Health Inequity Exposé: The Rhetoric of Racism as a Public Health Crisis

Analysis: Rhetorical Strategies in Holmes’s Healthcare Discourse

In “Toward a Cure: Cities Declare Racism a Public Health Crisis,” Holmes employs healthcare rhetoric to convey urgency, evoke empathy, and promote systemic critique. Holmes employs deliberate use of language with phrases like "public health emergency" and “crisis” to evoke a sense of urgency, while cultivating compassion among readers. Secondly, instead of focusing on individual responsibility, Holmes emphasizes institutional accountability by utilizing Kinkead's concept of systemic critique as a framework of broader healthcare structural transformation. Lastly, Holmes’s calls for policy reform, demonstrating how discourse can move past simple awareness to cultivate action and structural change. Together, this rhetorical framing is consistent with the larger objectives of healthcare rhetoric, which include understanding how discourse affects public opinion as well as institutional reactions and the development of policies.

Urgency and Empathy as Rhetorical Appeals

Holmes utilizes a tone that is both urgent and empathetic, conveying the severity of racism as a public health crisis while also appealing to the morale of her audience through her utilization of intentional selection of language. Her choice of words, such as "crisis" and "emergency," emphasizes that this is a current issue that needs immediate attention; these two words are cited countless times throughout the articles, via direct quotes from regular people, to credible people of power, to Holmes utilizing the words herself.  Prior to citing statistics regarding disproportionate mortality rates in Black populations, she added the phrase “disturbing health trends,” cultivating a feeling of concern among readers. In the same way, phrases like "we must act" create a sense of collective responsibility for the public, as the word “we” makes all readers feel responsible. Holmes’s language aligns with what Kinkead describes as a discourse that "reveals deeper social and cultural influences,” (210) as in the societal need for empathy toward marginalized communities. By creating a sense of exigence through careful selection of language that calls to emotion among readers, Holmes encourages her readers to view the health disparities faced by communities of color not merely as statistics but instead as an urgent issue that affects individuals within affected communities. Throughout her article, Holmes quotes a variety of people who represented a variety of agencies, from statements from the American Medical Association, the American College of Emergency Physicians and the American Psychological Association declaring racism an urgent public health issue, to personal anecdotes of regular people from the community and their experiences on health disparities, to even citing online movements like #defundpolice. The various points of view Holmes references throughout the article allow readers to form their own opinions on the matter, as they can decipher whose viewpoint is meaningful for their own interpretation.

Systemic Critique vs. Individual Blame

A key aspect of Holmes’s argument is her focus on systemic accountability rather than individual blame. She differentiates between personal biases and the structural practices that perpetuate health disparities, writing, “This is not about blaming individuals but about acknowledging structures that disadvantage people of color.” This alludes to infrastructure and policies that allowed systemic racism to exist, and the first step for change is identifying the origins of these structures. This approach aligns with Kinkead’s model, which emphasizes the importance of analyzing discourse within systemic contexts (217).  By addressing institutional practices, Holmes broadens the scope of her argument, appealing to policymakers and healthcare providers as agents of systemic change.

Holmes’s utilization of rhetorical strategies is similar to existing publications that identifies racism as a structural determinant of health. Hardeman et al. describe structural racism as a “confluence of institutions, culture, history, ideology, and codified practices that generate and perpetuate inequity,” bringing attention to the fact that disparities are not the result of individual actions but broader systemic forces. Similarly, Bailey et al. argue that structural racism has shaped the distribution of social determinants of health, concluding they play “a substantial role in shaping the… population health profile of the USA, including persistent health inequities." Utilizing a similar foundation of thinking, Holmes reinforces this idea that health disparities are built upon long rooted systemic conditions rather than isolated factors. She addresses this by carefully selecting language to fully communicate this concept that has been established in public health literature. Additionally, by analyzing the impact of racism on healthcare access in New Zealand through a comparative study, Harris et al. give readers a global perspective on how systemic prejudices lead to disparities in healthcare outcomes and access. The study came to the conclusion that racism increases unmet needs, lowers satisfaction, and increases negative experiences with healthcare, all of which contribute to worse healthcare and healthcare disparities. By demonstrating how prejudice in healthcare can lead to detrimental health effects through both physical neglect and psychological pressures experienced by those who are disadvantaged, it connects to Holmes's stance that it is the public's duty to consider the consequences of individual biases and behaviors in addition to advocating for policy changes.

