III 

118TH CONGRESS 

1ST SESSION S. RES. 319 

Declaring racism a public health crisis. 

IN THE SENATE OF THE UNITED STATES 

JULY 27, 2023 

Mr. BROWN (for himself, Mr. BOOKER, Mr. PADILLA, Ms. WARREN, Mr. 

MERKLEY, Mr. MARKEY, Ms. SMITH, Mr. WHITEHOUSE, Mr. CARPER, 

Mr. CARDIN, Ms. HIRONO, Mr. BLUMENTHAL, Mr. MENENDEZ, Ms. 

BALDWIN, Mr. WYDEN, Mr. REED, Ms. STABENOW, and Ms. 

DUCKWORTH) submitted the following resolution; which was referred to 

the Committee on Health, Education, Labor, and Pensions 

RESOLUTION 

Declaring racism a public health crisis. 

Whereas a public health crisis is an issue— 

(1) that affects many people, is a threat to the public, and is ongoing; 

(2) that is unfairly distributed among different populations and disproportionately impacts health outcomes, 

access to health care, and life expectancy; 

(3) the effects of which could be reduced by preventive measures; and 

(4) for which those preventive measures are not yet 

in place; 


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Whereas public health experts agree that significant racial inequities exist in the prevalence, severity, and mortality 

rates of various health conditions in the United States; 

Whereas examples of those inequities include— 

(1) life expectancies for Black and Native American 

people in the United States are significantly lower than 

those of White people in the United States; 

(2) Black and Native American women are 2 to 4 

times more likely than White women to suffer severe maternal morbidity or die of pregnancy-related complications; 

(3) Black and Native American infants are 2 to 3 

times more likely to die than White infants; 

(4) the Black infant mortality rate in the United 

States is higher than the infant mortality rates recorded 

in 27 of the 36 democratic countries with market-based 

economies that are members of the Organization for Economic Co-operation and Development; 

(5) Hispanic women are 40 percent more likely to be 

diagnosed with and 30 percent more likely to die from 

cervical cancer compared to non-Hispanic White women; 

(6) Asian Americans face health disparities in cancer 

and chronic diseases, and are the only population in the 

United States for which cancer is the leading cause of 

death; 

(7) Native Hawaiians and Pacific Islanders suffer 

from a number of poor health outcomes such as high 

rates of overweight status, obesity, hypertension, and 

asthma and cancer mortality; 

(8) Native Hawaiians suffer from coronary heart 

disease, stroke, heart failure, cancer, and diabetes at a 

rate 3 times greater than in other ethnic populations in 

Hawaii and become afflicted with those diseases a decade 


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earlier in their lives compared with other ethnic populations; and 

(9) during the COVID–19 pandemic, Black, Hispanic or Latino, Asian American, Native Hawaiian or 

Pacific Islander, and Native American communities experienced disproportionately high rates of COVID–19 infection, hospitalization, and mortality compared to the 

White population of the United States; 

Whereas inequities in health outcomes are exacerbated for 

people of color who are LGBTQIA+; 

Whereas inequities in health outcomes are exacerbated for 

people of color who have disabilities; 

Whereas, historically, explanations for health inequities have 

focused on false genetic science such as eugenics; 

Whereas, historically, explanations for health inequities have 

focused on incomplete social scientific analyses that narrowly focus on individual behavior to highlight ostensible 

deficiencies within racial and ethnic minority groups; 

Whereas modern public health officials recognize the broader 

social context in which health inequities emerge and acknowledge the impact of historical and contemporary racism on health; 

Whereas racism is recognized in modern public health discourse as one of many social determinants of health, 

which— 

(1) are a broad range of nonmedical factors that can 

enhance or hinder quality of life and influence health outcomes; 

(2) are the conditions in which people are born, 

grow, work, live, and age, and include the wider set of 

forces and systems shaping the conditions of daily life; 


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(3) include such factors as housing, employment, 

education, health care, food, transportation, social support, poverty, crime, violence, segregation, and environmental toxins; 

(4) are linked to a lack of opportunity and resources 

to protect, improve, and maintain health; and 

(5) taken together, create health inequities that stem 

from unfair and unjust systems, policies, and practices, 

and limit access to the opportunities and resources needed to live the healthiest life possible; 

Whereas, since its founding, the United States has had a 

longstanding history and legacy of racism, mistreatment, 

and discrimination that has perpetuated health inequities 

for members of racial and ethnic minority groups; 

