resources
discrimination, systems and policies continue because White suburban voters often have
to produce racially disparate outcomes, even different and sometimes competing priorities
when they aren’t overtly or intentionally for limited resources.
racist.

Constantly reinforcing and far-

reaching, structural racism
confronts Black citizens with new
barriers at every turn, often
transforming the American dream
of working one’s way up the
economic ladder into an
unattainable fantasy. A recent study by Obstacles to voting: Across the nation,
researchers at Harvard University, Stanford Black citizens typically face more and larger
University and the U.S. Census Bureau found barriers that suppress voter turnout. In
that Black children are less likely to reap the recent years, half of the states have imposed
benefits of upward mobility and more likely new burdens on the voting process that
to slip down the rungs of prosperity.28 White effectively disenfranchise people of
children born into the lowest income group color. Strict voter-ID laws are an example of
are nearly twice as likely as their Black peers policy which may seem race-neutral on the
to climb their way to the middle-income surface, but disproportionately impact Black
group, 46% vs. 25%. And while 41% of Americans who are much more likely to not
White children with parents in the highest have a current government-issued photo
income group stay at that level, only 18% of ID. Additionally, because of inequities in the
highest income Black children maintain their distribution of electoral resources, Black
affluent standing. Such inequity in economic voters wait an average of 46% longer in line
opportunity reduces access to resources such than White voters, according to a recent
as healthy food, health care and social study by the Brennan Center for Justice.31
determinants of health more broadly. Beyond these obstacles, there are an
Structural racism also reduces political power estimated 1.8 million Black citizens who have
for the Black community through: been stripped of their right to vote because
of state laws that disenfranchise – sometimes
Wealth inequity: Given that money permanently – those with felony convictions.
facilitates access and influence in the political Those laws also disproportionately affect
realm, the large economic inequities people of color because of inequities in the
What is structural racism? described above translate to large inequities
in political power.29
criminal justice system. While New York State
does currently allow people to vote post-
Structural racism is the cumulative and compounded effects of many forces – sentence and during parole, research
Segregation: Black voters tend to be suggests that confusion about the policy has
historical, cultural, institutional and interpersonal – that routinely disadvantage geographically isolated from White voters, prevented many eligible voters from actually
people of color. While the specific mechanisms evolve over time and may not limiting opportunities to build alliances voting.32
have racist intent, they consistently lead to power inequalities, unequal access to around shared interests in neighborhood
opportunities and differing policy outcomes by race.25 priorities.30 Black communities in cities like Taken together, systemic discrimination robs
Rochester have limited success pushing Black residents of the political power to drive
through county or state legislation and large-scale change. Without policy and
How does it damage health?
Structural racism ensures the persistence of many barriers to improving living
Structural racism confronts Black citizens with new barriers at every turn,
conditions and accessing resources that are foundational to health. often transforming the American dream of working one’s way up the
economic ladder into an unattainable fantasy.

11 12
 Only
Only25%
25%ofofBlack
BlackAmericans
Americansare
areable
abletotorise
risefrom
frompoor
poor
households
householdstotothe
themiddle
middleclass
class

What
Whatisisinstitutional
institutionalracism?
racism?
Policies
Policiesand
andpractices
practiceswithin
withinand
andacross
acrossinstitutions
institutions(including
(includinggovernment,
government,
business,
business,schools
schoolsand
andmedia)
media)that
thatproduce
produceracially
raciallydisparate
disparateoutcomes,
outcomes,regardless
regardless
ofofthe
theintentions
intentionsofofthe
thepeople
peopleworking
workingwithin
withinthose
thoseinstitutions.
institutions.
3232

Source:
Source:
Race
Race
andand
Economic
EconomicOpportunity
Opportunity
in the
in the
United
United
States:
States:
An An
Intergenerational
Intergenerational
Perspective.
Perspective.
RajRaj
Chetty,
Chetty,
et.al.
et.al.
NBERNBER
Working
WorkingPaper
Paper
No.No.
24441.
24441.
December
December2019.
2019.
How
Howdoes
doesititdamage
damagehealth?
health?
Institutional
Institutionalracism
racismprofoundly
profoundlyshapes
shapesliving
livingconditions
conditions(including
(includingemployment,
employment,
systems
systemsreform,
reform,Black
Blackcommunities
communitieswillwill neighborhoods
neighborhoodsand andother
otherresources
resourcesthat
thatare
are housing
housingandandneighborhood
neighborhoodenvironment)
environment)which
whichare
arefoundational
foundationaltotohealth.
health.ItItalso
also
continue
continuetotohave
haveless
lessaccess
accesstotowell-paying
well-paying critical
criticalfor
forhealth
healthand
andwell-being.
well-being.
jobs,
jobs,quality
qualityhousing,
housing,healthy
healthyfood,
food,safe
safe limits
limitsaccess
accesstotokey
keyhealth
healthresources
resourcessuch
suchasasnutritious
nutritiousfood
foodandandquality
qualityclinical
clinicalcare.
care.

13
13 14
14
 F or many Americans, the term racism brings up the image of an individual,
such as “Bull” Connor, Birmingham, Alabama’s commissioner of public safety
who directed the use of police attack dogs against civil rights protestors,
including children, in 1963.

Or, more recently, Derek Chauvin, the officer opportunities, Black Americans experience
who pressed his knee against George Floyd’s worse outcomes than other groups at almost
neck for nearly nine long minutes until he every turn, from employment and housing to
died. education and the courts. The degradation of
these social determinants of health ultimately
By contrast, institutional racism is not tied to leads to the most tragic outcome of all for
a specific event or individual. Cloaked in Black residents of Rochester and the Finger
seemingly colorblind language or hidden Lakes region: sicker and shorter lives.
behind plausible denial, biased policies and
practices often exist below the radar of public Racism in the workplace
attention or understanding. Though not Employment plays a major role in access to
necessarily intentional, these policies and resources and well-being, so discrimination in
practices remain entrenched in industries and hiring and wages fundamentally undercuts
arenas decades after race-based the ability to lead a healthy life. A landmark
discrimination was outlawed, often ferreted study by Devah Pager at Northwestern
out only through research and undercover University found clear racial discrimination in
investigations. the hiring process for a wide variety of entry-
level positions. Black candidates with the
But the appalling consequences of same qualifications as White candidates were
institutional racism are anything but hidden. less than half as likely to get a callback for a
Faced with biased treatment and constrained follow-up interview.34 Even when Black workers find employment, Unfair housing
they are likely to face a major wage/benefits Housing is much more than just a roof over
gap. A 2017 report focused on Monroe one’s head. As Douglas Massey and Nancy
County found that Black full-time employees Denton explain in American Apartheid:
were paid roughly 15-20% lower wages than Segregation and the Making of the
Black employees are paid less regardless their White peers at every educational level.35 Underclass, where a family lives determines
of educational level “a variety of resources that shape and largely
Racial discrimination in the workplace results determine one’s life chances. Along with
Monroe County racial wage gap in large financial disparities for the Black housing, residential markets also allocate
community. Compared to the White schooling, peer groups, safety, jobs,
population in the Finger Lakes region, Black insurance cost, public services, home equity
residents face nearly triple the and, ultimately, wealth.”38
unemployment rate (14% vs 5%), lower
median income by half ($30,151 vs $60,919) The neighborhoods we live in were shaped by
and more than triple the poverty rate (34% housing policies that typically favored White
vs. 11%).36 These economic inequities homebuyers. New Deal programs like the GI
compromise health in many ways: limiting Bill and Federal Housing Administration loans
access to health-related resources like explicitly or effectively excluded Black
nutritious food and medical care because of participation, essentially subsidizing White
cost or transportation barriers; causing flight to the suburbs. Additionally, racially
chronic toxic stress rooted in the uncertainty restrictive covenants kept some
and overwhelming challenges of financial neighborhoods exclusively White for decades,
insecurity; and creating day-to-day further limiting housing options for Black
complexities and obstacles to taking care of residents.39
one’s self and family.37

New Deal programs like the GI Bill and Federal Housing Administration
Data compares the median earnings of White non-Hispanic and Black non-Hispanic populations.
loans explicitly or effectively excluded Black participation, essentially
For example, among people with bachelor’s degrees, Black workers are paid 87 cents for every dollar paid to White workers.
Source: Doucette, Luticha, and Henry Fitts. Wage Disparities in Monroe County by Race and Gender. City of Rochester Mayor’s Office of Innovation and Strategic
subsidizing White flight to the suburbs.
Initiatives. July 2017.

