In September 2016, just before President Trump was elected, I wrote about why Islamophobia was a looming public health crisis that would cost countless numbers of lives. In response, my family received hate mail, I received a torrent of threats for condemning discrimination against Muslims. Today, that “looming” crisis has more than arrived, as a horrific terrorist attack against Muslims is leading to a global reckoning and greater acknowledgement of Islamophobia as a global problem.

Those of us who work in public health aim to fulfill individuals’ right to health and wellbeing. As I struggle with heartache for the 50 lives lost and the countless others who remain injured, it is more clear than ever that white supremacy is a public health issue. Beyond those killed and injured and their devastated families, Islamophobia is harming the health and wellbeing of millions more.

{mosads}In the U.S., hate crimes have increased annually since 2015 and in 2017, there was a 17 percent rise in hate crimes across the U.S., the largest spike in these crimes since 2001. Hate crimes against Jews and Muslims have increased annually since President Trump took office. These numbers are likely even higher as there is also massive under-reporting of hate crimes among groups who are fearful of repercussions.

Most people identify public health work with vaccination campaigns or clean water projects, but decades of public health research also demonstrate links among racism, mental health issues, violence and stress-related chronic conditions like cardiovascular disease. Public health research has proven that hateful ideology causes increased stress, unequal access to resources and health care and strained social and community relationships.

Decades of research shows us that white supremacist rhetoric and xenophobic policies cause illness and lead to premature death. Reversing the trend of Islamophobia in the west is not easy, but the first step is recognizing that Islamophobia is a chronic disease, normalized by mainstream politicians, media personalities, grassroots groups and policy makers in the west, that limits the daily lives and wellbeing of those stigmatized and threatens overall population health.

For stigmatized groups, including victims of Islamophobia, the persistent exposure to discrimination can be traumatizing, with pervasive, negative effects on mental and physical health. Fellow researchers and I documented that religious discrimination targeting Muslims is significantly associated with a myriad of negative impacts: greater psychological distress, more depressive symptoms, higher levels of fear, anxiety and post-traumatic stress disorder, more self-harm, lower self-esteem, less physical activity, an unhealthier diet, a higher body mass index and worse blood pressure.

One study by the University of Chicago found that among women with Arabic names in California who gave birth within six months of 9/11, there was an increase in preterm births and low birth rate. There was no such increase for other women. My research and that of others also shows that Muslim subgroups, such as women and older people, may face “double jeopardy” based on multiple stigmatized identities and have even worse health outcomes.

Fear of being demonized or becoming the victim of a hate crime also affects how people approach health care. Those who experience discrimination of any kind are less likely to seek care. In my work, I’ve found a consistent trend that women who wear the veil report that they face greater discrimination in health-care settings. One study found that women who reported religious discrimination were less likely to have had a mammogram in the last two years. If you live in fear and the people who are supposed to care for you subject you to the very prejudice that is harming your health, it is not surprising that you would forego preventive care.

The persistence of white supremacy and Islamophobia should be a critical concern to those in the health-care sector. Medical professionals and public health practitioners must take a preventative approach and address the individuals and systems that create the ideologies that propagate hate and crimes, threatening the health of innocent people and cause premature mortality. We must be even more vigilant to condemn hateful ideology and actions and must remain dedicated to social justice and promotion of health for Muslims and all marginalized groups.

Since I wrote that first piece in 2016, I’ve watched politicians and leaders continue to deny the effects of Islamophobia, but those 50 people who lost their lives and the others who remain injured deserve better. We owe it to them to work actively to prevent the epidemic of Islamophobia from taking more lives and making more people sick.

Goleen Samari is an assistant professor in the Heilbrunn Department of Population & Family Health at Columbia University Mailman School of Public Health.