Board of Health calls commissioner’s comments an ‘embarrassment’

The strongly worded statement was adopted by 12 members of the board who were present (three were absent) at a Thursday board meeting, a week after The Washington Post reported that Greene — appointed by Republican Gov. Glenn Youngkin — had repeatedly downplayed the role of racism in health disparities during his five months as leader of the state’s Department of Health. 

In an interview with the paper, Greene said he had yet to see “compelling evidence” that racism played a role in well-documented maternal and infant health disparities for Black mothers and their babies. He also described racism as a “politically charged” word, telling the Post that “if you say ‘racism,’ you’re blaming White people.”

While Greene has since backpedaled on some of his comments, the board’s resolution described his interview as “contrary” to members’ positions and well-documented scientific evidence on the role of racism in public health disparities. Members directed both the commissioner and department staff to “acknowledge” those differences and allocate resources to divisions within the agency focused on “improving practices and delivery of care that will reduce these disparities over time.

The resolution also prohibits the commissioner and other agency spokespeople from making public statements “contrary to the board’s policy or intentions” regarding health disparities, or comments “that carry a message of denial of basic scientific facts.”

“You are the voice and the face for the Department of Health,” said Dr. Holly Puritz, a Norfolk-based OBGYN board member affiliated with the Medical Society of Virginia. “And whatever you may think personally, when you were speaking on our behalf, your words were very hurtful, your words were very damaging, and very damaging to the very hard-working people of this organization.”

The state’s Board of Health does not have supervisory authority over either Greene or VDH, and the resolution can only serve as guidance for the commissioner and department staff, according to a representative from the Office of the Attorney General who attended Thursday’s meeting. But it marked the first time that the board, currently made up of members appointed by former Democratic Govs. Terry McAuliffe and Ralph Northam, has publicly rebuked a commissioner or issued a public directive related to their leadership.

And while four members, including Chair Faye Prichard, will see their terms end June 30, Youngkin will not have the opportunity to appoint a majority on the board until 2024. That could put Greene at continued loggerheads with the body, which lists reducing health disparities as a priority public health issue and is tasked with providing assistance in both planning and policy development to the department.

In a more than hour-long question-and-answer session added to Thursday’s agenda, Greene said many of his comments in the Post’s article were taken out of context while maintaining that structural racism was not the only contributing factor to clearly documented disparities in pregnancy-related deaths and infant mortality between White and Black mothers and babies.

“We can’t talk about racial disparities without talking about the effects of racism,” he said, describing his comments to the Post as part of a broader discussion of the department’s messaging and his efforts to avoid being divisive. “But I would rather put emphasis on specific effects, such as maternal disparities, death disparities, infant death disparities.”

“One of the problems with structural racism is it’s not an objectively quantifiable variable,” Greene added later in the meeting. “That’s why I’d like to look at measures from the department so I can understand it.”

Multiple board members disagreed with Greene’s assessment that structural racism was not a measurable factor, especially given years of research on how discrimination affects health beyond socioeconomic status and other social determinants. The Washington Post cited research by David R. Williams, a professor of public health and African and African American studies at Harvard University, along with studies on how racial inequalities take a physical toll on the health of Black patients.

Patricia Anne Kinser, an assistant dean for research at the Department of Family and Community Health within VCU’s School of Nursing, pointed out the disparities remain regardless of education level. Pregnancy-related deaths among college-educated Black women are nearly twice as high as they are for White women without high school diplomas, and the infant mortality rate for their babies is more than three times as high.

While Greene described the interview as a “learning experience,” pledging to improve his public communications, he stood by other comments in sometimes-tense exchanges with board members. Those included his objections to the term “gun violence,” which he described to the Post as a “Democratic talking point.”

“I’m worried about getting the message across and losing the audience,” he told Prichard, who asked if his concerns over offending people with the term outweighed its importance in describing events like the recent school shooting in Uvalde, Texas.

“Gun violence is a term that actually combines — and again, conflates — four different issues,” Greene said. He told the board that firearm-related deaths as a category includes suicides, homicides and a relatively small number of accidents and mass shooting events, all of which have different sources and motivations.

“To lump those all together by the fact that there was a firearm involved ignores the fact that there are very different origins for those four different problems,” he said. “And I’m concerned that we’ll miss the opportunity to actually address the root causes of why people choose to take their own lives, why people choose to take other people’s lives, how dangerous items like firearms are handled carelessly to allow children to be hurt, and what it is in our society that causes people to want to be mass murderers.”

“Those are the things that I think we should be looking at,” Greene continued. “Not the actual method that people are using.”

His views stand contrary to policy recommendations from more than a dozen research groups and health organizations including the American Public Health Association, Johns Hopkins Center for Gun Violence Solutions, American Psychological Association and John Jay College for Criminal Justice. All use the term gun violence and list measures to control and limit access to firearms as crucial steps in reducing deaths across the United States.

The commissioner did not respond directly to the resolution, nor take questions from reporters after the meeting. And while he told the board he did believe there was compelling evidence that racism played a role in maternal and infant health disparities, walking back his previous statements, it’s unclear if the directive will change his plans for the department.

Earlier this month, the Post reported that Greene had removed an online presentation that listed one of the department’s priorities as exploring and eliminating “drivers of structural and institutional racism” within its Office of Family Health Services. The document has not been restored to the agency’s website, though Greene told the board that he had directed staff to investigate factors contributing to health disparities including the state’s high rates of infant and maternal mortality among Black families.

In Thursday’s meeting, he also said he had removed a VDH webpage with links to “inappropriate” resources on sexual health at the request of a lawmaker, though it was not immediately clear what exact information was removed from the agency’s website or who made the request. 

Board member James Edmondson said those actions, combined with Greene’s responses to many of the questions posed throughout the meeting, left him with lingering concern over the future direction of the agency.

“Despite his denials, this was a political act,” Edmonson said. “He’s reflecting the wishes of the current administration.” 

And Greene himself bristled at the idea that he couldn’t continue to question the root causes of health disparities and other long-running work within the health department.

“This meeting is a start, but I also maintain that we need to make better use of data and objective measures,” he told the board’s vice chair, Dr. Wendy Klein, in response to a question on how he planned to rebuild morale and trust within the department.

“You talk about ‘established science,’ and that’s kind of a chilling word for me,” he continued. “That tells me I’m not allowed to disagree.”