The death of George Floyd has recently ignited protests across the world calling out institutional (or systemic) racism. Institutional racism operates at the societal level rather than at the individual level and refers to how old ideas and laws of white superiority are institutionalized in our current laws and practices of America. It is institutional racism that has black people living in dilapidated apartments and crime-ridden neighborhoods, their children going to under-resourced schools, and have them systematically more sick (morbidity) and dying (mortality) earlier than any other racial group. This broader perspective of racism at the systemic level takes into account the many ways a society fosters racial discrimination through housing, education, employment, media, health care, criminal justice, and other systems. Examples include segregation of schools, neighborhoods, and workplaces, redlining practices by lending institutions, negative stereotypes in the media, and mass incarcerations, to name a few.
Communities of color have suffered from health disparities since America’s inception. Health disparities refer to differences in health and health care between groups that are closely linked with social, economic, and/or environmental disadvantage. Numerous studies and analyses consistently show how black men, women, and children (and other people of color) categorically have worse health outcomes when compared to whites. For example, African Americans are 40% more likely to have high blood pressure than their white counterparts and 20% more likely to die from heart disease; African American women are 60% more likely to have high blood pressure than their white counterparts; and infant mortality rates for black infants are 11.46 per 1,000 live births, compared to 4.61 for non-Hispanic white infants (NHIS, 2019). These differences cannot be explained by genetics alone, or biological differences between people of color and white populations. Using racial segregation as a specific construct of its broader impact, minority neighborhoods often have lower tax bases to support basic infrastructure, greater exposures to environmental toxins, fewer jobs, less access to fresh fruits and vegetables, and fewer services close by, such as hospitals, etc. (Gee, 2004, Williams, 2001).
Social determinants of health (See below table) is a framework that is used to organize the many different factors that impact the health, well-being and quality of life for an individual.
This framework attributes health outcomes to more than just an individual’s genetics and life or lifestyle choices. As long as any one of these many complex issues are impacted by institutional racism, racism must be considered a public health issue.
Treating institutional racism as a critical public health issue allows us to use the incredible tools of public health to both understand a problem and design targeted interventions to address it.
Systemic racism must be addressed as more than an individual issue. By definition, when institutional racism remains unspoken or accepted, white privilege prevails. Addressing systemic injustices and inequalities makes our society accountable as a whole, and creates a shared call for change and reform.
Artiga, S., Orgera, K., & Pham, O. (2020, March 04). Disparities in Health and Health Care: Five Key Questions and Answers. Retrieved June 08, 2020, from https://www.kff.org/disparities-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/
Gee GC, Payne-Sturges DC. Environmental health disparities: a framework integrating psychosocial and environmental concepts. Environ Health Perspect 2004;112(17):1645-53.
Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press. https://doi.org/10.17226/10260.
NHIS – Tables of Summary Health Statistics. (2019, November 05). Retrieved June 08, 2020, from https://www.cdc.gov/nchs/nhis/shs/tables.htm
Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep 2001;116(5):404-16.