The Black Health Commissioner at the Center of the Fight Against Covid-19 Racism

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Jeanette Kowalik, a Black woman, is the health commissioner for Milwaukee, a city that regularly ranks as one of theworst cities for livabilityfor Black women. She now presides over the health future of a city that at one point was the epicenter of the Covid-19 pandemic in the U.S., particularly for African Americans. The discovery that the majority of people with the virus in Milwaukee weremiddle-aged Black men was one of thefirst signals in the nation that this disease was not just for white people who had recently traveled abroad. 

Fortunately Kowalik, who was appointed health commissioner in September 2018, was prepared to deal with the racialized revelations concerning coronavirus. In July 2019, Milwaukee became thefirst city in the nation to declare racism a public health crisis, following the lead of Milwaukee County, which made the declaration a few months prior. Since then, more than80 cities and counties across the U.S. have followed suit withdeclarations of their own.

Under Milwaukee’s ordinance, Kowalik has been deputized, in a way, to help lead the city in addressing its racial disparities, in addition to her otherpolice powers to enforce law and order during the pandemic. In Milwaukee, people are mandated to wear masks, via city ordinance, and the city is one of the few that offers free masks to its residents — rather stylish ones at that. 

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Kowalik’s authority has been challenged from the beginning: A smattering of Milwaukeeans and Wisconsinites have created their own pro-choicemovement of sorts,fighting to exercise theirchoice not to wear masks. On top of that, Kowalik has to contend with the arrival of the Democratic National Committee, scheduled to hold its presidential nomination convention August 17 — 20 (though aconsiderably scaled-back version). The visit will serve as a stress test for Milwaukee,especially if it stirs protests, and especially with President Trump announcing he'll send a “surge”of federal officers to Milwaukee.  

CityLab spoke with Kowalik about her plans for making Milwaukee a more livable city for Black women, expanding the conversation around racism as a public health disaster, how she plans to handle the DNC and other uninvited visitors, and what to do about the “Karens” in her midst. The conversation has been edited for length and clarity.

Why was it important that Milwaukee declare racism a public health crisis, and what do you see as its obligation to the dozens of other cities that have since declared the same?

As a Black woman, I felt it was very important that we needed to acknowledge the elephant in the city, that Milwaukee has a pronounced history of segregation and redlining, like many other Northern cities. Many of our family members had relocated here from the South for a better life, and still had to deal with boundaries set up to contain Black folks living in certain areas of town, which obviously impacts access to a variety of resources: education, quality of food, healthcare services. We have always been top of the list for a number of health disparities, such as infant mortality. 

In 2017 we finished our community health improvement plan, called Milwaukee Elevate, and there are three focus points for this plan. One of them is focusing on dismantling racism. That the health community wanted to address racism head on is really unique because most health improvement plans only focus on specific things, like decreasing obesity or increasing immunizations. Our community health improvement plan said: Nope, we’re going to focus more on structural issues.

 Of course there was a lot of resistance from some of our local elected officials, but eventually we got it passed. Still, there were some concessions that we had to make to get it through. For instance, we wanted to address housing in our ordinance, but that was removed because of some concerns about the optics about present-day segregation and housing. The administration of the city wasn’t comfortable including that. So I have been telling other jurisdictions to make sure they're including housing because housing is health.

It was prescient that Milwaukee made this declaration before the pandemic. How has it applied in the Covid-19 context?

We just did a mask ordinance for Covid and we went through a number of clarifying questions for equity in the development of that ordinance to make sure that it wasn’t going to cause undue burden towards our communities of color. The fact that the county had made the declaration as well as the city, that racism is a public health crisis, really motivated us to be more intentional about tracking where Covid was in our communities. By maybe the second or third week of our response, we could clearly see who was being hit the hardest by Covid and it was African-American middle-aged men. One hotspot is in the Sherman Park neighborhood, which is where I grew up. It’s also where a number of the challenges that we’ve had for health disparities have occurred: a lot of infant mortality, a lot of violence, and a lot of issues with obesity. Now we’re seeing the same thing play out for Covid, which was very emotional for me.