Whereas that history and legacy of racism, mistreatment, and 

discrimination includes— 

(1) the immoral paradox of freedom and slavery, 

which is an atrocity that can be traced throughout the 

history of the United States, as African Americans lived 

under the oppressive institution of slavery from 1619 

through 1865, endured the practices and laws of segregation during the Jim Crow era, and continue to face the 

ramifications of systemic racism through unjust and discriminatory structures and policies; 

(2) the failure of the United States to carry out the 

responsibilities and promises made in more than 350 

treaties ratified with sovereign indigenous communities, 

including American Indians, Alaska Natives, and Native 

Hawaiians or Pacific Islanders, as made evident by the 

chronic and pervasive underfunding of the Indian Health 

Service and Tribal, Urban Indian, and Native Hawaiian 

health care, the vast health and socioeconomic inequities 


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faced by Native American people, and the inaccessibility 

of many Federal public health and social programs in 

Native American communities; 

(3) the enactment of immigration laws in the United 

States that scapegoated Asians, separated families, and 

branded Asians as perpetual outsiders, such as— 

(A) the enactment of the Act entitled ‘‘An Act 

supplementary to the Acts in relation to immigration’’, approved March 3, 1875 (commonly known as 

the ‘‘Page Act of 1875’’) (18 Stat. 477, chapter 

141), which effectively prohibited the entry of East 

Asian women into the United States; 

(B) the Act entitled ‘‘An Act to execute certain 

treaty stipulations relating to Chinese’’, approved 

May 6, 1882 (commonly known as the ‘‘Chinese Exclusion Act’’; 22 Stat. 58, chapter 126), which 

banned thousands of Chinese-born laborers, who 

were essential in the completion of the transcontinental railroad and development of the West 

Coast of the United States; and 

(C) the Act entitled ‘‘An Act to regulate the immigration of aliens to, and the residence of aliens in, 

the United States’’, approved February 5, 1917 

(commonly known as the ‘‘Immigration Act of 

1917’’) (39 Stat. 874, chapter 29), which barred all 

immigrants from the ‘‘Asiatic zone’’ and prevented 

the migration of individuals from South Asia, Southeast Asia, and East Asia; and 

(4) during the Great Depression Era, the deportation of approximately 1,800,000 individuals based on 

their Mexican ethnic identity, although approximately 60 

percent of the deported individuals were citizens of the 

United States, and the targeting of individuals of MexiVerDate Sep 11 2014 23:01 Aug 17, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6300 E:\BILLS\SR319.IS SR319

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can descent for ‘‘repatriation’’ due to scapegoating efforts, which blamed those individuals for ‘‘stealing’’ jobs 

from ‘‘real’’ Americans; 

Whereas, in 1967, President Lyndon B. Johnson established 

the National Advisory Commission on Civil Disorders, 

which concluded that White racism is responsible for the 

pervasive discrimination and segregation in employment, 

education, and housing, causing deepened racial division 

and the continued exclusion of Black communities from 

the benefits of economic progress; 

Whereas overt racism was embedded in the development of 

medical science and medical training during the 18th, 

19th, and 20th centuries, causing disproportionate physical and psychological harm to members of racial and 

ethnic minority groups, including— 

(1) the unethical practices and abuses experienced 

by Black patients and research participants, such as the 

Tuskegee Study of Untreated Syphilis in the Negro Male, 

which serve as the foundation for the mistrust the Black 

community has for the medical system; and 

(2) the egregiously unethical and cruel treatment of 

enslaved Black women who were forced to be the subject 

of insidious medical experiments to advance modern gynecology, including those perpetuated by the so-called ‘‘father of gynecology’’, J. Marion Sims; 

Whereas structural racism cemented historical racial and ethnic inequities in access to resources and opportunities, 

contributing to worse health outcomes; 

Whereas examples of that structural racism include— 

(1) before the enactment of the Medicare program, 

the United States health care system was highly segregated, and, as late as the mid-1960s, hospitals, clinics, 


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and doctors’ offices throughout the northern and southern United States complied with Jim Crow laws and were 

completely segregated by race, leaving Black communities 

with little to no access to health care services; 

(2) the landmark case Simkins v. Moses H. Cone 

Memorial Hospital, 323 F.2d 959 (4th Cir. 1963), which 

challenged the use of public funds by the Federal Government to expand, support, and sustain segregated hospital 

care and provided justification for title VI of the Civil 

Rights Act of 1964 (42 U.S.C. 2000d et seq.) and the 

Medicare hospital certification program by establishing 

Medicare hospital racial integration guidelines that applied to every hospital that participated in the Federal 

program; 

