The violent clashes between white nationalists and counter-protesters in Charlottesville, Va., on Aug. 12 is part of a rise in hate-related crimes, a trend that could be harming the nation's health beyond the direct effects of the actual hate crimes.
According to the Southern Poverty Law Center, more than 1,800 race-related incidents occurred between Nov. 9 and March 31, with more than 1,000 occurring within the first month after the election.
The current toxic social and political environment has a negative effect on the public's health, experts say, giving increasingly population health-minded providers a responsibility to raise awareness in the community and better educate patients. That harmful environment should also inform providers' clinical approach when caring for those directly affected by hate-based incidents.
"I think hate is a public health concern, and I worry that one of the challenges of the current administration is that the use of divisive language has resulted in giving permission to the expression of hate that ultimately will have a real effect on public health," said Dr. Sandro Galea, dean at the Boston University School of Public Health.
A 2015 report by the American Psychological Association found that 61% of U.S. adults said they experienced some form of day-to-day discrimination, which ranged from being treated with less courtesy to being threatened or harassed. The same report found that nearly half of adults had experienced a "major form of discrimination, such as unfair treatment by police or receiving unfair treatment when receiving healthcare.
Evidence has shown stress caused by discrimination has been associated with poorer health outcomes, resulting in health disparities between populations that are victims of discrimination and those that are not. A 2014 study published in the American Journal of Public Health found a greater likelihood of suicide among LGBT public school students who lived in neighborhoods in Boston where there was a higher prevalence of hate crimes targeting those populations.
Other research has shown hate crime victims are at higher risk of developing long-term behavioral health disorders such as depression and anxiety as a result of their trauma. According to the American Psychological Association, perceived discrimination has been found to contribute to chronic stress-related health disparities among minority groups.
Galea last week authored an opinion article in the Boston Globe where he called racial tensions a "health crisis." He said the violence that was sparked in Charlottesville, and the willingness of President Donald Trump to defend some of the white nationalist rally participants as "some very fine people," created a void in leadership that had to be filled by healthcare leaders.
One of those leaders was American College of Physicians President Dr. Jack Ende, who last week released ACP's policy statement adopted in July that recognizes hate crimes as a public health issue.
"That act of violence can be associated with PTSD, and other psychiatric and more direct health-related consequences," Ende said.
The move follow similar actions taken by a number of leading medical and health advocacy organizations in recent years to educate the public on the association between such crime and health.
In 2015, the American Public Health Association launched a public education campaign against racial discrimination as a means of addressing health inequities found among different ethnic and racial populations. Since 2003 the American Academy of Family Physicians has held as its position an acknowledgment that hate crime posed "specific and distinct health risks for our patients", and has supported the pursuit of anti-discrimination laws. The American Medical Association has for years had a policy recognizing that hate crimes pose a "significant threat" to public health and has advocated for the passage of hate-crime laws.
Ende said healthcare had a large role to play toward educating the public, but also had a responsibility to raise awareness among clinicians about the effect discrimination may have had on the health conditions of patients within those affected groups.
"If they are a member of one of those populations—ethnicity, race, gender, sexual orientation or nation of origin—I think clinicians should really be sensitive to the fact that this person may be under increased stress, and some of the symptoms that they present with may be explainable by what they're having to live through," Ende said.
Much like other parts of society, the healthcare system has had its own history of discrimination against certain groups that it still contends with today. "Our nation tragically has a long history of the health system having to fight for equality within the (societal) system," said Dr. Georges Benjamin, executive director of the American Public Health Association.
Benjamin cited the passage of Medicare in 1965 as a transformative moment for the advancement of healthcare equity. The program instituted reimbursement rules that barred federal funding to hospitals that discriminated against patients based on race, which had the almost immediate effect of desegregating every U.S. hospital.
Benjamin said healthcare providers in impact areas such as Charlottesville where hate-based violence has taken place can offer counseling services to help community members cope with the stress induced by such actions.
Yet despite the progress that has been made, Benjamin said that overall healthcare providers still had a poor understanding of the stress-induced health effects that are caused by discrimination, which makes it less likely that those effects and their root causes are factored into clinical decisions.
On a macro level, Benjamin said clinicians could advocate for alleviating the social inequities that have contributed to disparities in health outcomes. He urged physicians to call on their medical societies to take up activities that address social factors such as housing, poverty and food insecurity, all of which affect more greatly populations that are discriminated against.
"You can call for your medical society to support things that you know will improve the health of the population in which you serve," Benjamin said.
Individually, Benjamin said clinicians can take a more proactive role in identifying and addressing the social factors that may affect their patients' health.
"Clinicians often don't realize what they can do," Benjamin said.
