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“Unnatural Causes”: Health Takes a Hit in Portland, Oregon

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Over the past month, Multnomah County, one of the largest employers in the Portland Metropolitan area has been roiled by claims of systemic employment discrimination. While other major cities across the U.S. have experienced an increase in African American residents in recent years, between 2012 and 2014, “liberal” Portland, Oregon’s Black community—already among the smallest of any major city in the country–saw its numbers drop even further.

For some in Portland, the recent firing of Tricia Tillman, one of the highest-ranking Black professionals in Multnomah County, and the first person of color to serve as the director of Multnomah County Public Health, has sent a chilling message about the prospects for upward mobility among professionals of color—and Black professionals in particular– in city and county government. But it also signals a potentially serious setback for people of color across the board, because arguably no one in the state has done more than Tillman to raise public awareness of equity, particularly with respect to the links between health disparities and environmental racism. Both are part of the long and lethal legacy of white supremacy in Oregon, the only state in the union with founding documents that expressly excluded African Americans.

On August 18, as Portland activists began gearing up for another face-off between anti-fascists and white supremacists, at a meeting with Joanne Fuller, Tillman’s supervisor, the Director of the Multnomah County Health Department, Tillman was reportedly pressured to “gracefully” resign from the position she had held for the past two years. Over the past month, Tillman’s firing has set off a storm of criticism culminating in the launch of a formal investigation into institutional racism in the Multnomah County government, a hefty financial settlement, and the abrupt resignation of Fuller.  For many, Tillman’s dismissal also serves as yet another reminder of the disconnect between Portland’s reputation for progressive politics and sustainability, and the lived experience of people of color in Portland. For many, Tillman’s dismissal demonstrates that white supremacy often takes more subtle and insidious forms than the visible and high profile violence that drew national attention to Portland in May.

Tillman, who was widely expected to succeed Fulton as Director of the Health Department, was seen by many in the city as uniquely skilled, well suited and committed to advancing equity in a region where it is sorely lacking. A native Portlander, raised by a single mother, Tillman graduated from St. Mary’s Academy in downtown Portland, and went on to earn an undergraduate degree at Catholic University in Washington, D.C., the first on her mother’s side of the family to complete university. In this respect, her background could hardly form a more stark comparison to the inherited wealth and privilege of Multnomah County Chair Deborah Kafoury and Portland Mayor Ted Wheeler.  Kafoury’s mother Gretchen Kafoury preceded her as a member of the Multnomah County Commissioner and also served on the Portland City Council, and as an Oregon state representative. If Deborah Kafoury hails from a family of regional power brokers, her immediate predecessor as County Chair, Wheeler could easily serve as a kind of poster boy for the benefits of intergenerational capital—and political power—accrued through settler colonialism. Wheeler descends from a family of lumber barons, who set up business in the coastal town that still bears the family name. As documented in a 2016 Willamette Week article, after merging with Willamette Industries, the family business would be sold to Weyerhauser in 2002 for $6 billion, with Wheeler’s father Samuel garnering an estimated $83 million from the sale.

As she recounted in a phone interview, Tillman’s interest in pursuing a Masters in Public Health was spurred by her experience working in Tucson at the El Rio Neighborhood Health Center. Tillman describes her experience in Tucson as “transformative,” as a critical lesson in “working in partnership with communities…in a culturally specific capacity.”  As The Skanner has reported, as a graduate student pursuing a Masters in Public Health at Boston University, Tillman “received a Martin Luther King Fellowship” from BU and a public health fellowship through the Congressional Black Caucus Foundation.”

While she worked on her MPH, Tillman honed her commitment to a community-based approach to health issues impacting communities of color. She volunteered at a childcare center focused on children “infected or affected by HIV”; and with an organization that served Haitian women, with services addressing health care, immigration and domestic violence. After completing her MPH, Tillman went on to intern with the famed Boston Women’s Health Collective and the Codman Square Women’s Health Center.