(3) Pacific Islanders from the Freely Associated 

States experience unique health inequities resulting from 

United States nuclear weapons tests on their home islands while they have been categorically denied access to 

Medicaid and other Federal health benefits; 

(4) language minorities, including Chinese-, Korean- 

, Vietnamese-, and Spanish-speaking Americans, were not 

assured nondiscriminatory access to federally funded 

services, including health services, until the signing of 

Executive Order 13166 (42 U.S.C. 2000d–1 note; relating to improving access to services for persons with limited English proficiency) in 2000; 

(5) the COVID–19 pandemic exacerbated economic, 

health, housing, and food security barriers for Black, 

Hispanic or Latino, Asian American, Native Hawaiian or 

Pacific Islander, and Native American households, which 

already suffer from disproportionately higher rates of 

food insecurity; and 


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(6) members of the Black, Native American, Alaska 

Native, Asian American, Native Hawaiian or Pacific Islander, and Hispanic or Latino communities are disproportionately impacted by the criminal justice and immigration enforcement systems and face a higher risk of 

contracting COVID–19 within prison populations and detention centers due to the over-incarceration of members 

of those communities; 

Whereas subtle or implicit racism in all sectors of the medical 

service profession continues to cause disproportionate 

physical and psychological harm to members of racial and 

ethnic minority groups; 

Whereas examples of subtle or implicit racism in the medical 

service profession include— 

(1) the history and persistence of racist and nonscientific medical beliefs, which are associated with ongoing 

racial inequities in treatment and health outcomes; 

(2) implicit racial and ethnic biases within the 

health care system, which have an explicit impact on the 

quality of care experienced by members of racial and ethnic minority groups, such as the undertreatment of pain 

in Black patients; 

(3) nearly 1⁄5 of Hispanic or Latino Americans avoid 

medical care due to concern about being discriminated 

against or treated poorly; 

(4) the United States health care system and other 

economic and social structures remain fraught with biases based on race, ethnicity, sex (including sexual orientation and gender identity), and class that lead to 

health inequities; 

(5) women of color, including Black, Native American, Hispanic or Latina, Asian American, and Native 


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Hawaiian or Pacific Islander women, have faced and continue to face attacks on their prenatal, maternal, and reproductive health and rights; and 

(6) physicians routinely, through the early 1980s, 

sterilized members of racial and ethnic minority groups, 

specifically American Indian and Alaska Native women 

(with 1⁄4 of childbearing-age women sterilized by the Indian Health Service) and African American and Latina 

women, performing excessive and medically unnecessary 

procedures without their informed consent; 

Whereas structural racism perpetuates racial and ethnic inequities in the social determinants of health, which produces unintended negative health outcomes for members 

of racial and ethnic minority groups; 

Whereas examples of that structural racism include— 

(1) there are fewer pharmacies, medical practices, 

and hospitals in predominantly Black and Hispanic or 

Latino neighborhoods, compared to White or more diverse neighborhoods; 

(2) environmental hazards such as toxic waste facilities, garbage dumps, and other sources of airborne pollutants, are disproportionately located in predominantly 

Black, Hispanic or Latino, Asian American, Native Hawaiian or Pacific Islander, and low-income communities, 

resulting in poor air quality conditions, which can increase the likelihood of chronic respiratory illness and 

premature death from particle pollution; 

(3) employed Black adults are 10 percent less likely 

to have employer-sponsored health insurance than employed White adults because of racial segregation in occupation sectors and the types of organizations in which 

they work, nearly 1⁄4 of American Indians and Alaska 


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Natives lack health insurance, and nonelderly Native Hawaiian or Pacific Islander adults and certain groups of 

nonelderly Asian American adults, including Korean, Vietnamese, and Cambodian adults, also have lower levels 

of insurance than White adults; 

(4) several States with higher percentages of Black, 

Hispanic or Latino, and Native American populations 

have not expanded their Medicaid programs, continuing 

to disenfranchise minority communities from access to 

health care as of the date of adoption of this resolution; 

(5) discriminatory housing practices, such as redlining, which have, for decades, systemically excluded 

members of racial and ethnic minority groups from housing by robbing them of capital in the form of low-cost, 

stable mortgages and opportunities to build wealth, and 

the use by the Federal Government of its financial power 

to segregate renters in public housing; 

(6) social inequities such as differing access to quality health care, healthy food and safe drinking water, 

safe neighborhoods, education, job security, and reliable 

transportation, which affect health risks and outcomes; 