How have Black and Latinx people responded to these efforts?

The Black community was initially upset. They were like, “What is going on? Where’s the help? Where’s the testing?” But there weren’t enough testing kits. The state was really rationing who could get tested. They were making sure that the people who were most at risk for death or disability were getting a test instead of just doing broad-based community testing. Then we started getting questioned about how we’re only doing stuff for the Black community, but not the Latinx community. We told them that actually the health department doesn’t have the bandwidth for that, but that community partners, like the federally qualified health centers, have been stepping up and helping, and so now we’re all communicating and collaborating.

You mentioned that the health department didn’t have the bandwidth to help the Latinx community. I want to be clear what you mean by that. Are you saying that because the health department was focusing on Black and White disparities, that it didn’t have enough resources to look at Latinx resources?

Part of the issue was that initially a lot of the focus was on international travelers. The CDC said that if you traveled to a“Level 3" country, then you should quarantine. Even some of the media at that time, or even just social media, we would see some of our community of color folks basically saying, “Well, I don’t need to worry about Covid, because Black people can’t get Covid.” But then we started to see Black people being the majority of the people getting Covid. We had to pivot quickly and switch the messaging, which was extremely difficult because our department, like many other health departments across the country, is always under-resourced. 

Read more: No, Black People Aren't Immune to Coronavirus

We were always behind because as things evolved along the way, we were playing catch-up on the messaging. Of course, with any non-English speaking community, you have to make sure you’re not only translating materials, but that they’re culturally relevant. That takes additional time to make sure you’re getting things out that are meaningful to the segments of the community that you’re trying to hit. But we were really playing defense for most of the response because of limited resources. Our health department typically only receives 2% of the tax revenue. Our budget is $14 million for a city of about 600,000 people. 

I’m not saying all of the Latinx community was up in arms. Some people understood, but there was just no messaging for them, or the messaging that we had was not resonating for them. It was, “Stay home, save lives.” And they were like, what does that mean? They told us, “Look, the messaging needs to be created for us by us, and not through some White marketing firm,” which is what the county had because they were thinking initially, “Oh, this is a general emergency response.”

Do you think the mask issue would have stirred so many protests if Covid-19 was disproportionately impacting White people?

No! Let’s be clear: When the virus first hit the scene, why was it getting so much attention? Because it was mainly affecting white people, right? People who would have the money and resources to go to China and Italy. There was no talk of domestic travel being a risk factor. But we started seeing that within our own early weeks of the outbreak, our second case was a Black man who got it from Atlanta. How come nobody’s talking about domestic travel? This was even in some of the feedback from our communities. They said, “Oh, we don’t have to worry if we don’t go to China. I don’t know anybody that goes to China.”

Revealing the race and ethnicity data helped to save what would be more targeted, poor communities of color, but also it served in a negative way because then White people were able to use it as a form of bioterrorism, in my opinion. Like, “Oh, well, we’re gonna just shut down these shelter-in-place orders, and we’re going to walk around and live our life and exercise our quote-unquote freedoms.” They weren’t saying that before. Look at the timing of all those protests. That didn’t happen until after we started revealing race and ethnicity data.

And you have actual police powers, as a health commissioner, to enforce these public health ordinances, right?

Yes, that’s state law, that empowers health officers to have the ability to take certain police powers to prevent the spread of disease. So what we have done is we issue an isolation order. It’s a legal order. If they violate it they can be fined up to $10,000 and they can be jailed. We haven’t jailed anybody, because obviously it’s Covid and the last thing you want to do is put somebody in jail now. I can also have law enforcement present at the house to make sure that they don’t leave. We have had to do that for TB, where you have a squad just sitting outside the house for days. But because the demand for Covid is so large, police and sheriffs do not have the ability to do that right now. Shutting places down is another one, or restricting access, getting orders where you’re limiting how many people can be in an establishment. That’s why some say that a health officer has more power than the police chief, because the police chief cannot do that. 

