Lessons From Flint: The Long Term Impact Of Systemic Unconscious Racism, And The Social Determinants Of Health

—Dayna Bowen Matthew

Just days after news of the public health crisis in Flint, Michigan broke, I listened to the fury and pain in one Flint native’s voice as she explained the situation in her hometown. Her voice was bewildered and angry. “Everyone knows the Flint River is filthy! How could anyone tell people to drink it?” she asked. Her interactions with family and neighbors were heart wrenching. She told me of a grown man weeping because he believed he was responsible for poisoning his grandchildren. She told me of family members trying to run tubs full of water to boil until it was safe enough to wash – that is, until rashes, and hair loss, and inexplicable symptoms began to appear. “Who would do this to a people? – How could this happen?” she wondered aloud.

The answer is no less disturbing than the tragedy itself. And yet, I find a ray of hope in the understanding that far more than Flint Michigan’s water system was poisoned. Every aspect of where Flint residents lived, worked, and played was tainted by unconscious racism. Every major social determinant of good health in Flint reveals the impact of systemic, un-checked implicit racial bias. That is how “Flint happened”.

I have studied the ravages of unconscious racism on health disparities for a decade. The evidence that people of color live sicker and die quicker than whites do in this country, because they are subjected to discrimination in health care based on their race, color, and national origin is copious. However, the lead contamination crisis in Flint provides a tragic object lesson of how much beyond our health care system, the deadly tentacles of unconscious racism reach to create health disparities. In Flint, we see the awful scope and scale of unconscious racial bias that permeates every social determinant, and condemns poor and minority communities to inferior health in this country.

Systematic unconscious racism has reproduced separate and unequal educational opportunities throughout the Flint school system, making a mockery of the hard fought civil rights victories we associate with Brown v. Board of Education. Recent studies reveal that Flint’s school system is still “intensely segregated,” with black students comprising over 90% of the populations in 4 of the city’s 15 public schools, and over 80% in 4 more. Thus Flint, Michigan’s youth are perfectly positioned to live out the well-documented association between poor education and poor health outcomes.

Unconscious racism has yielded residential segregation in Flint, reminiscent of housing patterns in the deepest parts of the Jim Crow south. As many researchers have demonstrated, “place matters” to health disparities and residential segregation is a sure-fire risk factor for poor health outcomes. Flint’s built environment is plainly the product of unconscious racial bias. Flint’s transportation, recreation, and environmental conditions reflect utter disregard for the health of populations who are predominately black (57%), predominately poor (42% below federal poverty line), or both.  No matter that Genesee County Land Bank oversees Flint lands saturated with toxins leftover from departed auto plants, such as arsenic, chromium, mercury and lead solvents while petroleum leaks into the river to create the familiar stench of which residents regularly complain. Take transportation, for example. Interstate highways bisect Flint, Michigan, not only separating whites from blacks physically, but also ensuring that transportation options are limited for those wishing to access health care, higher education, or even healthy food. Not a single major supermarket chain serves the city of Flint. Therefore, the only fresh vegetables available for Flint’s population are sold at a farmers market run by the Department of Health, but to access the weekly market, residents from the black side of town must ride two buses, in each direction, to and from the food desert that surrounds them.

Unconscious racism explains the terrifying disregard for the health and civil rights of Flint’s population that is revealed in Governor Rick Snyder’s emails. They show that soon after the governor was elected, to make good on his promise of “austerity,” he swept away the democratically elected local officials, and appointed an emergency manager to cut expenses and reorganize government in Flint. The emails reveal that in April 2014, to save roughly $100 per day, the governor’s emergency manager changed Flint’s water source to the Flint River – a body of water well known to be polluted and filthy – and Governor Snyder discounted the criticism and complaints from Flint’s residents by citing what he called a track record of “perfectly good water for Flint” coming from the Flint River.

Unconscious racism explains how people who are not bigots, but pride themselves as objective scientists in the Michigan’s Department of Environmental Quality’s Office of Drinking Water, discounted health complaints and outcry from Flint’s residents and instead chose to credit studies that declared the incredulous to verify that “Flint water is safe to drink.” They wrote, “there have been numerous studies and tests conducted on its water. . . . [T]he quality of the water being put out meets all of our drinking water standards and Flint water is safe to drink.” Surely one could only believe this about the orange, sludge spewing from Flint’s taps by involuntarily allowing venomous assumptions about the people to unconsciously blind and overwhelm science, decency, and common sense.

Unconscious racism caused a nurse in Michigan to tell a mother whose child displayed elevated blood levels that would surely doom the child to developmental disabilities for life, “It’s just a few IQ points. . . . It is not the end of the world.”

This is how unconscious racism works. It automatically calls up stores of stereotypes about black people, poor white people, single moms and their sick babies, about the unemployed, about the down-and-out – and it mercilessly drives decision makers to contradict their belief in equality and preference for fairness. Unconscious bias, unchecked, forces decisions informed by an unintentionally constructed view that some people’s lives are less valuable, less worthy, less important than others. A nurse, otherwise committed to do no harm; a governor, who assures us that “race played no part” – these actors sincerely believe themselves free of implicit bias. But they are wrong.

And here is why I find hope in the dissonance of the explicit pronouncements as compared with their implicit decision-making. Their unconscious racism is both classic, and malleable. It can be changed. The effects of their unconscious racism can be reversed. Here’s how: If those responsible for the infrastructures that organize and distribute the social determinants of health will acknowledge their vulnerability to implicit racial bias, and turn their attention to eradicating the deadly injustices it causes, then we can free housing, education, food and medical access, neighborhoods, and governments to produce equal opportunity for healthy lives for all. Science tells us this can happen. Now all that is needed is courage.

Dayna Bowen Matthew is Professor at University of Colorado Law School and the Colorado School of Public Health. She is the author of Just Medicine: A Cure for Racial Inequality in American Health Care (NYU Press, 2016).