“Whether they've done anything beyond performance could be argued”: A focus group study examining the perceived impact of a racism is a public health crisis declaration

In recent years, local governments have begun to explicitly recognize that racism is a public health crisis that requires policy reforms to address systemic drivers of inequality. In May 2019, Milwaukee County, WI became the first locality in the U.S. to adopt such a resolution. It is not clear to what extent these declarations foster substantive change. We use Milwaukee County, WI as a case study to determine community perceptions of the impacts of declarations naming racism as a public health crisis. Between December 2022 and March 2024, we conducted ten focus groups with minoritized communities in Milwaukee County, WI. The 50 participants were stratified based on self-identified race/ethnicity, with one group specific to LGBTQ+ members of these communities. Focus group transcripts were analyzed using rigorous and accelerated data reduction (RADaR) and reflexive thematic analysis (RTA) approaches to qualitative data. Focus groups suggest little awareness of the resolution and some skepticism toward its ability to foster change. Few indicated that the inequities within the county have improved since 2019. Analysis of perceptions of the declaration’s impact yielded three key themes: 1) the declaration represents the potential for needed reform, 2) limited public-facing action fosters frustration and skepticism, and 3) communication failures impact the promotion of health equity. There was a strong desire to see active, direct engagement from government officials in their communities. Overall, findings indicate that declarations alone may not be sufficient to spur meaningful policy action that impacts communities in a broadly noticeable manner. • Structural racism remains a key driver of health inequities in the U.S. • Milwaukee County, WI was first locality to declare racism a public health crisis • Local policy actions are a pathway for mitigating inequities • Declarations alone appear insufficient to spur publicly noticeable policy change • Declarations without noticeable action are seen by community as performative