Over the last two months, at least 14 city councils across California have declared racism a public health crisis, including Los Angeles and Riverside. 

The Orange County Register spoke with Dr. Ravi Kavasery, who said he sees racism each day as a doctor working to save people with a number of ailments. One of the biggest problems he has to deal with is directly related to rules passed by the Trump administration that make seeking medical help dangerous for immigrants. 

The "public charge" rule penalizes immigrants seeking green cards if they try to access government services, like health care, and potentially damages their chances at citizenship or legal status. 

“The very first thing I see is patients who are scared to seek medical care because of policies such as the ‘public charge’ rule,” Kavasery told the newspaper.

“The public charge rule actively discourages immigrants and people of color from seeking medical care. It’s an excellent example that shows the link between systemic racism and public health. You see unequal access and health outcomes,” he added. 

On June 23, San Bernardino County was the first county in the state to declare racism a public health crisis, according to The San Bernardino Sun.

County Supervisor Josie Gonzales told The OC Register that it was a necessary first step in addressing the state's inequality. 

“This was our ‘a-ha’ moment. The need for this declaration has been there for a very long time. But, in government, you need to build consensus and, many times, you wait for the right people to get in office. We had four other supervisors who were not afraid to support this resolution," Gonzales said.

"This needed to be said aloud,” she added. 

In June, Gov. Tony Evers made Wisconsin the first state to issue a universal declaration.

“We must fix what we know is broken in our society,” Evers said during a press conference according to PBS Wisconsin.

“We cannot look away from the reality that inaction, indifference and institutional racism has harmed generations of Black and brown Wisconsinites. We have an opportunity now to fix some wrongs that have been longstanding for decades,” he added.

Paula Tran Inzeo spoke to The OC Register about the state's decision earlier this week. As director of Mobilizing Action Toward Community Health with the Population Health Institute at the University of Wisconsin, Madison, Inzeo helped lead the effort to push the state to make the declaration.

“The city and the state as well as several community organizations have talked about racism for a long time. We have among the worst infant mortality gap that is driven by race. So mobilizing and naming racism as a problem was a very important step,” Inzeo said. 

“Racism has an impact on access to social determinants such as food, housing, jobs and education. Therefore, people have poor health outcomes with regard to immune function, chronic stress loads and chronic diseases. The toxic stress they experience due to racism and discrimination puts their bodies in a constant state of fighting. The get sick sooner and stay sick longer,” Inzeo noted. 

The city of Denver made the declaration on June 8, and the state began making plans to join the movement shortly after. According to The Denver Post, officials within the Colorado Department of Public Health and Environment were frustrated that Executive Director Jill Hunsaker Ryan spent weeks refusing to declare racism a public health crisis.

Ryan was open with the newspaper about her staff's concerns and said she has a few concrete goals with the declaration, which include diversifying the overwhelmingly white workforce of the department, providing more opportunities for community organizations to help people of color and hiring an equity and inclusion officer.

“I would hope that everyone that works at CDPHE would recognize that systemic racism impacts our work and has for longer than the past month,” an unnamed employee of color told The Post. 

Just one county in Georgia, DeKalb County, has taken the step of declaring racism a public health crisis. The county, which includes parts of Atlanta and Decatur, made the declaration on July 14.

The resolution includes the desire for more concrete measures to be laid out at a later date, according to the Atlanta Journal-Constitution. 

In July 2019, Chicago's Cook County took the step of making the declaration. Earlier this year, more than 35 hospitals came together to release a statement outlining how racism has affected their work in dealing with the coronavirus pandemic. 

"Systemic racism is a real threat to the health of our patients, families and communities. We stand with all of those who have raised their voices to capture the attention of Chicago and the nation with a clear call for action," the statement read. 

"The health centers and hospitals we represent are deeply woven into the fabric of the communities we serve, live and work in, and we stand united as frontline staff against racism, injustice and inaction," the statement added.

The hospitals committed to increasing bias training, pushing efforts to improve equity in health care, addressing systemic healthcare issues and more. 

According to the American Public Health Association, nearly 10 town councils in Connecticut made the declaration throughout June and July. These counties include Bloomfield, Hamden, Manchester and New Haven. 