(7) exclusionary disciplinary practices (such as detention and suspension) in primary education and even 

early education settings, which disproportionately affect 

children from racial and ethnic minority backgrounds, 

particularly Black children; and 

(8) that, as much as 60 percent of the health of a 

person in the United States can be determined by their 

ZIP Code; 

Whereas structural racism perpetuates ongoing knowledge 

gaps in data, research, and development, which produces 

unintended negative health outcomes for members of racial and ethnic minority groups; 


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Whereas examples of that structural racism include— 

(1) most participants in clinical trials are White, so 

there is insufficient data to develop evidence-based recommendations for people from racial and ethnic minority 

groups; 

(2) medical research equipment and medical devices 

are typically developed by majority-White teams and thus 

can have racial blind spots unintentionally built into their 

design, rendering them less effective for people from racial and ethnic minority groups, such as— 

(A) electroencephalogram (EEG) electrodes 

used in neuroimaging research do not collect reliable 

data when used on scalps with thick, curly hair; and 

(B) pulse oximeters produce less accurate oxygen saturation readings when used on fingertips 

with darker skin; 

(3) a lack of images depicting darker skin in medical 

textbooks, literature, and journals contributes to higher 

rates of underdiagnosis or misdiagnosis in patients with 

darker skin; and 

(4) many health-related studies fail to include data 

on Native Americans, Asian Americans, and Native Hawaiians or Pacific Islanders, or do not disaggregate data 

among those groups, leading to their invisibility in health 

data and unjust resource allocation and policies; 

Whereas racism produces unjust outcomes and treatment for 

members of racial and ethnic minority groups, with such 

negative experiences serving as stressors that over time 

have a negative impact on physical health (leading, for 

example, to high blood pressure or hypertension) and 

mental health (leading, for example, to anxiety or depression); 


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Whereas there is evidence that racial and ethnic minority 

groups continue to face discrimination in the United 

States, examples of which include that— 

(1) social scientists have documented racial microaggressions in contemporary United States society, including— 

(A) assumptions that members of racial and 

ethnic minority groups are not true Americans; 

(B) assumptions of lesser intelligence; 

(C) statements that convey color-blindness or 

denial of the importance of race; 

(D) assumptions of criminality or dangerousness; 

(E) denial of individual racism; 

(F) promotion of the myth of meritocracy; 

(G) assumptions that the cultural background 

and communication styles of an individual are pathological; 

(H) treatment as a second-class citizen; and 

(I) environmental messages of being unwelcome 

or devalued; 

(2) compared to White Americans, Black Americans 

are 5 times more likely to report experiencing discrimination when interacting with the police, Hispanic or Latino 

Americans and Native Americans are nearly 3 times as 

likely, and Asian Americans and Native Hawaiians or Pacific Islanders are nearly twice as likely; 

(3) 42 percent of employees in the United States 

have experienced or witnessed racism in the workplace; 

(4) Muslims, South Asians, and Sikhs were unjustly 

targeted for profiling, surveillance, arrest, discrimination, 

harassment, assault, and murder after 9/11; 


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(5) xenophobic rhetoric, including anti-immigrant 

rhetoric and the scapegoating of people of East Asian 

and Southeast Asian descent for the COVID–19 pandemic, resulted in a surge of hate against Asian Americans and Native Hawaiians or Pacific Islanders, including increased harassment, discrimination, bullying, vandalism, and assault; 

(6) nearly 1⁄2 of Asian Americans and Native Hawaiians or Pacific Islanders throughout the United States 

have experienced discrimination or unfair treatment that 

may be illegal and the majority of victims of discrimination name race or related characteristics as the reason 

for the discrimination; and 

(7) more than 50 percent of Hispanic or Latino 

adults experience at least one form of discrimination due 

to their racial or ethnic heritage, such as being treated 

as if they were not smart, criticized for speaking Spanish, 

told to return to their country, called offensive names, or 

unfairly stopped by the police; 

Whereas Black people in the United States experience overt 

and direct forms of violence that, when not fatal, can 

cause severe physical or psychological harm; 

Whereas examples of such forms of violence include— 

(1) that Black people are confronted and threatened 

by armed citizens while performing everyday tasks, such 

as jogging in neighborhoods, driving, or playing in a 

park; 

(2) that Black people are 3 times more likely to be 

killed by police than White people, and police violence is 

the sixth leading cause of death for young Black men; 

(3) the killings of Tamir Rice, Ahmaud Arbery, 

Breonna Taylor, George Floyd, Elijah McClain, Jayland 


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Walker, Jeenan Anderson, Timothy McCree Johnson, 

Jordan Neely, and countless other Black Americans by 

law enforcement; 

