During any health crisis, but especially the ongoing COVID-19 pandemic, those without access to adequate healthcare have suffered the most. Though income is a key determinant of health access, state healthcare structure and budgeting also play a principal role in the survival of disenfranchised communities during this time. When considering the multiple spheres this virus has impacted, Maryland’s economic plan for the next few years becomes a key resource to determine how the state’s government prioritizes healthcare workers and provides resources to communities. A breakdown of budgeting focus as well as economic structure can indicate where Maryland is in terms of funds, and how Maryland prioritizes equity through this pandemic.

Public Health Liberation is not antiracism. It is also not critical race theory, critical public health, or public health praxis, which are part of the antiracism tradition. PHL recognizes the urgent need for addressing racism and the essential role of those approaches and philosophies. These traditions can most accurately be understood as a complement to liberation. However, PHL differs in several ways. We are most concerned with change affecting the material and social conditions of populations in real-time through actions within and outside of public health. We are disheartened by the pace of change in reducing health disparities and demand efforts at all levels of accountability to accelerate health equity, particularly regarding at-risk socioeconomic and racial/ethnic groups.

The classic definition of an infectious disease occurs when microscopic organisms “penetrate the body’s natural barriers and multiply to create symptoms that can range from mild to deadly.” Causal agents include bacteria, viruses, fungi and parasites. Infections can affect the entire body (measles, malaria, HIV and yellow fever) while others can be limited to a system or organ. Tuberculosis and the common cold are examples of local infections. Virulence, immune response, and health of the host influence the outcome of infection. As evidenced by recent pandemics (e.g. SARS, COVID), infectious diseases present an ongoing public health issue.

Public Health Liberation upholds the inherent right to speak about human suffering and to seek relief. It forms a model of practice in which individuals engage with issues of health equity with the resources that are available to them. It does not require mass mobilization, grant funding, or long-term commitments, although it can. I was working with Public Health Liberation interns on their research projects and stumbled across startling racial and intersectional disparities in HIV burden in Washington, DC. A DC Department of Health report has shown ongoing challenges in racial health equity. Since I run a community-based, social justice newsletter as the editor-in-chief, I sent a letter to the director of the DC Department of Health to call for more resources and interventions for these population.Public Health Liberation encourages advocates to engage in such liberation practices.

Public health has developed a consensus that structural racism is a major driver of persistent and chronic racial health inequity in the United States. Yet, research has infrequently treated the United States as a whole as the “exposure.” More than 100 years of biomedical and social science research has supported that racial disparities persist and intersect with broad domains of social and economic life to include measures of clinical outcomes, health care access, income, education, and community determinants. Turn-of-the-century African American scholars including W.E.B. DuBois and Benjamin Brawley described social and environmental conditions that are still relevant to contemporary discussions about violence against Black bodies, economic marginalization, and criminal justice. Before we begin developing any tool, it is important that we have conceptual clarity and ontological positionality.

Science has not caught up with the consensus. It is rare to see researchers account for community factors such as neighborhood poverty or segregation. The structural influence of racism is almost negligible in the body of public health literature. In fact, there are no measures of structural racism that capture its multi-level and temporal dimensions, much less how to apply it in analytic models. Individuals, groups, or communities can be exposed to racism sporadically or chronically.

The public health discourse does not generally situate Public Health Liberation theory. As a preview, liberation concerns optimal resources, information, and power to provide communities pathways for their own self-seeking liberation practices. Public health can often be concerned with the impact of racially biased policies (e.g. assessing the association with gentrification and health outcomes). Public Health Liberation provides a blueprint or a set of political, social, economic, and legal options to secure health equity throughout the process. For example, over the opposition of the community, Washington, DC approved two new sources of industrial pollution about ten years ago next to a Black public housing community. We resolved to stop the environmental racism, so we challenge the renewal permit (to pollute) last year. We brought together community leaders, researchers like myself, and former employees in the EPA. We argued that the polluter was not doing x,y,z to mitigate harm to the community by comparing it to standard practices. We also discovered that the polluter had not had a business license for over ten years, for which they received a hefty fine.

When George Floyd uttered “I can’t breathe” more than 20 times moments before his murder, that was an expression of Black liberation. It was an attempt to speak to his experience and pain as a Black man under the literal and figurative weight of a system that devalued who he was and what he represented. Derek Chauvin barked back orders to “stop talking, stop yelling, it takes a heck of a lot of oxygen to talk.” Mr. Floyd’s exercise in liberation that day on May 25, 2020 showed us the most abhorrent and vile consequences when a single Black man encounters a single white officer. In the years following his murder, Mr. Floyd has become a venerated figure in the antiracism movement. Yet, we are challenged to find space in this discourse to situate Black liberation.

Recently, I was curious about data on the prevalence of lead service lines in my neighborhood given forthcoming federal and local funding for replacement of lead pipes. I found that Washington, DC had a sophisticated map-based database showing data for the presence of lead on the public and private sides. You can see it here - DC Lead Database. As I reviewed the data for my neighborhood, I soon discovered that there were missing data for major areas in public housing. I emailed our city council alerting them to this omission. Given that low-income communities were a priority population, these data were critical. Read their response.

American Journal of Public Health discussed the lead industry’s nearly century-long efforts to persuade federal and local agencies to install lead pipes for drinking water. Following mainstream media reports on lead poisoning and its ties to lead pipes, the lead industry increased its lobbying and media efforts

Reuters examined lead testing results across 21 states, representing about 61 percent of the U.S. population. They found 3,000 areas with lead poisoning rates worse than Flint, Michigan. Their analysis at the census tract or zip code level provided local estimates that highlight the acute lead crisis still engulfing the United States.

Before the lead crisis in Flint, Michigan, Washington, DC had a lead crisis that was “20 to 30 times larger” in 2004. WTOP News covered the lethal and life debilitating consequences of a change in water treatment chemicals. Unlike in Flint that involved a attempt at cost-saving, the federally-operated Washington’s Water and Sewer Authority (WASA) (now “DC Water”) sough to reduce disinfectant byproducts to align with the Environmental Protection Agency’s ‘disinfectant byproduct rule”. The result was that a switch from chlorine to chloramine eroded “decades of protective mineral coating — or scaling — from the lead service lines”.

Public Health Liberation Board Member Darrell Davis recently became Charleston County’s new director of Community Revitalization and Housing Affordability. In an article in the Post and Courier, he describes his personal challenges with securing affordable housing

Eriq Martin, a resident of a public housing community in Washington, DC, is an ambitious young man with a bright future who recently suffered the loss of a parent. Neighbors can often find him selling his art on public sidewalks throughout the city. We most recently found him in Chinatown, just outside the metro.

In 2020, the NIH faced a problem. It wanted to study the mental health impact of the covid pandemic, but was worried that typical recruitment strategies would not work. The idea of placing an image of the covid virus on a recruitment flyer was not appealing.

When it comes to Public Health Liberation, we look everywhere for opportunities to improve community health and reduce health disparities. We seek gains wherever we can get them - if that means political engagement, organizing a march, using the courts, and coalition building. It requires that we keep our finger on the pulse across social, political, economic, and various other “systems” of accountability.