Carolyn Swope, MPH
Recent events in the United States — from the disproportionate impact of Covid-19 on Black communities to nationwide protests against police brutality — have brought racial inequity in the U.S. to the forefront. While health and policing might seem like separate issues, their disproportionate effect on Black communities illuminates a common root: that of structural racism.
Structural racism is a pervasive underlying element of our society that has been found to affect lives, whether we notice it or not, in countless ways – from health to housing and our built environments. Indeed, many local and state leaders have now officially declared racism to be a public health crisis. This is the first of a series of articles exploring the disparities caused by structural racism. In this first post, we’ll unpack the state of health disparities in the U.S. Next, we’ll discuss unequal access to healthy housing. And finally, we’ll examine broader disparities in access to healthy built environments.
Note that in this article series, given current events and a history of oppression and discrimination in the U.S. specific to the Black experience, we’ll specifically highlight the impact of structural racism on Black communities. However, this is not to say that other marginalized groups in the U.S. do not also face structural racism and its impact on health.
What is Structural Racism?
Structural racism, also known as systemic racism, refers to the ways in which racial inequity is built into our social structures and creates unequal access by race to goods, services, and opportunities. Structural racism goes beyond the racist beliefs that individuals may have at a personal level, and includes, for example, differences in access to high-quality education and housing, inability to build wealth through homeownership, or barriers to exercise the right to vote.
Because our overarching social structures influence the possibilities of how and where we live, structural racism can be seen across many different outcomes in the U.S. For example, a recent New York Times article vividly visualized the gaps between Black and white Americans, which have persisted from the 1960s to today. The article highlights discrepancies including, unemployment rate, college graduation, median household income, homeownership rate, incarceration rate — and life expectancy. Indeed, one major way that structural racism is manifest in the U.S. is in the form of health disparities.
The State of Health Disparities in the U.S.
Across almost every possible health outcome, there are well-documented, glaring disparities between Black and white Americans. Taken cumulatively, these disparities result in over three years of life lost for Black people as compared to white people.
In terms of chronic disease, Black Americans are more likely to have high blood pressure and diabetes, and to experience stroke, than their white counterparts. What’s more, Black Americans are prone to experience these diseases at younger ages. For example, African-Americans ages 18-49 are twice as likely to die from heart disease as white Americans.
Even if we consider an entirely different type of health outcome like maternal and child health, we find that Black mothers, newborns, and children face disproportionate threats to their health. As Delos has noted in its research on healthy maternal environments with the Humanity 2.0 Lab and its collaborators, maternal mortality is 3-4 times higher among Black women than among white women, and Black mothers also experience higher rates of severe pregnancy complications such as sepsis.
Structural Racism and Covid-19
In light of overarching health disparities in the U.S., the impact of Covid-19 is striking — but, unfortunately, not surprising. According to the CDC, hospitalization rates relating to Covid-19 are five times higher among Black Americans than white Americans. Death rates are higher as well. For example, the death rate is estimated to be six times higher for Blacks than whites among people aged 55-64.
What might cause these disparities? The CDC attributes Black communities’ increased risk to “long-standing systemic health and social inequities” — spanning everything from living, working, health, and social conditions. Due to these inequities, members of the Black community may be more likely to live in neighborhoods with pollution and environmental hazards linked to chronic diseases; to work in essential-industry jobs that don’t allow them to stay home and self-isolate; or to rely on public transit because they don’t own cars — to name only a few factors. All of these factors, in turn, increase risk of getting and/or having more severe illness from Covid-19.
How Structural Racism Shapes Health Disparities
Note that none of the above-mentioned causes for racial disparities in Covid-19 are rooted in biology or genetics. Racial disparities cannot be accounted for by biological differences alone. As explained by the American Academy of Pediatrics in their recent policy statement on racism’s impact on child and adolescent health, “health inequities are not the result of individual behavior choices or genetic predisposition but are caused by economic, political, and social conditions, including racism.” That is, health disparities are not caused by race itself: They are caused by racism, or the adverse effects of the social conditions we attach to race.
On a direct physical level, the chronic stress caused by interpersonal experiences of discrimination or by navigating the hassles of discernably unequal systems can lead to a stress response in the body: the “fight or flight” reaction. Researchers believe that constantly activating this stress response can, over time, lead to increased risk of disease. For example, one component of the stress response is an increase in blood pressure. Over time, higher blood pressure can contribute to hardened arteries and heart problems. In other words, racism can literally get “under the skin” to affect health.
Indirectly, structural racism also shapes health disparities by affecting access to the resources we need to be healthy — as described in the Covid-19 section above. For example, residential segregation is linked to lower-quality housing, air pollution, and worse access to quality health care, to name a few — all of which can adversely impact our health. (Our next two articles will examine the built environment, including housing and neighborhoods, in more depth.)
What Can We Do?
Structural inequity goes beyond individual behavior; thus, the solution must also be systemic. We can exercise our right to vote in a manner that supports driving structural change, just as we are encouraged to do with all of our beliefs and values. Another critical tool is to support organizations that are helping to drive structural changes in this regard, such as Black Lives Matter (find your local chapter here). Finally, we can organize our own communities to enact policies that promote racial equity at work, at school, in our neighborhoods, or at the city, state or national level.
Stay tuned for upcoming articles in which we explore the relationship between structural racism, healthy housing, and built environments.
Edited by Radhika Singh and Regina Vaicekonyte