Since 2019, a growing number of local governments in the United States (US) have made declarations that racism is a public health crisis. These resolutions proliferated in the wake of the COVID-19 pandemic. The resolutions recognize the conjunctural nature of racism in the US and institute organizational changes and new policies but often fail to implement meaningful change in racial and health inequalities on the ground. Comparing the cases of Milwaukee, Wisconsin and Chicago, Illinois and drawing on theories of biopower and stratified biomedicalization, this paper argues that these declarations instigate a shift in public health governance. Public health authority is expanded across multiple government domains, widening the scope of its jurisdiction and massifying the process of biomedicalization, combined with an economization of downstream programming by triaging resources via epidemiological metrics of vulnerability. Public health departments shift from providing services to becoming policy "strategists," which entails efforts to reduce organizational bias and a devolution of programming to communities. As a result, the biomedicalization of racism through these declarations enables an uneven and intermittent public health response that fails to attend to the lived experience of racism on the ground.