You said you didn’t want to see any “Karens” — people frivolously calling the police on others for not wearing masks and other matters that could be considered trivial.

It’s true though, right?

Let’s unpack that.

If you think about it, who normally creates laws? And who normally benefits from those laws? Normally not us. It’s meant to preserve their [Karens’] power position, which is why I’m happy that thiswhole Karen thing is being exposed because obviously it’s been going on far too long and it needs to stop. I didn’t want something that’s meant to save lives to backfire and be used against us. That’s why I called that out.

The upcoming DNC has been scaled back tremendously, but there will still be some level of traffic coming in. How have you been preparing for that?

We have been planning and working with the Secret Service on the DNC plans since last summer. The DNC host committee is still trying to have an in-person convention, definitely scaled back, but we’re holding the line. We know that travel is how Covid got here. Bringing in thousands of people from all over is not going to be wise. So the [DNC] has developed all of these rigorous plans to try to screen and make sure that people are not importing and spreading Covid. But our city’s order is still in effect, and should be for a while because obviously cases are not getting better. It says that for gatherings, there’s a limit of 250, or 50% of a building’s occupancy, or one per 30 square feet, whatever is less. It’s pretty much a wait-and-see, week-by-week, conversation on what will be allowed come the 17th of August. 

If you had it your way, would anyone be coming?

Nope. The reason why I say no is because the level of planning and the need to pivot from Covid response to DNC response is significant. We are already strapped and strained. The DNC having an in-person convention is going to really stress us even more. I’m not just talking about public health. I’m talking about everybody that’s involved — law enforcement, first responders, hospital systems, basically anybody involved with making sure that there’s a safe convention.

What is happening to make Milwaukee a more livable city for Black women, and for addressing this demographic’s unique challenges in the city?  

The work that I did in D.C. before I moved back to Milwaukee was totally about this. I was the associate director for women’s and infant health at the Association of Maternal and Child Health Program. We were very intentional about addressing maternal morbidity and mortality prevention specifically for Black women because of the trends that we were seeing through the review process. We were seeing a dramatic increase in Black women dying in childbirth or within the first year after having a child because of the health care system and their role in that. The bias, the variance in quality of care, the not listening to Black women — likewhat happened with Serena Williams. So one of the things that I helped to make a reality here in Milwaukee was our doula program. We were able to receive some seed money to develop a doula pilot program called BOMB: Birth Outcomes Made Better.

It provides some cash payments to contracted doulas who are already in the work and serving families in the zip code that is being hit hardest in our city, 53206, which tends to have the most disparities for Black and Brown women. The other side of the program is a health department actually hiring its own doulas to serve the community and provide a free service. Instead of women having to find $2,000 to have their own doula, we would provide these services. There has also been some support for establishing birthing centers here in Milwaukee, especially during the pandemic to serve as safe spaces for Black women.

I don’t want to skip the fact that you yourself are a Black women, with your own health challenges.

My experience in this role has been very brutal. I have been diagnosed with a number of autoimmune conditions including MS (multiple sclerosis) and AS (ankylosing spondylitis). I am a firm believer that the weathering of racism has contributed to my chronic illnesses. I think I’m the only Black health commissioner in the state. There needs to be more diversity in health commissioner roles. But the level of stress and harm that we experience in these worlds definitely creates an environment where it’s not safe to stay in these roles long. I’ve put myself through a lot career-wise, so my health isn’t the best. I took two weeks off to address a surgery that I had put off, which made my issue worse. But then conservative radio tried to turn it into this thing, saying something about my judgment isn’t good or something, because I took time out during the pandemic for myself. BS like that — the fact that we’re dehumanized and devalued and constantly disrespected while we’re trying to do good work for our community is very unfortunate. I just want to bring light to the need to protect Black women, especially those of us who are in leadership roles.

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