The enactment of racist laws, creation of discriminatory policies, and implementation of biased practices across the social, political, and economic spectrum to uphold White patriarchy has produced and sustained an interwoven and deeply embedded system of structural racism in the United States. This system of structural racism, established to maintain oppression over racialized and minoritized groups, continues to produce gross inequities across the board in access to education, social services, criminal justice, safe and healthy food and water, housing, employment, safe environments, and health care. These created inequities yield stark inequalities in physical and mental health and well-being for individuals and communities that are racialized and marginalized in the United States.
While the public and scientific discourse now clearly call out structural racism, there is much work yet to be done to dismantle the systems that keep it in place. Our work must evolve in the ways in which we study inequalities in health and well-being within and across racialized and marginalized groups. Quite simply, our public health enterprise cannot and should not simply stop at identifying inequalities in health status across racialized and marginalized groups (e.g., Black‒White differences in a given health status outcome). Rather, we must strive to carefully consider and expose the underlying system as well as intersecting systems of structural racism that produce these inequalities.
What appears to be a simple and logical next step does present challenges. To understand how structural racism operates, we must have and employ frameworks that recognize and appropriately center structural racism as a fundamental driver of inequities in the social determinants of health. Again, a simple and, yet, not simple task. Understanding and acknowledging inequities in the social, political, and economic structures that produce unequal health status requires taking the time and doing the work of recognizing the discriminatory laws, policies, and practices that undergird these inequities.
Next, we must be able to link these findings to concrete approaches that dismantle the racist and discriminatory laws, policies, and practices driving inequities in the social determinants of health. This means providing actionable steps at local, state, and federal levels. Equally important is the work to dismantle the cultural and societal norms, attitudes, beliefs, and practices that support and perpetuate racist and discriminatory laws, policies, and practices. The latter involves working at the community and grassroots level and cannot be undervalued for its ability to influence change from the ground up—an especially important consideration given the current divisiveness on these issues in the United States.
The articles in this supplement offer frameworks for future research that center structurally racist laws, policies, and practices as the fundamental drivers of health inequities. There are also articles that provide empirical evidence to this effect. But this is only the beginning. We hope that this issue serves as a clarion call for public health researchers, practitioners, advocates, and policymakers who will dedicate themselves and their work to provide further evidence as well as insights on approaches to dismantling the laws, policies, and practices that uphold structural racism. The health and well-being of all the people in the United States, not just some, depend on it.
Farzana Kapadia, PhD, MPH
AJPH Deputy Editor
Professor of Epidemiology School of Global Public Health, New York University, New York
Luisa N. Borrell, DDS, PhD
AJPH Associate Editor
Distinguished Professor Graduate School of Public Health and Health Policy City University of New York, New York
15. Years Ago
Who’s Using and Who’s Doing Time: Incarceration, the War on Drugs, and Public Health
Persons of color compose 60% of the incarcerated population. In 1996, Blacks constituted 62.6% of drug offenders in state prisons. Nationwide, the rate of persons admitted to prison on drug charges for Black men is 13 times that for White men, and in 10 states, the rates are 26 to 57 times those for White men. People of color are not more likely to do drugs; Black men do not have an abnormal predilection for intoxication. They are, however, more likely to be arrested and prosecuted for their use… . The impact of the criminal justice system is evident in the Black and Latino communities in major cities who often suffer from underserved state and government assistance for education, health, and employment. Services that might prevent drug use are underfunded, and the budget for the war on drugs increases… . There are more than 2 million men and women serving sentences in United States prisons, nearly three quarters for nonviolent offenses. The unequal enforcement of the war on drugs serves to fuel our spiraling incarceration rates and the removal of men, women, and children from our communities.
From AJPH, September 2008, Supplement 1, p. S177–S178
97. Years Ago
The Health Problem of the Negro Child
… [T]he data at hand … indicate that there is no marked physical inferiority in the negro race. Under similar economic and social conditions, the negro infants are born and reared as safely as … white children. The excessive morbidity and mortality rates among negro infants are due to conditions which are a menace to the whole population, white and black alike.
From AJPH, August 1026, p. 809
DOI: https://doi.org/10.2105/AJPH.2022.307175
Biography
