January 19, 2018

By nearly every marker, black residents in Multnomah County report poorer health than their white neighbors.

African American babies are more likely than white babies to be born underweight and die before they reach their first birthday. African American adults are more likely to become obese, contract HIV and die from cancer, heart disease, stroke, diabetes and homicide.

Dr. Frank Franklin, director of Community Epidemiology Services at the Multnomah County Health Department. Credit D. Scott Frey

There are socioeconomic disparities, too. African American families are more likely to live in poverty, to raise children in a single-parent household, and to be unemployed. African American children are more than twice as likely as white children fail to meet third-grade reading standards.

“In my work as an epidemiologist, we look at numbers and say, ‘race is a risk factor.’ But there’s no biological reason for that,” Dr. Frank Franklin, director of Community Epidemiology Services at the Multnomah County Health Department said Tuesday during an appearance at Science on Tap. “When we say race is a risk factor, the question is really a marker of something endemic of society. There’s no biological premise for the difference.”

“Income helps. Class helps,” he said. “But it doesn’t erase the problem.”

That’s because health disparities, like disparate rates of educational attainment and even imprisonment, are a result of inequity borne of racial discrimination and race-related stressors, Franklin said in his talk on “Racism, Poverty, and Public Health.”

Toxic stress changes the neurological development of a child’s brain, he explained. It doesn’t take acute, life-threatening events to do the job. Instead it’s a daily barrage of uncertainty — a child who feels judged, discriminated against, slighted; whose parents may not be there when he gets home from school; who may not rely on three meals a day. These are the Adverse Childhood Experiences, or ACEs, that taken together, cause black children to fall behind in school and fall behind in health.

“Living with chronic stress is like being born in a storm,” he said. “They don’t know they’re living under stress, constantly feeling threatened.”

Chronic stress impairs a child’s memory, ability to concentrate or navigate unfamiliar situations, cognitive flexibility, and ability to moderate emotional responses. Instead the child’s nervous system is preparing it to be hypervigilant and on-guard.

These neurological impairments lead to social ones — an inability to retain information leads to frustration in class and a lack of self-worth, which lead to behavior problems, isolation or risky behavior. From there, it’s easy to see the pipeline from classroom to prison cell, where Black people are incarcerated at seven times the rate of White people, and where one-in-three black men will go to prison or jail at some point in their lives.

“Going to prison has become like going to school,” Franklin said. “The rate of incarceration is so significant that going to prison has become a part of the natural life course for many people.”

Franklin spoke to a sold-out house at the Alberta Rose Theatre, where he earned applause and even laughter, along with questions about what could be done.

Franklin grew up in Philadelphia, where he said he watched some friends go to prison. Franklin instead went on to college at Morgan State University, where he planned to study immunology. “But it was too socially disconnected from daily life and social issues,” he said. “I didn’t want to spend 20 years in a lab to see if I could find the right gene.”  

Instead Franklin earned first a master’s degree in public health from the Morehouse School of Medicine, followed by a doctorate in epidemiology from the Bloomberg School of Public Health at Johns Hopkins University and a law degree from Drexel University. He went on to work in alcohol and drug treatment as director of Volunteers of America Oregon.

After living in cities with a larger black population, Franklin said Portland was an adjustment. “It can be draining sometimes,” he said, to be one of the only people of color in a room, in a restaurant or on the street. “There’s a different level of management that can be taxing,” such as backhanded compliments of “you’re very smart” or “you’re intimidating.”

And on some level, those are the stressors Franklin discusses in his talk — constantly being aware of how he presents himself. Always being, at some level, on guard.

Tuesday night’s talk spurred questions on how to break the cycle. If racism has such sweeping health impacts on one group of people in our society, one woman asked, “Why haven’t we declared racism a public health emergency?”

Franklin said he suspects policymakers are uncomfortable talking about race.

“Because it can be translated as a subtle indictment,” he said. White people, who are the majority of people in positions of power, want to distance themselves because they don’t like the idea that they could been seen as part of the problem.

“But here’s the flaw,” he said. “What they miss by not responding, is an accountability for the apathy.”

What can white people do to act as allies for people of color, another woman asked. “The men in my life advocate for me, but they let me talk,” she said.

“Mirror that,” Franklin said. “You’re not looking for a man to say, ‘I know what it’s like to be a woman because I’m underpaid.’ The equivalent is to let them talk. You listen. And then share resources that bear on the problem.”

Multnomah County has invested resources to create a system that is more culturally-responsive, Franklin said. Examples of culturally-responsive programs for African American residents include the Healthy Birth Initiative and Racial and Ethnic Approaches to Community Health (REACH), as well as the City of Portland’s Black Male Achievement Initiative.

But the precursor to creating a culturally-responsive system, he said, is cultural humility. And that requires White individuals to acknowledge they don't know what the experience is like for people of color. But they’re humbly willing to learn and to risk mistake.

“It’s more about acknowledging that I don’t know,” he said. “But I can allow you to teach me about your narrative and let that experience serve as a point of reference.”