This perspective is further supported by existing viewpoints of scholars on structural racism and health equity. Bailey et al. identify racism as a structural predictor of health disparities affecting outcomes like disease prevalence and mortality rates, acting as a structural predictor of health. This emphasis on structural accountability directly mirrors Kapadia and Borrell’s discussion specifying instances of institutionalized racism throughout United States history and providing examples of policies causing health care disparities, like redlining and housing segregation leading to worse social determinants of health in affected communities, or inequitable employment and economic opportunities as drivers of employment status and income inequalities, and even massive incarceration being a product of failing public systems like inadequate education and insufficient social services and affordable housing amplifying each other's health inequities. They further call for systematic policy changes to eliminate disparities.

Similarly, this is demonstrated when Holmes writes, “[The Food Trust in Philadelphia] advocates for food retail development in areas that don't have enough supermarkets—often in predominantly Black neighborhoods.” The Food Trust eventually caught the attention of state policy makers to create a Reinvestment fund that now provides 400,000 Philadelphia residents access to healthy food. This effort shows how cooperation between several systems, such as urban planning, nutrition, and healthcare, must work together to target racism in public health. It also goes on to prove that once policymakers get involved, they can covet change to improve the lives of masses, it just takes public outcry to motivate reasoning. The change required is not dependent on one or two public agencies, but instead cooperation among a community of organizations to support those disproportionately affected by systemic injustice.

The Rhetoric of Policy Reform: From Awareness to Action

Holmes makes an argument for lawmakers to consider racism as a health concern in her article's closing. She appeals to the audience's feeling of justice by framing healthcare reform as a moral duty. Holmes's argument links systemic injustices to measurable health effects, specifically when she discusses the impact of food deserts on the prevalence of obesity and other disparities in the black community. Holmes’s language mirrors Kinkead's focus on the persuasive power of structural critiques. Her demand for change is consistent with the claim made by Hardeman et al. that anti-racism journalism can influence social change by supporting laws that eliminate systemic injustices.

White versus Black mortality rates have been a long discussion in healthcare epidemiology, as historically the Black population has had a disproportionately higher mortality rate in various pathologies. However, when Yehia et al. analyzed mortality rates for Black and White patients hospitalized with COVID-19 with consideration of insurance status and hospital status, endpoint mortality is similar. These results suggest that racial differences in COVID-19 morbidity and mortality outcomes could have been mitigated by providing equal access to healthcare services. Furthermore, these results demonstrate that mortality outcomes were comparable across all racial groups if proper healthcare services were obtained, which highlights the necessity of equal access to healthcare. The 2021 National Healthcare Quality and Disparities Report discuss how equal access to healthcare is vital to promote health equity, prevent disease, and reduce premature mortality, ensuring everyone has a fair opportunity to reach their highest level of health. It improves overall quality of life, lowers financial strain and fulfills a fundamental human right by eliminating disparities.

The relationship between healthcare journalism and antiracism initiatives is also reflected in published literature. By presenting racism as a public health concern and advocating for structural changes in the healthcare system, media can strengthen antiracism efforts, as noted by Hardeman et al. This is evident in reporting on COVID-19 disparities in maternal health outcomes among Black and Hispanic women, such as those highlighted in a United States Government Accountability Office (GAO) report. Healthcare journalists used this data to connect unequal outcomes to factors like access to care and institutional bias, shifting attention toward systemic reform rather than individual behavior. Holmes’s strategy for addressing racism in healthcare follows a similar approach, using language and tone to promote awareness of racial health inequities while reinforcing the need for structural change. Her call for policy reform aligns with findings from the GAO, which emphasize the urgency of addressing these disparities (United States GAO). At the same time, Holmes tailors her rhetoric to different audiences: she frames reform as a moral obligation for policymakers while using inclusive and empathetic language, such as “we must act,” to encourage a sense of shared responsibility among the public. By doing so, she not only raises awareness but also motivates advocacy, demonstrating how healthcare rhetoric can bridge the gap between understanding inequities and pushing for systemic change.