15 16
 Government policies enforced segregation and 1960s, they were met with a sophisticated, In the Finger Lakes region, a 2015 study by
disinvestment that persist today far-reaching, government-sponsored the Empire Justice Center found that Black
infrastructure dedicated solely to keeping homebuyers continue to be turned down for
them out of ‘respectable’ white mortgages at more than double the rate of
1935 map with neighborhoods redlined by 2017 map with racially and ethnically neighborhoods, both in the city and the White applicants. Even within upper-income
Federal Home Loan Bank Board concentrated areas of poverty suburbs.”42 Acknowledging this history of groups, the Black denial rate is nearly
racial discrimination is critical, because such double.47
policies created
and reinforced One result of
patterns of historic and
segregation that persistent
endure in discrimination is
Rochester and that Black
most other families are less
cities. likely to own a
home. Across
Indeed, a the Finger Lakes
comparison of region, 32% of
historical and Black
current maps of households own
the city of their home,
Rochester compared to
shows that the neighborhoods that were 74% of White households.48 As home
labeled as high risk (“redlined”) by the ownership is the primary pathway to wealth
federal Home Owner’s Loan Corporation in accumulation for poorer and middle-class
the 1930s are generally the same which are families, this inequity has huge implications
now considered to be Racially and Ethnically that are both immediate and
Concentrated Areas of Poverty.43 This intergenerational.
segregation is particularly pervasive in
Rochester, which has a higher degree of racial Additionally, the cumulative effect of decades
concentration than 94% of cities around the of housing discrimination has led to high
country, according to the Racial/Ethnic levels of segregation, with Black people
Segregation Score developed by the City heavily concentrated in disadvantaged
Health Dashboard.44 neighborhoods. Seventy-seven percent of our
region’s low-income Black households live in
Although explicitly racist policies and areas with high poverty levels, low
practices have educational
Source: Robert K. Nelson, et al. Mapping Inequality: Source: Analysis of Impediments to Fair Housing Choice. not been legal attainment, high
Redlining in New Deal America The City of Rochester. 2020. since the percentages of
passage of the single-parent
Fair Housing Act households, and
In their new report, Confronting Racial guidelines in the 1938 Federal Housing in 1968, other markers of
Covenants, the City Roots Community Land Administration’s Underwriting Manual research shows deprivation. By
Trust and the Yale Environmental Protection effectively mandated keeping neighborhoods clearly that racial discrimination persists in contrast, only 25% of low-income White
Clinic detail the history and lasting impact of segregated: “Areas surrounding a location housing markets. A three-year undercover households are located in the region’s most
racial covenants in Monroe County. The are investigated to determine whether investigation of real-estate agents published distressed areas. And racial segregation
researchers found many examples of deeds incompatible racial and social groups are by Newsday in 2019 found that Black house transcends income; nearly half (46%) of
and development agreements from the 1920s present, for the purpose of making a hunters were denied the same treatment as high-income Black households live in under-
to 1940s that explicitly prohibited Black prediction regarding the probability of the White clients 49% of the time.45 Realtors resourced neighborhoods.49
people from property ownership in the newly location being invaded by such groups. If a steered Black clients to particular
developing suburbs. For example, in 1939, neighborhood is to retain stability, it is neighborhoods, provided fewer house The underinvestment in these neighborhoods
when Monroe County sold a group of necessary that properties shall continue to be listings, and/or imposed more stringent creates a variety of health risks and barriers.
foreclosed properties near Irondequoit High occupied by the same social and racial scrutiny of their finances. While this study For example, poorly maintained apartments
School to a developer, the agreement classes.”41 was conducted on Long Island, the findings and houses in distressed neighborhoods can
required that all homes “be occupied by are consistent with a 2017 national survey expose residents to lead, mold, dust and
persons of the Caucasian race only.”40 A recent report in the Rochester Democrat that found almost half (45%) of Black adults other contaminants and allergens. Such
and Chronicle described the tragic results: have experienced discrimination when environmental toxins lead to higher incidence
These covenants were consistent with “As tens of thousands of black people arrived seeking a new apartment or buying a home.46 of diseases including lead poisoning and
national policies. For example, one of the in Rochester from the South in the 1950s and asthma among Black families, and especially

17 18
 Black households are heavily concentrated in disadvantaged high quality, academically motivating schools, In the Finger Lakes region, not only are Black
neighborhoods students are less likely to find the path people more than 5 times as likely to be
toward jobs that provide health insurance arrested as White people, but when arrested,
Percent of households in census tracts with high deprivation (ADI 9/10) and a living wage. People without adequate they are more than twice as likely to be given
Finger Lakes region financial means face a variety of obstacles to a prison sentence.53 To blame are a host of
staying healthy: the cost and accessibility of policies that unfairly target people of color,
healthy food; affordability of health care; and from racial profiling to harsher sentencing.
the chronic stress of living month-to-month For example, possession of crack cocaine for
while worried about housing, transportation many years carried penalties 100 times
and other bills. higher than possession of an equal amount of
the powdered form, which was more
Segregation in public schooling is a commonly used by White people.
particularly grievous side effect of housing
discrimination, because it undermines Beyond the physical and mental stress of
academic opportunities that are foundational incarceration, serving time complicates and
to each child’s future wealth and health. damages family and community relationships.
Once released, a prison record makes it much
Criminal (in)justice harder to find employment. A recent report
Over the last half century, our nation has by the Brennan Center for Justice found that
implemented policies leading to mass people who spent time in prison saw their
incarceration at a scale beyond all other annual earnings reduced by more than
countries. The United States has the most 50%.54 Through these social and economic
people in prison and the highest percentage pathways, a conviction can have long-lasting
of its population in prison.52 This impacts on health.
Source: Household counts by income and race/ethnicity of head of household from ACS 2017 5-year estimates (table B19001);
indiscriminate “tough-on-crime” approach
Area Deprivation Index data from University of Wisconsin School of Medicine Public Health 2015 Area Deprivation Index V2.0. has devastated the Black community because The damage to health extends beyond the
Age/sex-adjusted analysis by Common Ground Health of racial inequities at every level of the imprisoned individual, explains Precious
criminal justice system, from misdemeanor Bedell, a community health worker at the
children, who live in these areas. The authors has been illegal since the Brown v. Board of arrests made by law enforcement to life University of Rochester and founder of
of one study on lead toxicity called it “a Education Supreme Court decision in 1954, sentences issued by the courts. Turning Points, a program to support family
source of ecological inequity by race and a schooling for Black children remains largely members of incarcerated individuals. Tearing
pathway through which racial inequality separate and unequal.
literally gets into the body.”50
The 2020 national Fault Lines study by
Another stumbling block to living a healthy EdBuild found that the “single most
life in resource-deprived neighborhoods is the segregating school district border in the
lack of healthy foods. Many of these areas country divides New York’s Rochester City
are considered ‘food swamps’ because they School District, which has a poverty rate of
tend to be 47%, from
densely packed Penfield, whose
with corner poverty rate is
stores and just 5%.”51 The
fast-food high poverty
restaurants but rate creates two
have no or challenges for
limited the Rochester
convenient options for accessing fruits, schools: a large proportion of high-needs
vegetables, and other nutritious food at students and relatively low levels of funding
affordable prices. available from the local tax base. These
disparities result in a very large performance
No equality in education gap. RCSD had a graduation rate of only 63%
Discrimination in housing is the driving force in 2019, compared to 93% in Penfield. And
behind entrenched racial and economic because of racial segregation, the vast
segregation across Monroe County’s public majority of RCSD students are non-White
schools, depriving students of color of equal (90%), whereas the vast majority of Penfield
access to a more robust learning students are White (86%).
environment. Despite the historic strides of
the Civil Rights movement, segregation in These educational disparities lead to longer-
schools persists. Though explicit segregation term health disparities. Without access to

19 20
 families
families
apart
apart
cancanlead
lead
to emotional
to emotional
health
health accused
accused
of aofcrime.
a crime.ThisThis
persistent
persistent
problems
problemsandand
trigger
trigger
risky
risky
coping
coping
behaviors,
behaviors, undercurrent
undercurrent of fear
of fear
andand
anxiety
anxietywithin
within
thethe
sheshe
says.
says.
When
Whena family’s
a family’s
breadwinner
breadwinner
is is Black
Black
community,
community, likelike
other
other
toxic
toxic
stressors,
stressors,
hashasbeen
beenshown
shown
to undermine
to undermine
physical
physical
andandmental
mental
health.
health.

