The recent murders of innocent black people are so deeply saddening that it is difficult to think about much else. It is hard to know how to respond, but it is clear that we—all of us—must do so. The longer the wound of systemic, structural and cultural racism festers, the greater a threat it becomes to humanity.

These words of the Rev. Dr. Martin Luther King, Jr. ground us in the listening needed now:

“A riot is the language of the unheard. And what is it that America has failed to hear? It has failed to hear that the plight of the Negro poor has worsened over the last few years. It has failed to hear that the promises of freedom and justice have not been met. And it has failed to hear that large segments of white society are more concerned about tranquility and the status quo than about justice, equality and humanity.”

How do we attune ourselves to hear the pain of another’s experience and allow ourselves to be moved past our comfort zone to respond? How do we cultivate empathy and compassion, and let love in action flow therefrom? How do we resist the temptation to be defensive, and instead search within ourselves for internalized cultural racism? I am listening for guidance on how I, with my privilege of whiteness, education, social status and all that that entails, can respond.

Understanding what it is like to live under oppression starts with empathy. We must hear directly from those who have lived the experience; for those of us with the privilege of not facing the constant oppression of racism, we must seek out listening opportunities as they arise. Another way of increasing understanding is to listen to the voices of those in public health and the social sciences, and to the community organizers themselves. What emerges is a factual, layered picture of how inhumanely challenging day-to-day life can be.

The impacts of racial discrimination span a lifetime. Even before a child is born, a fetus experiences the stress of poverty and racial prejudice. The trauma that the unborn child’s ancestors experienced is expressed through genetics, so the stress that one’s grandparent experienced living under oppressive laws enforcing segregation imprints on the health of future generations. African-American mothers are at far greater risk of developing complications in pregnancy, such as pre-eclampsia and preterm labor, and they are twice as likely as white women to die from complications after delivery.

Black children are far more likely to grow up in an urban, under-resourced neighborhood where there is a concentration of poverty and associated challenges, including violence inside and outside of the home, drug abuse, alcoholism and sexual trafficking. The likelihood that an African-American child will have adverse childhood experiences, which are predictive of physical and behavioral problems in and of themselves, is much higher than in white children. Compared to white children, African-American children are three times as likely to lose their mother by age 10.  My heart breaks writing these words, imagining a child coming into the world facing such staggering odds.

But the challenges only escalate from there. A child in a segregated school who has had frightening or threatening experiences—like one family I cared for in my residency that slept in the bathtub because it was the safest place to be—has a much harder time concentrating in school and less access to high-quality education. This increases the risk of not graduating from high school, and not being prepared for college. Systemic racism results in fewer job opportunities and makes it harder for African-Americans to rent or buy a house.

The stress of racial discrimination increases insomnia, depression, anxiety and unhealthy coping behaviors, including alcohol and drug use; it has also been shown to shorten telomere length, which translates to worse health and a shorter life.

It is hard for a white person to imagine what it is like to be considered at any given moment as lesser—dangerous, threatening, lazy or likely to steal. These experiences are regular for people of color, who describe being vigilant about the next act of racist discrimination. They have been shown to increase systemic inflammation, stress hormones, blood pressure, risk of heart disease, diabetes and other chronic disease. Indeed, African-Americans, and other people of color, have higher rates of chronic disease. They are diagnosed later and treated less aggressively, resulting in earlier mortality. Engaging with the medical system, they are again faced with more bias and racism, making it hard to follow a treatment plan from a provider that may not have earned a patient’s trust. All of this contributes to the increased risk of dying from illnesses like Covid-19.

Add to all of this the added threat of a prejudiced justice system that incarcerates five times as many African-Americans as white people. The threat of police brutality is real. I think of poignant times I bore witness to this inhumanity. As a medical student in my intensive care unit rotation, I took care of a beautiful human who had been recently paralyzed from the neck down after a police officer in Milwaukee violently kneeled on him. During my family medicine residency at San Francisco General Hospital, I admitted a critically ill gentleman who was in police custody for drug possession, who would die later that evening. As he moaned in discomfort in the emergency room, the police officers in the room, taunted and mocked him. It still brings tears and a wave of anger to recall how these two beings so deserving of care and compassion were treated.

I think a lot about what those of us with white—and other kinds of—privilege could do to protect our fellow humans of color from injustice, violence and hatred. What if I had come upon the horrific scene that unfolded in Minneapolis over those eight and a half unspeakable minutes? The police officer could have listened to a white person reflecting the horror of his actions. The officers I confronted years ago in the emergency room for their inhumane and inappropriate conduct were apologetic, and it felt good to report them to their supervisor. Yet such actions are far from enough.

We each need to find a way to serve our fellow human beings and our collective healing. Those of us with children have a responsibility to talk with them about injustice, prejudice and racism, and to encourage them to stand up for victims of discrimination. We can seek out opportunities to listen to the voices of those calling for allies, and we can listen with integrity and from a place of relationship. We can donate to those on the front lines who are doing the important work of community organizing and consciousness raising. We can place justice and equality in the center of our nonprofit, professional, political, ecological and philanthropic work, and our conversations with friends and family. We can be kind and compassionate and see every human being as someone’s son or daughter, deserving of love and respect.


Anna O’Malley, M.D., works with the Coastal Health Alliance and directs the Natura Institute for Ecology and Medicine in the Commonweal Garden.