“Many of us are victims of racism, therefore we experience the stresses, the income disparities, the discrimination. There’s anxiety that’s tied to that, there’s depression that’s tied to that. And there’s so many other medical complications that ethnic minorities experience … because of segregation and racism,” New Haven Alderman Darryl Brackeen Jr. told local news outlet WNPR.

The measures include efforts to diversify town leadership, improve the collection of data and increase opportunities for people of color. 

Since June, just two city councils in the state — Indianapolis City-County Council and the Common Council of Evansville — have passed resolutions declaring racism as a public health crisis.

Like most states, the move was spurred by the high percentage of Black people who have become infected and died from COVID-19, according to the Indianapolis Star. 

"This is a first great step, but it is a beginning. And I'm looking forward to the city council to come back with some concrete recommendations that can really help address this issue. Not just the symptoms, but how do we get to it systemically," said Virginia Caine, director and chief medical officer of the Marion County Public Health Department. 

However, Indianapolis community leaders criticized the resolution as an empty gesture that did little to address issues plaguing Black people. 

Boston and eight other towns across the state made the declarations in June.

"In Boston, we embrace the opportunity this moment and this movement offers us. We stand with our Black community and communities of color to lead the change toward a more just and equitable society," said Boston Mayor Martin Walsh in a statement.

"With these actions, we will increase equity in public safety and public health, and launch a conversation that can produce lasting, systemic change to eliminate all the ways that racism and inequality harm our residents," Walsh said.

The Massachusetts Black and Latino Legislative Caucus created a "10 Point Plan" outlining a series of reforms at the federal, state and municipal levels that address the core issues related to racism. 

Walsh has already committed to reallocating some of the city's police budget to other places and has made a number of budget decisions to begin addressing racism in the city. 

"Racism is a driving force that shapes access to the social determinants of health and is a barrier to health equity for all Bostonians. This declaration will bring this work into greater focus with real, intentional efforts to get to the root causes and see measurable solutions," said Marty Martinez, Boston's chief of health and human services.

One county in Maryland has taken steps to match what other states have done while another health department within the state has agreed to look into the issue. 

The Montgomery County Council passed a resolution about the issue, and the Anne Arundel County Health Department created a three-person office to look into how racism affects health care. 

County Executive Steuart Pittman decided in 2019 that the county would treat racism as a public health problem.

“It's a long-term effort. We don't expect to have a big rally and then have everybody say ‘Kumbaya,’ and have it be over. I believe we have a problem — the rising number of incidents suggests that we do. And I hope that enough people believe we have a problem that they are willing to help solve it,” Pittman said according to the Capital Gazette. 

Two counties and a city in Minnesota have joined the movement: Hennepin County, Olmsted County and Minneapolis. 

Minneapolis became the epicenter for protests after the killing of George Floyd.

"Systemic racism is among the greatest long-term threats our city and nation are facing, and the last two months have made that reality painfully clear. For Minneapolis to be a place where everyone can live and thrive, we must recognize this crisis for what it is and approach policymaking with the urgency it deserves," Mayor Jacob Frey said in July.

The Minneapolis City Council committed to addressing racism in the criminal justice system and other places where systemic inequality was rampant. 

On Tuesday, the Olmsted County Board of Commissioners passed a resolution that declared racism is a public health crisis as well. 

Kansas City remains the only city in the state to pass a resolution similar to the others seen countrywide since it did so in August 2019. 

“I’ve worked in the public health space for 11 years, and those that work in that space, we know that race is a huge factor as it relates to (early death among minorities). The data is clear,” said Councilwoman Melissa Robinson according to the Kansas City Star. 

Robinson worked with the Kansas City Health Department to create the measure.

The resolution focuses exclusively on health care and seeks to address systemic disparities in the lifespan and quality of care Black people receive. 

The Star noted that data shows a Black man living in urban Kansas City has a life expectancy that is 20 years shorter than that of a white woman in the city.

In June, councils in Charlotte and Mecklenburg County became the only ones in North Carolina to pass resolutions addressing racism as a public health concern. District 4 Commissioner Mark Jerrell told Spectrum News that the resolutions will provide a framework for how the county can start to address racial disparities. 

.@MeckCounty BOCC unanimously approved a proclamation declaring racism a public health crisis. Commissioner Mark Jerrell introduced the proclamation. pic.twitter.com/YkMHlDoPUX

— Estephany Escobar (@EstephanyNews) June 16, 2020

“The proclamation sends a signal to the community to let them know that we understand the impact that racism has had on certain segments of the population. It lets them know that we are committed to changing outcomes. It lets them know we understand people need greater access to health care,” Jerrell said.

