I Can't Breathe

June 04, 2020|3:45 p.m.| Ed Ehlinger, MD | Past-President of ASTHO

“I can’t breathe,” pleads George Floyd over and over as he lies on the pavement, a police officer’s knee pressed against his neck for 8 minutes and 46 seconds. He gets no reaction, no response, no release. Breathing and life stops.

We’ve seen this scene play out too many times, not just with knees or choke holds or guns but with policies and attitudes and actions that systematically and disproportionately harm and kill Black, Brown, and Indigenous people, creating an America where millions of people live their entire lives not being able to breathe.

“I can’t breathe,” gasps an elderly pursed-lipped gentleman with chronic lung disease sitting in his backyard beneath a major highway built in a minority neighborhood avoiding a wealthier and whiter one. Fine particle pollution (PM2.5), thanks to weakened EPA emission standards, irritating his lungs with every breath.

“I can’t breathe,” wheezes a young girl with asthma missing another day of school in the dilapidated and mold-riddled apartment—the best her mother could afford in a disinvested and crumbling neighborhood still reeling from “redlining.”

“I can’t breathe,” pants a pork processor with COVID-19 who is packed tightly with hundreds of other immigrants in an “essential business” without adequate personal protective equipment.

“I can’t breathe,” silently shout the 3,445 African Americans lynched in the United States since 1882—victims of a racist society that views them as threats.

“I can’t breathe” on the signs, masks, and tee-shirts of today’s protesters is a message that embodies not just the 8 minute 46 second plight of George Floyd but the plight of too many people who have been dehumanized, victimized, ostracized, and demeaned from the moment they were forcefully brought to this continent 401 years ago; people who have been told in so many ways that Black lives don’t matter, that their breath doesn’t matter, and that they don’t belong.

Their anger and frustration are justifiably boiling over. And all of us must collectively take responsibility for creating the conditions which make Frederick Douglass’s words, spoken 130 years ago, ring true today: “where justice is denied, where poverty is enforced, where ignorance prevails, and where any one class is made to feel that society is an organized conspiracy to oppress, rob, and degrade them, neither persons nor property will be safe.” Those of us in public health must concede that we have failed to “create the conditions in which [all] people can be healthy.” Our traditional public health approaches have been remarkably successful—for many. But we have failed Black, brown, and Indigenous people. Unacceptable disparities persist despite decades of effort and this demands that we acknowledge that racism is at the core of these inequities and recognize the need to fundamentally change how we do our work.

Our focus on data, biomedical science, healthcare and social services, and even on social determinants of health has kept us from recognizing the biggest impediment to health—the feeling of not belonging. As Mother Theresa of Calcutta stated, “the greatest epidemic today is not TB, HIV, or leprosy, [or SARS-CoV-2] it is being unwanted. Being unwanted, unloved, uncared for, forgotten by everybody is a much greater hunger, a much greater poverty, than the person who has nothing to eat.” The consequences of not belonging are now playing out in our streets and in the epidemic of deaths of disconnection and despair.

Having millions of people in our country feeling that they don’t belong is an existential threat to our society. In response, public health efforts must foster meaningful participation by everyone in the design, creation, and implementation of our political, social, and cultural structures and policies. Community engagement and community organizing must become core public health functions with individuals and institutions being accountable to each other. Sharing of power, having community members at decision-making tables, and effective inclusion of a wide range of voices, opinions, and ideas will be key to success.

Though our efforts to advance equity have not achieved our hoped-for improvements, public health must continue to address the inequities in our society and confront the racism that keeps all of us from being healthy. Public health is essential because, unlike most other sectors, its core value is social justice. And what we need now more than ever is a political, economic, and social systems built on social justice.

Our new way of doing public health work must begin immediately and we should all hold our breath until everyone can breathe. The healthy air of belonging, equity, and social justice will be our tribute to the memory of George Floyd, the elder choking on particulates, the asthmatic girl missing school, the immigrant meatpacker, the lynching victims, and all the protesters demanding to be part of an equitable, just, and healthier future.


Ed Ehlinger, MD, is an alumni representative on ASTHO’s board of directors. He is a past-president of ASTHO and previously served as the commissioner of health for the Minnesota Department of Health.