(4) that it took the United States 66 years after the 

senseless and brutal murder of 14-year-old Emmett Till 

to make lynching a Federal crime; 

(5) that, since 2015, mass shootings around the 

country, such as in Buffalo, New York, and Charleston, 

South Carolina, serve as reminders of the unresolved history of racism in the United States and highlight the 

threats Black people must take into consideration when 

going about their daily lives, both when outside their 

communities and within those communities; and 

(6) that the real threat of brutality and violence adversely impacts mental health among Black communities; 

Whereas American Indians and Alaska Natives experience 

historical trauma, systemic oppression, and cultural genocide that, even when not fatal, can cause severe physical 

or psychological harm; 

Whereas examples of such forms of violence include— 

(1) forced relocation, termination, and assimilation 

policies such as boarding schools that contributed to 

health disparities and legacies of trauma inflicted on indigenous people; 

(2) the United States Army attempting cultural 

genocide by instigating numerous massacres, including 

the mass execution of 38 Dakota men in Minnesota and 

the murder of 300 Lakota people at the Battle of 

Wounded Knee, to eradicate American Indians and Alaska Natives; 


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(3) murder being the third leading cause of death 

for Native women and 4⁄5 of Indigenous women experiencing violence in their lifetime; 

(4) since 2016, there have been 5,712 cases of missing and murdered indigenous women and people across 

the United States, including 506 cases in 71 urban cities 

and 153 cases missing from law enforcement databases, 

with those missing cases likely undercounting the actual 

number of cases due to the underreporting of cases within American Indian and Alaska Native communities; 

(5) the overall death rate from suicide among American Indians and Alaska Natives is 20 percent higher 

compared to non-Hispanic White populations; and 

(6) cycles of violence have overburdened indigenous 

communities to respond to levels of violence such as gender-based violence, human trafficking, suicide, and homicide with minimal resources; 

Whereas Hispanics or Latinos, Asian Americans, and Native 

Hawaiians or Pacific Islanders experience racially motivated kidnapping, murders, and mass violence, such as 

shootings in Oak Creek, Wisconsin, El Paso and Allen, 

Texas, Atlanta, Georgia, and Indianapolis, Indiana, that, 

even when not fatal, can cause severe physical or psychological harm; 

Whereas, throughout the history of the United States, members of racial and ethnic minority groups have been at 

the forefront of civil rights movements for essential freedoms, human rights, and equal protection for 

marginalized groups and continue to fight for racial and 

economic justice today; 

Whereas racial inequities in health continue to persist because of historical and contemporary racism; 


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Whereas public health experts agree that racism meets the 

criteria of a public health crisis because— 

(1) the condition affects many people, is seen as a 

threat to the public, and is continuing to increase; 

(2) the condition is distributed unfairly; 

(3) preventive measures could reduce the effects of 

the condition; and 

(4) those preventive measures are not yet in place; 

Whereas the Centers for Disease Control and Prevention— 

(1) declared racism a serious threat to public health; 

and 

(2) acknowledged the need for additional research 

and investments to address that serious threat; 

Whereas a Federal public health crisis declaration proclaims 

racism as a pervasive health issue and alerts the people 

of the United States to the need to enact immediate and 

effective cross-governmental efforts to address the root 

causes of structural racism and the downstream impacts 

of that racism; and 

Whereas such a declaration requires the response of governments to engage significant resources to empower the 

communities that are impacted: Now, therefore, be it 

1 Resolved, That the Senate— 

2 (1) supports the resolutions drafted, introduced, 

3 and adopted by cities and localities across the 

4 United States declaring racism a public health crisis; 

5 (2) declares racism a public health crisis in the 

6 United States; 

7 (3) commits to— 


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1 (A) establishing a nationwide strategy to 

2 address health disparities and inequities across 

3 all sectors in society; 

4 (B) dismantling systemic practices and 

5 policies that perpetuate racism; 

6 (C) advancing reforms to address years of 

7 neglectful and apathetic policies that have led 

8 to poor health outcomes for members of racial 

9 and ethnic minority groups; and 

10 (D) promoting efforts to address the social 

11 determinants of health for all racial and ethnic 

12 minority groups in the United States, and espe13 cially for Black and Native American commu14 nities; and 

15 (4) places a charge on the people of the United 

16 States to move forward with urgency to ensure that 

17 the United States stands firmly in honoring its 

18 moral purpose of advancing the self-evident truths 

19 that all people are created equal, that they are en20 dowed with certain unalienable rights, and that 

21 among these are life, liberty, and the pursuit of hap22 piness. 

Æ 


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