Communities
Communities of color
of color
areare
confronted
confronted with with
excess
excesspolicing
policing
— and
— and police
policebrutality
brutality— and
— and notnot
enough
enough psychiatrists
psychiatrists andandsocial
social
workers
workers to help
to help healheal
thethe
wounds
wounds
behind
behindbars,
bars,
dependents
dependents areare
alsoalso
deprived
deprivedof of of historical
of historicaltrauma,
trauma, sayssaysBedell.
Bedell.
financial
financial
support.
support.SaysSaysBedell,
Bedell,
“Incarceration
“Incarceration
locks
locks
individuals
individuals
andandfamilies
families
outout
of the
of the “George
“George Floyd’s
Floyd’sdeath
deathwas wasa lynching
a lynchingon on
thethe
American
American Dream.”
Dream.” cement
cement instead
instead of aoflynching
a lynching on on
a tree,”
a tree,”
sheshe
says.
says.
“Imagine
“Imagine what
whatwewe don’t
don’t
knowknowthat’s
that’s
notnot
Entire
Entire
Black
Black
communities
communities areare
locked
lockedoutout
as as caught
caughton on
camera.
camera. Now Nowthat that
people
peopleareare
well.
well.
Eroded
Eroded
trust
trust
in law
in law
enforcement
enforcement leads
leads coming
comingoutoutin droves,
in droves, so soangry,
angry,
there
there
is ais a
to constant
to constantconcern
concernabout
aboutbeing
being
stopped
stopped by by note note
of hope.
of hope. ButBut
wewe stillstill
havehave
a long
a long
way way
to to
thethe
police
police
without
without
cause
causeor being
or being
falsely
falsely go.”
go.”

What
Whatisisinterpersonal
interpersonalracism?
racism?
Interpersonal
Interpersonalracism
racism
occurs
occurs
between
betweenindividuals
individuals
duedue
to to
conscious
conscious or or
unconscious
unconscious
racial
racial
bias,
bias,
andand
takes
takes
thethe
form
form
of of
discriminating
discriminating
attitudes
attitudes
and
and
actions including
actions including
social
social
exclusion, unfair
exclusion, unfair
treatment
treatmentandand
threats
threats
or or
harassment.
harassment.
54 55
54 55

How
Howdoes
doesit itdamage
damagehealth?
health?
Interpersonal
Interpersonalracism
racismcancan
occur
occurin any
in any
setting
settingandand
cancan
therefore
thereforeundermine
underminehealth
health
in ainvariety
a variety
of of
direct
direct
ways
ways
(e.g.,
(e.g.,
implicit
implicit
biasbias
bybymedical
medical
providers
providers
cancan
lead
lead
to to
suboptimal
suboptimalclinical
clinical
care)
care)
andand
indirect
indirect
ways
ways(e.g.,
(e.g.,
disparate
disparate
treatment
treatment
byby
teachers
teachers
cancanundermine
undermine school
school
achievement,
achievement, which
whichis foundational
is foundationalto to
long-term
long-term
health,
health,
well-
well-
being
being
andand
socioeconomic
socioeconomic status).
status).
2121 2222
 I nterpersonal racism can be intentional and vicious, unintentional Tuskegee Study of Untreated Syphilis in the clinic; we were there doing exams for our
Negro Male, a 40-year government-run daughter. We knew they looked at my wife as
and subtle, or anywhere in between. experiment which withheld information and if she were a drug user, that they assumed
treatment from a group of poor Black men we’d created a [disabled] baby. I remember
“We wake up each day with these including the cardiovascular, metabolic and who had the disease. Scholars today see a my wife just started crying… I told her I
challenges,” says Jackie Dozier, program immune systems. Called “weathering,” the strong link between the public revelation of would never have her come back there again.
manager of community health and well-being physiological process is associated with a the study in 1972 and poor health outcomes The reality is that no matter how high I get
at Common Ground Health. “It is our life’s decline in cognitive and physical functioning, for Black men today.64 up on the ladder, I will always be Black.”
journey to walk through the microaggressions and an increase in all-cause mortality.60 61
and the macroaggressions every day.” “People are fearful because of some of the Norwood isn’t alone. A University of
Notably, researchers have specifically linked stigma attached Rochester
Microaggressions are brief yet common the anticipation and stress of everyday to history,” says survey of more
verbal or behavioral snubs that communicate interpersonal racism to high blood pressure62 Jackie Dozier. than 700 Black
hostile or negative messages, often targeting – which is a significant risk factor for heart “They begin not patients
someone who is culturally marginalized. disease, the number-one cause of premature to trust the revealed that
Macroaggressions are more explicit and mortality among our region’s Black health care system. It becomes a ‘Why 31% reported experiencing discrimination
represent a larger-scale form of oppression. population.63 bother? I know how they’re going to treat while receiving medical care.66
me.’ So they have a tendency not to go to
A 2015 Monroe County survey by the Dr. Sharitta Gross, an African American the doctor. They don’t feel it would matter.” That discrimination can be unintentional,
Rochester Area Community Foundation and educator at a local college, explained how coming from well-meaning physicians who
Democrat and Chronicle found that 37% of microaggresssion at work led to health National statistics show that 22% of Black may come to faulty conclusions about the
Black residents recalled being treated unfairly problems. Following the death of her adults avoid seeking health care for needs and preferences of people from
in the previous few months because of their grandmother, Dr. Gross was wracked with themselves or family members due to backgrounds and living situations very
race, ethnicity or some other personal sadness that the woman who raised her was anticipated discrimination.65 different from their own.
characteristic. The most common situations going to miss her wedding and she took two
for this weeks leave Common Ground Health CEO Wade Norwood Regardless, racial biases in the doctor’s office
discrimination from work to knows firsthand the pain and danger of can result in suboptimal care, which is
were: shopping recover. When experiencing racism in a clinical setting. “My another contributor to health inequities.
at a store she returned, wife’s second pregnancy resulted in the death
(51%); working her supervisor of one of our daughters and our surviving Implicit bias – often driven by unconscious
(50%); being at reprimanded twin was born with cerebral palsy. She assumptions about patients – combined with
a restaurant or her for taking required a great deal of medical intervention a lack of cultural understanding and empathy,
bar (37%); and dealing with police (36%).57 the time off and demanded that she in the early weeks of life... I have the can undermine any type of therapeutic
apologize to coworkers, who were also profound memory of being at a regional intervention. A 2003 study from the National
Whether inadvertent or premeditated, blatant judgmental.
or covert, discrimination — in all its forms —
can be toxic to physical and mental health. “I felt humiliated,” recalls Dr. Gross, who was
diagnosed with high blood pressure during
The daily indignities start young. Black this upsetting period. “All of it was culturally
adolescents average more than five racial insensitive, because I was raised by my
discrimination experiences per day.58 They maternal grandmother and as a Black
might come across a racist image online, woman, that’s not unusual. My grandmother
hear a joke about the negative treatment of was my mother.”
Black people, observe a store clerk giving
preferential treatment to a White customer, One of the challenges in understanding the
get looked at suspiciously, or be teased extent of racism is that it can be hard to see
because of their skin tone. This is just a when you’re not the person who experiences
sampling of typical exposures to racism which it repeatedly. “Racism is really hard to assess
have been associated with depressive until you feel it at the personal level and even
symptoms and poor mental health in then you’re not always sure if the bad
general.59 treatment you’re receiving is actually the
result of racism,” explains Lisa Goff, a retired
These persistent experiences of registered nurse and active community
discrimination can also degrade physical health advocate. “You just know you’re being
health. Research has found that coping with treated as an other. And you’ve been treated
the stress of everyday racism triggers as an other throughout your life.”
physiological responses that have a “wear
and tear” effect on the body and mind. Over Health care
time, this eroding process disrupts the The medical mistreatment of Black people
regulation of several systems in the body— has historical roots, most notoriously in the
23 24
 Academy
AcademyofofSciences
Sciencesfound
foundthat
thatBlack
Black outcomes
outcomesare area awell-studied
well-studiedissue,
issue,and andhashas
patients
patientsreceived
receivedfewerfewerprocedures
proceduresandand been
beenlinked
linkedtotoimplicit
implicitbias
biasononthe
thepartpartofof
lower-quality
lower-qualityclinical
clinicalcare
carethan
thanWhite
White teachers
teachersandandstaff.
staff.A A2018
2018United
UnitedStates
States
patients,
patients,and
andthisthiswas
wastrue
trueofofprocedures
procedures Government
GovernmentAccountability
AccountabilityOffice
Officereport
report
ranging
rangingfrom
fromcomplex
complexsurgeries
surgeriestotobasic
basic studied
studiedthese
thesedisparities
disparitiesandandfound
foundthey they
diagnostics.
diagnostics.67 67
surfaced
surfacedasasearly
earlyasaspre-school.
pre-school. InInthe
70 70
the
Rochester
RochesterCity CitySchool
SchoolDistrict,
District,out-of-school
out-of-school
Strikingly,
Strikingly,these
thesedifferences
differencespersisted
persistedeven
even suspension
suspensionratesratesfor
forBlack
Blackstudents
studentsare aremore
more
after
afteradjusting
adjustingforforvariations
variationsininhealth
health than
thandouble
doublethose
thosefor forWhite
Whitestudents.
students.That That
insurance,
insurance,socioeconomic
socioeconomicstatus,
status,stage
stageand
and disparity
disparityisiseven
evengreater
greaterininMonroe
MonroeCounty’s
County’s
severity
severityofofdisease,
disease,and
andother
otherfactors.
factors. suburban
suburbandistricts,
districts,where
whereBlack
Blackstudents
studentsare are
suspended
suspendedatatnearly
nearly4 4times
timesthetheraterateofofWhite
White
Since
Sincethat
thatcomprehensive
comprehensivestudy studywas was students.
students.71 71