By 2007, when she was tapped to launch the Multnomah County Health Equity Initiative at the instigation of then County Chair Wheeler, Tillman already had a history of collaborating with grassroots organizers on environmental racism in the region, alongside work on adolescent sexual health disparities and county policies impacting HIV. A September 13 letter of support for Tillman signed by fourteen prominent leaders of color, including two retired state senators, Avel Gordley and Margaret Carter, describes Tillman as “a critical architect in much of the equity work that was implemented throughout the county and health department,” and as a “visionary” who was “notably effective at building community partnerships with organizations that are often left out and marginalized.” As an article in the Portland Tribune noted, Tillman has been the recipient of “several awards, including the Oregon Advocacy Commission’s Health Equity Champion award, and was appointed by Gov. Kate Brown to the state Public Health Advisory Board last year.” Tillman, moreover, is presently “awaiting state Senate confirmation to the Oregon Housing Stability Council.”

Under Tillman’s leadership, the Health Equity Initiative, the first in the state to address health issues that disproportionately impact communities of color, was among the frontrunners nationwide. Tillman would go on to be appointed in 2009 to direct the Oregon Health Authority’s Office of Equity and Inclusion, before being heavily recruited to return to lead Multnomah County’s Public Health Division. Documents secured by the Portland Tribune demonstrate that Tillman received strong formal reviews from her supervisor, Health Director Joanne Fuller.

Six weeks after Tillman returned, however, from a family leave caring for her mother, who has been diagnosed with stage 4 recurrent lung cancer, citing conflicts with two subordinates under Tillman’s supervision, Fuller reportedly informed Tillman that she had “no future” at an agency where she had worked for a total of twelve years. .

Under Tillman’s leadership, the Multnomah County Equity Initiative, along with other emerging initiatives nationwide, would gain traction with the 2008 release of the four-part PBS documentary series “Unnatural Causes—Is Inequality Making Us Sick?” which helped spur national and local dialogue and awareness of the health effects of racism and inequality. “The single strongest predictor of our health,” extolls the educational materials accompanying the film, “is our position on the class pyramid.” Historical and ongoing patterns of housing, education and employment discrimination, together with the chronic stress of racism in the U.S., mean that “African Americans typically have worse health and die sooner than their white counterparts,” even those with comparable incomes. Historic patterns of housing discrimination and discriminatory practices in the siting of toxic waste and interstate highways are among the variables accounting for higher rates of asthma and other diseases among communities of color.

If higher wealth and income correlate with better health outcomes, nationwide, people of color have lost considerable economic ground over the past three and a half decades. According to a 2017 study by the NGO Prosperity Now and the Institute for Policy Studies, “between 1983 and 2013, the wealth of median Black and Latino households decreased by 75% (from $6,800 to $1,700) and 50% (from $4,000 to $2,000), respectively, while median White household wealth rose by 14% (from $102,200 to $116,800).”

Excluded from the housing loans and benefits that helped spur white homeownership among veterans returning from World War II, and subjected to “redlining” and other forms of housing discrimination, historically oppressed communities of color in the U.S. only began to gain ground in homeownership in the wake of the Civil Rights Movement and passage of the 1968 Fair Housing Act. But much of the wealth gained during that era was lost during the subprime lending crisis, which “erased” any progress since realized in Black homeownership, which was reduced nationally by six percent, to 41.2 percent .

While nationwide health outcomes for communities of color are significantly lower for several markers than their white counterparts, in “progressive” Multnomah County, the situation for communities of color and Blacks in particular is, by a number of markers, significantly worse than the national average. In the wake of the subprime lending crisis, amid a wave of gentrification and housing speculation, while “white homeownership held steady…black homeownership [in Portland] fell by more than one-quarter, from 37.7 percent to 27.1 percent”.  According to a 2014 study by the Multnomah County Health Department, “child poverty prevalence is higher for all communities of color” in Multnomah County” than it is nationally, with the stats on Black/African Americans in Multnomah County (50.5%) exceeding by 15% the national average (35.4%) for Black/African Americans.”