“It allows us to leverage this document as a backdrop for policy and funding and really address and level the playing field,” Jerrell added.

Ohio has 17 city councils or counties that declared racism a public health issue between May and July.  

“If we are going to say that this is a public health issue and that we are taking this serious, then I’m holding people accountable. Because my work depends on saving the lives of Black babies every day," said Christin Farmer, a nonprofit worker who spoke to Ideastream about Cleveland's resolution. 

The state Legislature is mulling a resolution as well, but it has stalled for months. 

Reporters for Ideastream said city council members in a number of cities called the resolutions a starting point to larger efforts to address systemic racism, particularly in health care. 

Cleveland City Council member Basheer Jones said talks have included a variety of potential efforts.

“Whether it’s hospitals, whether it’s banks, whether it’s whatever it is, we want to see something tangible happen. We want to see something tangible happen to show us that you truly believe that these practices have had an impact," Jones said.

Pittsburgh pushed a resolution through in December, and Allegheny County put forward a motion to do the same in May. 

According to the Pittsburgh Post-Gazette, the city commissioned a report which contained startling findings highlighting large disparities in health care and economic stability.

The racial disparities in health care and income forced city council members to take action. 

“This is not just a Black issue; this is a humanity issue as we heard in the many statements that came before [the meeting]. … I appreciate the confidence and the recognition that this is important work that needs to be done throughout the county,” said Councilwoman Olivia Bennett.

The measure passed in Pittsburgh is a resolution, meaning it is not legally binding.

The city council in Memphis is the only one in the state that has passed a resolution about racism. 

"Today, many decades after the passage of the Civil Rights Act, Black Americans continue to endure unfair treatment and violence resulting from police brutality with the death of George Floyd and countless other Black men and women illustrating that Black Americans are treated as second-class citizens by certain segments of the population," the resolution stated. 

Shelby County, where Memphis is located, also passed similar resolutions and committed to addressing racial issues, particularly in relation to health care. Shelby County Director of Health Alisa Haushalter called racism "a pandemic in our country.”

“We in public health have always since the origins of public health in our country focused on the root causes of health and poor health, and what we know is that there are many systemic issues in our country that continue to impact communities of color that result in poor health outcomes, poor economic outcomes and poor education outcomes," Haushalter told Commercial Appeal.

"As a result of that, it’s time that we declare racism as a pandemic. That allows us to really address it from a more comprehensive perspective,” Haushalter added. 

Dallas County has been the only place to make the declaration in Texas. The resolution, which passed on June 16, includes 10 points that call for equity programs, bias training, healthcare initiatives and other efforts to address racism holistically, reports NBC DFW. 

"We already know that there is an unspoken, spoken divide when it comes to the city in terms of north and south. These are things people have known for a long time, and they have not just happened. They were designed and very intentional. To acknowledge that racism is a public health crisis is the right thing to do because it is," Jerry Hawkins, executive director of Racial Healing & Transformation, told WFAA.

Burlington took similar steps on July 16 when Mayor Miro Weinberger and a number of healthcare groups made the declaration.

“Racism is a public health crisis. As a result of deeply embedded structural racism, Black and brown Americans experience far worse outcomes than their white contemporaries,” Weinberger told WCAX.

The resolution will involve commitments to root out racism in certain organizations and investigate the issue further through data collection. 

The city is also hiring a public health equity manager to help address systemic racism. 

Within a week of each other, King County and Tacoma-Pierce County joined counties in other states with their declarations. 

"Today, we declare that racism is a public health crisis. Public Health – Seattle & King County and all of King County government are committed to implementing a racially equitable response to this crisis, centering on community," the King County resolution stated. 

"King County government and Public Health – Seattle & King County are committed to working in stronger and better resourced partnerships with community organizations and leaders to disrupt and dismantle racism and protect the health and well-being of Black, Indigenous People and People of Color," the resolution added. 

Like others, the resolutions include commitments to collect data, work with partner organizations within communities of color and make legislative changes when needed. 

King County also committed to an "Anti-Racism Crisis Response Bill of Rights” that revolves around helping communities of color and reversing the legacy of racism.