published,
published,additional
additionalresearch
researchhas hascontinued
continued
totodocument
documentthe therole
roleofofracial
racialbias
biasand
and The
Theundermining
underminingeffects
effectsofofbiased
biasedtreatment
treatment
misconceptions
misconceptionsininhealth healthcarecaredisparities,
disparities, ininthe
theclassroom
classroomare arecompounded
compoundedfor formany
many
including
includingthe the2016
2016research
researcharticle
article“Racial
“Racial Black
Blackchildren
childrenbybythethedisadvantage
disadvantageofof
bias
biasininpain
painassessment
assessmentand andtreatment
treatment attending
attendingunder-resourced
under-resourcedschools.schools.Black
Black
recommendations,
recommendations,and andfalse
falsebeliefs
beliefsabout
about students
studentsare aremore
morelikely
likelytotoattend
attendschools
schools
biological
biologicaldifferences
differencesbetween
betweenblacks
blacksand
and with
withfewer
fewerresources
resourcesand andpoorer
pooreroutcomes
outcomes
whites.”
whites.” 68 68
because
becauseofofhousing
housingsegregation
segregationand andschool-
school-
funding
fundingpolicies
policieswhich
whichdisfavor
disfavorlower-income
lower-income
ToTocounteract
counteractimplicit
implicitbias,
bias,health
healthcare
care districts.
districts.The
Theresult
resultofofthese
theselayered
layeredburdens
burdens
providers
providersmustmustbebemore
moreaware
awareofof isislarge
largeand
andpersistent
persistentdisparities
disparitiesininacademic
academic
assumptions
assumptionsthey theymaymaymake,
make,according
accordingtotoDr. Dr. achievement.
achievement.InInour ourregion,
region,thethehigh-school
high-school
Candice
CandiceLucas,
Lucas,Chief
ChiefCommunity
CommunityEngagement
Engagement graduation
graduationrate ratefor
forBlack
Blackstudents
studentsisis71%,
71%,
Officer,
Officer,Monroe
MonroeCounty
Countyand andLead
LeadStaff
Stafffor
forthe
the compared
comparedtoto90% 90%for forWhite
Whitestudents.
students.72 72

Commission
CommissionononRacialRacialandandStructural
StructuralEquity.
Equity.
“This
“Thiscan
canrange
rangefrom
fromassuming
assumingthey
theyknow
knowif if ItItisisvery
verysad,
sad,butbutnotnotsurprising,
surprising,that thata a
a apatient
patientcan
canafford
afforda amedication
medicationtotowhether
whether survey
surveybybythe theUnited
UnitedNegro NegroCollege
CollegeFund Fund
the
thepatient
patienthashassupport
supportatathome.
home.TheThebest
best found
foundthatthatBlack
Blackstudents
students“are “areallalltoo
tooclear
clear
practice
practiceisistotoask
askandandprovide
providecare
carefrom
from about
aboutthe thebarriers
barriersthatthatimperil
imperiltheir
their
there.”
there.” educational
educationalaspirations.”
aspirations.” Beyond
73 73
Beyondthe the
widespread
widespreadconcernconcernabout aboutthe theaffordability
affordabilityofof
Schools
Schools college,
college,moremorethan
thana athirdthirdofofthetheBlack
Blackyouth
youth
Racial
Racialbias
biasfrom
fromteachers
teachersandandadministrators,
administrators, were
werespecifically
specificallyconcerned
concernedthat thattheir
their
even
evenwhen
whenunintentional,
unintentional,cancanundermine
undermine opportunities
opportunitieswere werelimited
limitedbybytheir theirrace.
race.
educational
educationalachievement
achievementofofBlack
Blackchildren.
children. Given
Giventhe thefoundational
foundationalrole roleofofeducation
educationinin
Given
Giventhe
theimportance
importanceofofeducation
educationtotolong-
long- determining
determiningone’s one’slife
lifepath,
path,the theundermining
undermining
term
termsocioeconomic
socioeconomicstatusstatusand
andaccess
accesstoto effects
effectsofofracism
racismininthe theschool
schoolenvironment
environment
resources,
resources,these
theseschool
schoolexperiences
experiencescan can have
havea aparticularly
particularlydevastating
devastatingand andlong-
long-
reduce
reducethethelikelihood
likelihoodofoflong-term
long-termgood
good lasting
lastingimpact
impactononthe theability
abilitytotolive
livea afulfilling,
fulfilling,
health
healthand
andwell-being.
well-being. healthy
healthyand andlong
longlife.
life.

Underestimated
Underestimatedpotential,
potential,reduced
reduced
encouragement
encouragementand andsupport,
support,and andharsher
harsher
disciplinary
disciplinaryactions
actionsare
aresome
someofofthe the What
Whatisisinternalized
internalizedracism?
racism?
consequences
consequencesofofracism racismininthetheschool
schoolsystem.
system.
A ARutgers
RutgersUniversity
Universitystudy
studyfound
foundthat
thatWhite
White Internalized
Internalizedracism
racismisisananindividual’s
individual’sconscious
consciousand andunconscious
unconsciousacceptance
acceptanceofof
teachers
teacherswere werethree
threetimes
timesmore
morenegative
negative negative
negativeattitudes,
attitudes,beliefs,
beliefs,ideologies
ideologiesand
andstereotypes about
stereotypes aboutthemselves,
themselves,their
their
with
withBlack
Blackstudents
studentsthanthanwith
withWhite
Whitestudents
students racial
racialgroup
groupand
andother
othergroups
groupsbased
basedon ona aracial
racialhierarchy.
hierarchy.7373
when
whenresponding
respondingtotobehavior,
behavior,emotions
emotionsand and
contributions.
contributions.For Forexample,
example,teacher
teacher
responses
responsestotobehavioral
behavioralissues
issueswere
weremore
more How
Howdoes
doesititdamage
damagehealth?
health?
likely
likelytotobebeintense
intenseback-and-forth
back-and-forthexchanges
exchanges
that
thattended
tendedtotoescalate
escalaterather
ratherthan
thansolve
solve Internalized
Internalizedracism
racismisisa achronic
chronictoxic
toxicstress,
stress,reinforced
reinforcedinineveryday
everydaylife,life,that
thaterodes
erodes
problems.
problems. 69 69
mental
mentaland
andphysical
physicalhealth.
health.ItItcan
canalso
alsogenerate
generatefeelings
feelingsofoflow
lowself-esteem
self-esteemand and
hopelessness,
hopelessness,which
whichincrease
increasethe thelikelihood
likelihoodofofunhealthy
unhealthycoping
copingmechanisms
mechanismsininbothboth
Racial
Racialdisparities
disparitiesininschool
schooldiscipline
discipline
the
thenear
nearterm
termand
andfar
farinto
intothe
thefuture.
future.
25
25 26
26
 properly? Do they understand me? So you try up, what they poured into me has kept me
to find your grounding. You try to find your afloat… I am happy and whole.”
tribe within some of those spaces to reassure
you and help validate what it is you already Internalized racism is exhausting. Even those
know.” who don’t self-doubt can have persistent
sensitivity to the way they’re being perceived
While that tribe can include individuals from in a race-conscious society.
any race, a research paper by the Ackerman
Institute for the Family concludes that a You can use replacement thoughts to
group of people exclusively of
African descent can provide an
optimally safe space for initial
stages of healing from
internalized racism.80