By many measures, according to the 2014 report,  health outcomes for people of color in Multnomah County lag significantly below not simply those of “non-Latino whites” but of their own demographic groups nationwide. With the exception of Native Americans, the death rates from cancer for all other communities of color in Multnomah County exceed those of the same demographic groups nationwide, while significantly outstripping cancer death rates for whites both locally and nationally. With the exception of American Indian/Alaskan Natives, infant mortality rates among communities of color in Multnomah County are, lower than the national average –in a country that, according to the Center for Disease Control, ranks 26th in the world, behind the Czech Republic and Slovakia). However, compared to infant mortality rates among non-white Latinos in the County, the disparities are startling, with the Black/African American infant mortality rate “2.6 times greater than the non-Latino white rate.”  The 2014 study also demonstrated significant racial disparities in exposure to diesel particulate matter, which, the study notes, citing the World Health Association, is correlated with a host of health issues, from “irritation of the eyes, throat, and lungs,” to asthma and “early death caused by heart disease, lung disease, and a variety of cancers.”

While Portland’s record of health disparities has yet to garner significant media attention, over the past few years the city’s reputation for “sustainability” has been more than a bit sullied in the wake of wide spread airborne heavy metal contamination. In 2013, researchers at the University of Massachusetts identified Portland as the home of the nation’s number 1 industrial polluter Precision Castparts Corp. Toxics emitted from Precise Castparts, noted a story in the Oregonian, topped even that of the notorious polluter E.I Dupont. Three Portland-area Precision Castparts factories emitted high levels of cobalt and cobalt compounds, placing exposed communities in danger of a host of respiratory problems. In early 2016, the Oregon Department of Environmental Quality (DEQ) and Oregon Health Authority (OHA) announced that high levels of arsenic and cadmium—159 times the rate deemed safe for arsenic, and 49 times the “safe” rate for cadmium –had been detected in Portland neighborhoods in proximity to two Portland glass factories. The agency had reportedly waited eight months to make the information public. Within a week or two of the announcement, Oregon senators Jeff Merkley and Ron Wyden declared the air borne contamination a “public health emergency,” as the DEQ and OHA worked to map the toxic plume and set up neighborhood meetings to field questions and concerns. Frustrated by the DEQ’s foot dragging, Merkley and Wyden “demand[ed] that the agencies entrusted to protect public health act decisively on the matter.”

In the week following news of Tillman’s dismissal, with the county commissioners ironically poised to vote on a new workforce equity initiative, the September 14 county commissioners meeting was jammed with employees of color and outraged supporters. Among them was Sarah Clark, an activist with the community group South Portland Air Quality, whose testimony in support of Tillman drew a standing ovation from the crowd. Clark spoke to Tillman’s role in working with residents of the low income Brentwood Darlington neighborhood, where “families speak eleven different languages” and residents have a long history of being shut out of public processes. While other officials told activists it would be months before they could expect to hear back about their concerns, Tillman “reached out” to organizers; she “listened to all our needs….She honored the role of the community and supported rather than directed.” Tillman, said Clark, was instrumental in facilitating a “joint effort” between residents and “the Multnomah County Health Department, DEQ and OHA” to address community concerns. “When DEQ, OHA, and the Mayor’s Office [and] the city commissioners were giving us the runaround, dismissing our concerns, and speaking with condescension, and trying to put us off at every turn, in her role as public health director,” Tillman “stood shoulders above her colleagues….” As a result, the health department had “garnered a reputation for being a resource and for taking thoughtful action.” With other community voices joining with Tillman to demand an investigation into the role that institutional racism may have played in Tillman’s dismissal, the investigation, Clark argued, needed to solicit particular input from “communities and individuals” who would be most “impacted” by the loss of her leadership at the County.

As the Oregonian reported, Tillman’s claims of systemic racism in Multnomah County government were bolstered at the hearing as “more than a dozen employees testified about experiencing or witnessing systemic racism within Multnomah County’s workforce. Among those testifying was Leslie Thomas, an employee with the County’s Aging and Disability Services, who recounted an incident in which a coworker jokingly equated the post-Harvey Texas clean up efforts with “killing every n—— in sight”.