Dr. Clark’s parents — her father

was a physicist, her mother an
educator — provided her a safe space while counteract the influence of racism that
ceaselessly encouraging her and advocating surrounds you, says Smith, but replacement
for her rightful opportunities at school. thoughts only go so far. “If the things
happening outside you aren’t changing, then
“They could not overcome the world, but they it’s like you’re continuously riding a carousel,
kept me going, pushed me to achievement, hoping you’re going to see something
and [though deceased] continue to guide and different. You’re just going around and
undergird me today,” Dr. Clark explains of her around and around.”
parents. “Whereas self-doubts can still pop

R acism underlies so many parts of our society that it soon begins to inform
the self. The result is internalized racism — a form of personal oppression.

From W.E.B. Du Bois’ seminal book The Souls argument with one girl who said, ‘You think
of Black Folks: “It is a peculiar sensation, you’re so smart. What’s the matter — you
this double-consciousness, this sense of think you’re White?’ People would call me
always looking at one’s self through the eyes ‘ugly’ or ‘spook.’ Those things wear on you,
of others, of measuring one’s soul by the and early on you start to doubt whether
tape of a world that looks on in amused you’re pretty or likeable or smart. That’s
contempt and pity.” something that’s always with me.”

Internalized negative stereotypes

can engender lower self-esteem
and perceived potential, resulting
in reduced academic and
vocational achievement, both
foundational to long-term health
and well-being.75

And the combination of self-doubt

and stress undermine mental
health, which can lead to depression76 and
This double-consciousness is the powerful anxiety.77 These forces are also associated
phenomenon triggered by internalized racism with a higher risk of alcohol78 and substance
– eroding self-perception and creating toxic use.79
stress.
“It’s a very real thing that racism makes
Dr. Linda Clark, practicing physician, adjunct people of color sick,” says Chiara Smith,
assistant professor at the University of associate program officer at Greater
Rochester and chief medical officer at Rochester Health Foundation. “When I’m the
Common Ground Health, recalls of her high- only Black person in all-White spaces, I begin
school days: “I remember having an to question myself: Am I articulating
27 28
 I n the snowy early morning hours of March 23, 2020, Daniel Prude,
unarmed and in the throes of a psychotic episode, was handcuffed by
Rochester police and forcibly held face down until he stopped breathing.

“I can only imagine Daniel’s sense of Rochester and the Finger Lakes.82
confusion and helplessness during his last
moments,” Dr. David Paul, a Black That focus on mental health is well founded.
neurosurgeon at the University of Rochester Research shows strong connections between
and Prude’s cousin, wrote in a personal essay racial discrimination and poor mental health,
in the New England Journal of Medicine. including higher rates of depression, anxiety
and psychological stress, and lower levels of
“Naked, hooded, vomiting, breathless, he lay self-esteem and well-being.83
with his head pinned to the pavement under
a police officer’s weight. My cousin was Structural and institutional racism limits
someone’s brother, son, and nephew. He was access to food, housing and other essentials
known as a comedian who could light up a for many lower-income African Americans,
room with his jokes. And there he lay, creating an environment of constant stress
suffocating on that can be
Jefferson emotionally
Avenue.” 81 exhausting and
mentally
Six months debilitating. In
later, when our region,
video of the nearly 1 in 3
fatal arrest was Black residents
released by his making less
grieving family, than $25,000
Prude become a annually
national symbol of racial injustice and his reported poor or fair mental health.84
treatment provoked months of protests on
the streets of Rochester. Segregation and poverty also increase the
likelihood that Black individuals will face
Prude’s preventable death exemplifies the Adverse Childhood Experiences (ACEs),
lack of culturally appropriate mental-health potentially traumatic events that occur
responses for people of color and the tragic between birth and age 17. Examples of ACEs
consequences of such neglect. His 41 years include: experiencing violence, abuse or
of life were marred by a series of personal neglect; exposure to mental-health issues or
tragedies, including the premature deaths of substance abuse within the household; or
two brothers and his mother, and the suicide separation from a parent. The 2017 Monroe
of a nephew with whom he shared a home. County Youth Risk Behavior Survey found
that 29% of Black high-school students
Without support to manage his anguish, reported three or more ACEs, almost double
Prude’s behavior became increasingly erratic the 16% rate of White students. For children
and he struggled with drug addiction. The who experience ACEs, studies have shown a
night of his arrest, his brother worried he was link to long-term mental health, substance
hallucinating and a danger to himself and had use and chronic health problems.
him hospitalized for a psychiatric evaluation,
only to be released hours later. Coping with the dual stresses of racism and
poverty can have a particularly toxic effect on
Prude’s story illustrates why, when asked in mental health. However, the psychological
2018 to identify the biggest concern for their impacts of racism are not restricted to Black
own health and well-being, Black residents in families of limited means or those living in
our region were clear: mental health tops all under-resourced neighborhoods.
other worries. More than access to health
care, more than aging or weight, Regardless of income, education or
psychological wellness ranks as the number- professional standing, Black residents
one health concern for African Americans in regularly experience interpersonal racism in

29 30
 the form of outright discrimination and micro- and grief were reported at significantly higher wariness, she noted, is rooted in the well- have built long-term trusting relationships
aggressions, including everyday slights, rates by Black respondents than by White documented history of substandard care and with congregation members and clients, but
indignities and invalidations that express a respondents. unethical experimentation on communities of may need more training and resources to
prejudicial attitude, whether intentional or color, as well as present-day disparities in provide appropriate guidance.
not.85 Together, these subtle and not-so- This increased psychological burden is access to quality care. Unfortunately, unequal
subtle forms of unfair treatment can create reflected in hospitalizations related to care is not a relic of a bygone era: research In addition, Emotional Emancipation Circles
feelings of anxiety, depression, fear and behavioral health, including depression, has found that Black patients with depression and other grassroots healing methods can
hopelessness. anxiety and substance-use disorders. For or anxiety are less likely than White patients improve mental health and well-being, says
Black residents in our region, the rate for to receive the best available treatments.90 Funchess. Such community-driven support
As Dr. Clark put it: “Every day I wake up behavioral health inpatient visits has nearly groups can help Black people understand
Black, I’m tired.” doubled in the last 15 years, and the When Black residents do seek mental-health their experiences in the context of historical
disparity between Black people and White treatment, they may be stymied by a lack of and community forces and develop the skills
Steeped in a racist culture, many Black people has grown.88 culturally relevant support and may have to needed to counter these pressures and
individuals internalize racist attitudes, rely on White mental-health providers. nurture wellness.
absorbing Despite the Nationally, only 3% of health-service
negative higher psychologists identify as Black or African Without trusted and effective mental health
cultural prevalence and American for a population that is 12% support, Black people like Daniel Prude face
stereotypes, self-reported Black.91 increased risk of
which can erode concerns about developing
self-esteem and mental health, Funchess points unhealthy
discourage a Black residents out that the coping
person from are less likely to racial mismatch mechanisms.
seeking help. get needed can be For example,
Researchers professional frustrating 28% of Black
have found that internalized racism is help. Among the Black population that because gaps in residents
associated with depressive symptoms, reported they received the needed help for cultural identify as
psychological distress, substance use and their mental- or emotional-health issues, empathy create smokers, which
chronic physical-health problems.86 65% said their support came from barriers to is significantly
professionals, compared to 80% of Whites.89 building trust. higher than the
The cumulative toll of racism leads to With therapists from dissimilar backgrounds, 16% rate for White residents.93 Substance
significantly higher rates of poor or fair Melanie Funchess, CEO and President of patients may need to spend extra time use is a particular problem, as measured by
mental health among Black residents in Ubuntu Village Works, said the reasons for explaining culturally recognizable relationship Black rates of emergency department visits
Rochester and the Finger Lakes region than not seeking professional help are complex. In dynamics, reactions and language, which can for alcohol and drug use, which are more
their White counterparts, 22% vs 14%.87 addition to the stigma surrounding mental undermine both the genuine re-telling of than three times higher than White rates.94
Depression and anxiety are the most illness within the Black community, she these events and the overall relationship,
commonly cited mental- and emotional- pointed to the community’s widespread Funchess explained. For example, a patient Increasing Black representation among
health concerns. While less common, anger mistrust of the medical system. This may be afraid to discuss an argument mental health professionals, implementing
because of fear that a Black male partner training in culturally-responsive practice
could be inappropriately criminalized due to across the behavioral health system, and
The rate of behavioral health-related hospitalizations bias. Having to provide these explanations to building new channels for support are
for Black people has nearly doubled since 2000 create understanding is exhausting and an important steps to getting people the help
Behavioral health-related inpatient visit rate
unfair burden on the people seeking help. they need. But they don’t address the root
Finger Lakes region
“When you have providers who don’t have causes of mental health inequities: the many
the same background, it can make it more ways that racism undermines mental health
difficult because sometimes the critical for so many people.
connection that needs to happen with a
therapist doesn’t exist,” she said. “Fixing how we solve these issues is just part
of the problem,” said Funchess. “As long as
A lack of trusted, professional mental-health we have people living in the conditions they
providers forces many Black people to seek do, treated the way they are, Black people
aid elsewhere, from those they do trust – will continue to see their mental health
including friends, family and the church. More undermined.”
than a quarter of Black adults who got help
for mental health-issues turned to faith
leaders, highlighting an opportunity to bolster
faith- and service-based organizations in
their effort to provide better opportunities for
Rates are age/sex adjusted and shown per 1000,000 residents. Includes visits with primary or secondary behavioral health diagnosis.
psychological treatment.92 Ministers, barbers,
Source: NYSDOH SPARCS Inpatient Data; Analysis by Common Ground Health stylists and other community-based leaders

31 32
 While recovering after an emergency Beyond this large maternal mortality
C-section, Williams had trouble breathing. disparity, Black mothers also experience
Because of her history with pulmonary much higher rates of potentially life-
embolisms, she recognized the signs, alerted threatening delivery complications, including
a nurse and asked for appropriate treatment. hemorrhaging, sepsis and eclampsia. In the
No one listened. Instead, Williams endured a Finger Lakes region, these and other serious
different procedure before her medical team maternal illnesses are 50% more frequent
relented, tested and, as feared, found several among Black women compared to White
dangerous blood clots in her lungs. Williams women.99
ended up with other life-threatening
complications and spent her first six weeks of Local data paints a similarly grim picture for
motherhood bedridden.95 newborn health. The Black infant mortality

Black women and their newborns

face the highest rates of mortality
and major birth complications,
even after adjusting for
socioeconomic status,
highlighting the necessity and
urgency of addressing racism and its rate in Monroe County is more than 3 times
undermining effects on health. the rate for White infants (13.2 per 1,000 live
births vs. 4.2 for White).100 The largest cause
Nationally, Black women are more than 3 of infant mortality is premature birth, when a
times as likely to die in childbirth as White baby is born before 37 weeks of pregnancy.
women, a wider disparity today than a Premature birth is associated with a variety
century ago.96 97 of longer-term health problems that persist
through adulthood, including chronic disease,
Even when comparing mothers with the same disability and premature death.101 In our
pregnancy condition, Black women are 2 to 3 region, the premature birth rate is 77%
times more likely to die than White women.98 higher for Black mothers (11.3% vs 6.4% for

Childbirth is more dangerous for Black mothers and babies

Source (Severe Maternal Mortality): Finger Lakes region, 2009-2018; Analysis by Dr. Christopher Glantz at University of Rochester Medical Center
Source (Infant Mortality): NYSDOH Vital Records; Monroe County, 2013-2015; Analysis by the Monroe County Department of Public Health and Common Ground Health
Source (Pre-term birth): NYSDOH SPARCS Inpatient Data; Finger Lakes region (Oct 2015 - Dec 2016); Analysis by Common Ground Health

33 34
 White mothers).102 Knowing that Black maternal-health inequity Black babies are more likely to be born prematurely regardless of
is a major problem, the New York State socioeconomic level
No genetic or biologically predetermined Department of Health set up listening
reason accounts for these large disparities; sessions around the state to hear from Black Pre-term birth rates in Finger Lakes region
maternal health risk factors are the same for women about their birth experiences. A
White women and Black women. However, subsequent state report included descriptions
Black mothers and their infants of being misheard or ignored in the clinical
disproportionately suffer pregnancy and setting: “Nobody would answer you,” “I was
childbirth complications due to the layered never told why I was high-risk,” “Always see
effects of racism. a different doctor that doesn’t know me,” and
“Receptionist put single on the form,
Hypertension, a major risk for pre-term birth, automatic assumption because you’re
is much more common among Black women. Black.”108
A regional survey found that 48% of Black
women report having hypertension, a rate Medical providers should more consistently
85% higher than the rate for White women take the time to listen and respond to the
(26%).103 Such disparity is not
surprising given the chronic toxic
stress and physiological
weathering that comes with Pre-term birth rate calculated as % of single births delivered prior to 37 weeks gestation
Data is for single live births from Oct 2015 to Dec 2016 for Black non-Hispanic and White non-Hispanic mothers
racism.104 Layers of racism Source: NYSDOH SPARCS Inpatient Data; Analysis by Common Ground Health
undermine socioeconomic
opportunities as well, creating
additional stressors and limiting predominantly White, and exposure to these mothers with specially trained nurses who
access to healthy food and other resources concerns of their patients, which would help types of discrimination and stress can make at-home visits throughout the
that help prevent and manage hypertension. Black women advocate for themselves, says negatively affect birth outcomes. pregnancy and until the baby is 2 years of
Sherita Bullock, executive director of age. And the Healthy Baby Network’s Black
Poor mental health is another common Rochester’s Healthy Baby Network. “People As we take steps to illuminate and eliminate Doula Collaborative, comprised of Black
pregnancy risk factor, with Black women aren’t just dealing with pregnancy, they also racism, it is critical to promote programs that women, provides mental, physical and
being far more likely to rate their mental and are dealing with multiple layers of health and help Black mothers manage the elevated spiritual support during and after pregnancy.
emotional health as only fair or poor, other issues. When you have a fear of the risks they face while building trusting
compared to White women (24% vs. 14%).105 medical world, you carry this emotional relationships to ensure they’re connected to Says Bullock: “It’s important that when
A clear link exists between premature birth burden with you every time you go in,” she the right resources. Monroe County’s Nurse- women speak to us, we listen.”
rates and maternal depression, anxiety and says. Family Partnership matches first-time
perceived stress.106 A regional analysis
conducted by Common Ground Health found Frustrated with lack of access and the overall
that women diagnosed with depression or quality of care received, many new mothers
anxiety have a 41% higher likelihood of a simply elect out of necessary clinical care
pre-term delivery.107 entirely, sometimes leading to catastrophic
results for both mother and baby.
While Black women are more likely to need
clinical care and support, regional data show As Serena Williams’ experience illustrates,
they are less likely to get the help they need racism threatens maternal and infant health
to manage their risks and complications. across the socioeconomic spectrum, affecting
both poor Black women and high-income
A historic lack of trust in the medical system Black women alike. The premature birth rate
poses one of the greatest barriers to prenatal for Black mothers living in areas with the
care. Even when physicians have the best of highest socioeconomic status (10.3%) is
intentions, implicit bias and a lack of deep much higher than the rate for White mothers
sensitivity to the issues Black women face living in areas with the lowest socioeconomic
can interfere with a provider’s ability to make status (7.6%).109
meaningful connections with expectant
mothers. Their assumptions are frequently An additional toll of racism, which blends
rooted in cultural stereotypes, without an personal experience with chronic worry, may
understanding that their patients’ deep- help explain why large disparities continue to
seated skepticism should be taken seriously, exist at higher-income levels.110 Black women
particularly since that skepticism adds to at the higher socioeconomic levels may have
stress — in itself a pregnancy risk factor. more exposure to racism in educational, work
and social environments that are