Publicly calling out the “inactive role” of the County and her own supervisors,” Thomas reported that the incident was treated as a workplace “conflict” requiring mediation, rather than as a matter warranting disciplinary action. Also testifying at the hearing, as the Portland Tribune noted, was “Sherelle Jackson, a county human services manager,” who “called racism ‘rampant and prevalent in this county,’ saying ‘this is personal to me and to every employee who’s pulled me in a corner, pulled me in a room or sent me an email pleading for help because of discrimination they are facing.’”

Within days of the hearing, at which Chair Kafoury promised a sustained investigation into racial discrimination in the Multnomah County workforce, the county settled with Tillman, offering her an expanded severance package amounting to $165,000 on the condition that Tillman agree not to pursue any further legal claim. The county issued a letter on September 25, reporting on the results of an investigation conducted by the county’s Human Resources Director Travis Graves concluding that racial discrimination had played no part in Tillman’s termination.  Tillman’s termination, the county has continued to insist, was rooted in complaints from subordinates about her managerial style–complaints that were never formally documented in Tillman’s employment reviews.

The same day that the determination was issued, the Director of the Multnomah County Health Department, Joanne Fuller, Tillman’s supervisor who, together, presumably, with Kafoury and Multnomah County Chief Operating Officer Marissa Madrigal, presided over her termination, announced her retirement—effective the same day.

Two days later, Loretta Smith, the sole Black county commissioner, held a joint press conference with other community leaders of color, including Gordly, Carter and Oregon Senator Lew Frederick.  In a rare political contest for Portland, Smith, herself the focus of an earlier County ethics investigation, will be facing off against another highly visible Black community leader, Jo Ann Hardesty, an outspoken police accountability advocate, former Oregon state representative, and current President of the Portland NAACP, for a seat on the Portland City Council. The group dismissed the results of the County’s investigation, particularly in light of Graves’ own role—as County Human Resources Director—in Tillman’s termination. “This appears to be a one-sided process focused on justifying the previous actions of the human resources bureaucracy, said Smith, “and the end result is the manager of color is the one left having been smeared in the media and, more importantly, in the public’s eye.”

The group called for an independent investigation into both the treatment of Tricia Tillman, and systemic racism in Multnomah County.

In an interview with Portland’s Willamette Week, “Multnomah County Chief Operating Officer Marissa Madrigal pledged… that there will be a thorough independent review of the type Smith is seeking” with Tillman’s firing to be used as a “’case study’” . While Smith specifically sought input from the county commissioners in selecting the reviewer, the selection, it seems will be Madrigal’s to make. Given the long history of involuntary medical experimentation on people of color, and the repeated relegation of people of color to objects of a white medical gaze, the prospect of treating Tillman– whose career has focused on empowering people of color and low-income people–as a “case study” seems bitterly ironic. It seems likely, moreover, that serving as a “case study” for the county will only open her up to forms of disproportionate scrutiny that, as a number of people testified at the September county commissioners hearing, are common among people of color in Multnomah County.

Given the sizable severance package Tillman ultimately secured, she undoubtedly fared better than many other people of color who have been fired by the county. Tillman is currently working under contract on an organizational equity assessment for the Oregon Department of Human Services. And while hopefully her expertise will continue to benefit Oregonians statewide, one is left to ponder the health effects of this ordeal for Tillman, her family, and more broadly, for other workers of color in Multnomah County, who’ve followed Tillman’s “case” over the past six weeks. One thing is certain: communities like Brentwood Darlington are unlikely to find any time soon another ally and advocate like Tillman who, in the words of South Portland Air Quality’s Sarah Clark, “listened to all our needs…. honored the role of the community and supported rather than directed,” one who “stood shoulders above her colleagues.”

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Desiree Hellegers is a co-founder and affiliated faculty of the Collective for Social and Environmental Justice at Washington State University Vancouver, and author of No Room of Her Own: Women’s Stories of Homelessness, Life, Death and Resistance (Palgrave, 2011).

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