35 36
 “To eat healthy, you have to go broke,” survey, Black adults in Rochester and the
concludes the northeast Rochester resident. Finger Lakes region are significantly more
“There’s a lot of poverty in this neighborhood, likely to say that a healthy diet is very
and we can’t afford it.” important to them — 66% vs. 52% for White
adults. Despite this greater interest in eating
Copeland aims for good nutrition anyway. His well, Black people are less likely to be able to
entire family had no choice but to make reach that goal. Only 31% report good or
dietary changes after his wife’s heart attack excellent eating habits, compared to 43% for
several years ago. He explains: “We cut down White people.111
the salts. We went from white bread to wheat
bread. Even the crackers, everything wheat. The large gap between the Black
From butter to margarine. We went to a more community’s desire to eat healthy and the
heart-healthy diet not only for her, but for all ability to eat healthy is due to several
of us.” obstacles — with cost, as in Copeland’s case,
being the number-one complication,
While beneficial, these dietary improvements according to the survey. Other top challenges
have been extremely challenging to maintain. include lack of time, transportation and
Aside from budgetary concerns, convenient nearby grocery stores.
access to nutritious food presents another
hurdle. Because Copeland’s family doesn’t Food insecurity — being without reliable
have a car, grocery store visits require hiring access to affordable, nutritious food — is a
a taxi, making each trip more complicated, major public-health concern. The My Health
time-consuming and expensive. Story survey showed that nearly 1 in 5
(19%) Black adults were “always stressed
Copeland’s challenges are common. about having enough money to afford healthy
According to the 2018 My Health Story food” compared to 11% of White adults. The

Barriers prevent many Black people from meeting their

healthy eating goals
Self-reported survey responses Finger Lakes region

Source: My Health Survey 2018. Analysis of Finger Lakes nine county region by Common Ground HealthAge/Sex-adjusted

37 38
 percentage is even higher, at 24%, among Racial-dietary inequities are more than a
Black adults with children in the household. matter of income, however. More than 1 in 4 At every income level, Black families are more likely to live in
Black residents with annual incomes above disadvantaged neighborhoods that lack convenient access to healthy food.
A healthy diet is a key ingredient for long- $50,000 report their eating habits to be “poor
term health. Barriers to accessing nutritious or fair,” which is twice the rate of White
food contribute to racial disparities in chronic residents in the same income range.117
is about how to put this into practice for amount that could be increased.120
conditions and premature mortality. Black
someone living in poverty,” says Eaton. Opportunities also abound to encourage and
residents in our region face higher rates of One culprit is residential segregation, which
facilitate the opening of grocery stores in
obesity (47% v 34% for White residents),112 limits housing and neighborhood choice for
Additionally, policies can make healthy food underserved areas.
diabetes (18% vs. 12%)113 and uncontrolled Black families, regardless of income. At every
more accessible and affordable. The federal
hypertension (12% vs. 6%).114 Each of these income level, Black families are more likely to
government directs less than 1% of farm The right steps by local, state and federal
chronic conditions is a risk factor for heart live in disadvantaged neighborhoods that lack
subsidies toward research, production and policymakers can increase access to healthy
disease, which is the leading cause of early convenient access to healthy food. In the
marketing of fruits and vegetables — an food in poorer neighborhoods and schools.
death in our Black community.115 For children, Finger Lakes region, nearly half of Black
food insecurity often leads to delays in households with incomes of $75,000 or more
cognitive, emotional and physical live in resource-deprived ZIP codes.118 Many
development.116 of these neighborhoods are awash in fast-
food restaurants and convenience stores but
While socioeconomically related obstacles to lack grocery stores and markets, making
eating healthy are not unique to the Black unhealthy eating the easy choice.
population, they are more common because
of racism’s impact on economic opportunity Not only are Black families more likely to be The racial disparity in eating habits is larger at higher
and the surrounded by income levels
concentration of food outlets
Black individuals with less
at lower income nutritious Percent of adults reporting poor/fair eating habits
levels. The offerings, they
challenges and are also more
constraints of likely to be
living with bombarded with
limited means ads for fast-food
present more restaurants, soft
barriers to drinks, candy
accessing and and other
preparing snacks. A
nutritious systematic
meals, and makes it much harder to maintain study of food-related advertising found that
the focus and energy necessary to “companies almost exclusively target
consistently overcome those barriers. Hispanic and Black consumers with
advertising for their least nutritious products,
Eating healthy is rarely seen as an urgent led by fast food, candy, sugary drinks and
priority when more pressing challenges take unhealthy snack brands.” 119 Such pervasive
center stage, says Calvin Eaton, a community marketing can set up young people for poor
educator and the founder of 540WMain, a eating habits that can last a lifetime.
Rochester-based nonprofit focused on
antiracism and equity. Unpredictable work While our region’s Black population likely will
schedules, the demands of caregiving for continue to face significant barriers to eating Source: My Health Story Survey 2018. Analysis of Finger Lakes nine county region by Common Ground Health

children and other family members, and healthy as long as they face the
other everyday demands make it “tough to socioeconomic impacts of racial
make anything a routine,” says Eaton. discrimination, meaningful interventions can
mitigate the problem.
“When you don’t have a car, you need to plan
grocery trips, but then something else comes Educational programming, for example, can
up that throws the whole thing off — and help people learn how to prepare healthy
then you don’t have healthy food for that meals that are affordable on a limited
week. But you still need to eat and it’s easy budget, well suited to dietary restrictions,
to make a quick run down the street to and culturally appealing. 540W Main offers
McDonald’s,” he says. classes with a combination of budgeting,
planning and cooking advice. “The education

39 40
 healthy lives at almost every turn. As addressing the many ways that racism
research has made clear, layers of undermines the economic, socioemotional
discrimination undermine living conditions and physical well-being of Black people in our
and resources that are foundational to community.123
health. Bias in housing, education,
employment, criminal justice and other Additional efforts that specifically address
domains are behind higher rates for pre-term inequities in the clinical care system are also
births, chronic disease and depression. needed. It is critical to apply an antiracist
Behind higher rates of homicide and lens when developing and evaluating health-
substance abuse. And behind deplorably improvement interventions. And increasing
higher rates of infection and deaths from the number of Black doctors and other health
COVID-19. care professionals is essential to ensuring
that the needs of Black patients are heard,
Such tragic outcomes are unacceptable and understood and addressed.
are undeniable proof that our institutional
norms, intentionally or not, create and Finally, we can all take steps to support racial
perpetuate racist results. As Donald Berwick, equity in our everyday actions and
one of the nation’s foremost experts on conversations. Systemic change will be driven
health improvement put it, “Every system is by individuals with the courage to speak up
perfectly designed to achieve the results it for, and act on behalf of, what is right.
achieves.”121

Working harder within broken

systems or simply acknowledging
racism on a personal level is a
path to failure. Real and lasting
improvement depends on a
commitment to redesigning the
institutions that structure our
society to ensure that policies
and programs produce fair and equitable
outcomes regardless of race. National and local conversations on racial
injustice are gaining momentum, moving the
The calls to action within this report are focus from symptoms to solutions —
wide-ranging and aimed at institutional especially at structural and institutional
change. As Ibram Kendi, author of How to Be levels, where large-scale and lasting changes
an Antiracist reminds us, “Racial inequity is a have the best chance of success.
problem of bad policy, not bad people.” The
same principle holds true for life experiences “It’ll be documented, who was doing what at
within the Black community. “Individual this period…,” reminds National Medical
behaviors can shape the success of Association President Dr. Oliver Brooks. “This
individuals. But policies determine the is a turning point.”124
success of groups,” Kendi writes.122 Imagining
and building better policies in housing, A crisis is a terrible thing to waste. We are
education, lending, criminal justice and other being handed an opportunity to support
areas begins with the refusal to accept the equality like never before. We do not seek a

G eorge Floyd’s words have been a haunting refrain throughout this season of
racial reckoning, a visceral reminder of the crushing weight of injustice that
persists for Black people.
status quo and a commitment to change.

Some of the important actions we can take

are supporting the objectives and
return to normal; we aim to build something
better. If we rise to this occasion, our region
will enjoy a brighter, more just future.

recommendations of local initiatives focused

on eliminating systemic racism. In its final
“Please — I can’t breathe.” breathing room for families already living
report, the Commission on Racial and
paycheck to paycheck, families that are
Structural Equity (RASE) provides a deeper
Those same words are an equally apt disproportionately Black.
assessment of many of the inequities
reminder of the COVID-19 pandemic that has
highlighted in this report. And the RASE
stolen the breath from communities of color Woven into the fabric of American society,
Commission puts forth five broad solutions,
at an alarming rate and of the echo pandemic even if less explicit than in years past and
each with numerous specific actionable
of unemployment, food insecurity, eviction sometimes unintentional, racism is thwarting
recommendations that are critical steps to
threat and stress that has left little financial the ability of Black people to lead long and
41 42
 What can we do?

43 44
 Notes Sources operative System data. Age-sex adjusted analysis 30 Massey, Douglas, and Nancy Denton. Ameri-
* Years of Potential Life Lost (YPLL) is a widely 1 Craig, Gary. “Alvin Simmons’ life was turning by Common Ground Health. can Apartheid: Segregation and the Making of the
used measure to assess the rate of premature around. Then COVID-19 took it.” Rochester Demo- Underclass. Harvard University Press. 1993.
16 My Health Story Survey 2018. Analysis by
mortality. YPLL places a larger weight on crat & Chronicle, 9 Apr. 2020.
Common Ground Health 31 Klain, Hannah, et al. “Waiting to Vote: Racial
the deaths of younger people, in contrast 2 The COVID Racial Data Tracker. The Atlantic Disparities in Election Day Experiences.” Brennan
with overall mortality statistics which are 17 Galarneau, Charlene. “Getting King’s Words Center for Justice. 3 June 2020.
Monthly Group. covidtracking.com/race. Accessed
dominated by deaths of the elderly. The YPLL Right.” Journal of Health Care for the Poor and Un-
9 Nov 2020.
derserved, vol. 29 no. 1, 2018, p. 5-8. 32 “Voting Rights Restoration Efforts in New York.”
rates in Common Ground Health’s analyses
3 Monroe County COVID-19 Surveillance data as Brennan Center for Justice. 8 Oct. 2019.
are derived using 75 years of age as the 18 White, Kellee. “The Sustaining Relevance of
of October 21, 2020. Rochester Emerging Infec-
baseline. Therefore, a death at age 65 has a W.E.B. Du Bois to Health Disparities Research.” Du 33 “Levels of Racism.” Multicultural Resource Cen-
tions Program. Center for Community Health &
YPLL of 10, whereas a death at age 35 has a Bois Review: Social Science Research on Race, vol. ter. www.multiculturalresourcecenter.org/s/Level-
Prevention, University of Rochester Medical Center.
YPLL of 40. Rates are calculated per 100,000 8, no. 1, 2011, pp. 285–293. sofRacismFINAL-1.pdf
Rates are age-adjusted.
population, and are age- and sex-adjusted 19 Fine, Michael J, et al. “The role of race and 34 Pager, Devah. “The Mark of a Criminal Record.”
to account for differences in population 4 Keshavan, Meghana. “The Direct Result of Rac-
genetics in health disparities research.” American American Journal of Sociology, Vol. 108, No. 5,
distribution. ism: Covid-19 Lays Bare How Discrimination Drives
Journal of Public Health, vol. 95, no. 12, 2005, pp. March 2003.
Health Disparities Among Black People.” STAT, 9
2125-2128.
Jun 2020. 35 Doucette, Luticha, and Henry Fitts. Wage
† The Socioeconomic Status (SES) index
20 Paradies Yin, et al. “Racism as a Determinant Disparities in Monroe County by Race and Gender.
ranking was developed by Common Ground 5 Bonilla-Silva, Eduardo. Citatis. citatis.com/
of Health: A Systematic Review and Meta-Analy- City of Rochester Mayor’s Office of Innovation and
Health and calculated using a variety of a35970/1741c7/
sis.” PLoS ONE, vol. 10, no. 9, 23 Sep. 2015. Strategic Initiatives. July 2017.
socioeconomic indicators from the American
6 Report of the National Advisory Commission On
Community Survey, including average income, Civil Disorders. Kerner Commission: U.S. G.P.O.,
21 Williams, David, et al. “Racism and Health: 36 US Census Bureau; 2018 American Community
poverty rates, education levels, housing Evidence and Needed Research.” Annual Review of Survey 5-Year Estimates, Tables S2301, S1903 and
1968.
value and homeownership. Each ZIP code is Public Health, vol. 40, 2019, pp. 105-125. S1701. Analysis by Common Ground Health.
assigned an SES index ranking from 1 to 5. 7 No Time for Excuses: It’s Time for Action. Pre-
22 Paradies Yin, et al. “Racism as a Determinant 37 Overloaded: The Heavy Toll of Poverty on Our
The lower SES ZIP codes tend to have lower pared for the Commission on Racial and Structural
of Health: A Systematic Review and Meta-Analy- Region’s Health. Common Ground Health. Nov.
average income, higher poverty rates, lower Equity by the Center for Governmental Research,
sis.” PLoS ONE, vol. 10, no. 9, 23 Sep. 2015. 2019
2021.
prevalence of college degrees, etc.
23 Williams, David, et al. “Racism and Health: 38 Massey, Douglas, and Nancy Denton. Ameri-
8 Premature mortality measured in years of po-
Evidence and Needed Research.” Annual Review of can Apartheid: Segregation and the Making of the
‡ A Racial Equity Impact Assessment (REIA) tential life lost. NYSDOH Vital Statistics for Finger
Public Health, vol. 40, 2019, pp. 105-125. Underclass. Harvard University Press. 1993.
is a systematic examination of how different Lakes nine-county region. 2015-2017. Age-sex
racial and ethnic groups will likely be affected adjusted analysis by Common Ground Health. 24 “Levels of Racism.” Multicultural Resource Cen- 39 Rothstein, Richard. The Color of Law: A Forgot-
by a proposed action or decision. REIAs are 9 Premature mortality measured in years of po-
ter. www.multiculturalresourcecenter.org/s/Level- ten History of How Our Government Segregated
used to minimize unanticipated adverse sofRacismFINAL-1.pdf America. Liveright Publishing. 2017.
tential life lost. NYSDOH Vital Statistics for Finger
consequences in a variety of contexts, Lakes nine-county region. 2015-2017. Age-sex 25 Geronimus Arline, et al. “‘Weathering’ and Age 40 Confronting Racial Covenants: How They
including the analysis of proposed policies, adjusted analysis by Common Ground Health. Patterns of Allostatic Load Scores Among Blacks Segregated Monroe County and What to Do About
institutional practices, programs, plans and and Whites in the United States.” American Journal Them. City Roots Community Land Trust and the
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of Public Health, vol. 96, May 2006, pp. 826-833. Yale Environment Protection Clinic. 2020.
tential life lost. NYSDOH Vital Statistics for Finger
tool for preventing institutional racism and
Lakes nine-county region. 2015-2017. Age-sex 26 Racial Equity Tools. www.racialequitytools.org/ 41 Underwriting Manual: Underwriting and Valua-
for identifying new options to remedy long- adjusted analysis by Common Ground Health resources/fundamentals/core-concepts/structur- tion Procedure Under Title II of the National Hous-
standing inequities. For more information, go
al-racism ing Act. Federal Housing Administration. 1938,
to: www.raceforward.org/practice/tools/racial- 11 Premature mortality measured in years of po-
section 937.
equity-impact-assessment-toolkit tential life lost. NYSDOH Vital Statistics for Finger 27 “11 Terms You Should Know to Better Under-
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15 NYSDOH Statewide Planning and Research Co-

45 46
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104 Brondolo, Elizabeth, et al. “Racism and Hy- mates, Table B19001. Analysis by Common Ground St. John Fisher College Common Ground Health Common Ground Health Exercise Express

pertension: A Review of the Empirical Evidence Health. Area Deprivation Index data from Univer- Sebrone Johnson Vice Chair Dionne Dempster Kelvin Johnson Solome Rose
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Melanie Funchess University of Rochester
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cial Discrimination: A Missing Piece of the Puzzle

49 50
 About Common
About Common Ground
GroundHealth
Health
Founded in
Founded in 1974,
1974, Common
Common Ground
Ground Health
Health is
is the
the
health research and planning organization for the
health planning organization for the nine-county
nine Finger Lakes counties of Chemung, Livingston,
Finger Lakes region. We bring together health care,
Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne
education, business, government and other sectors
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