Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-20T14:59:16.336Z Has data issue: false hasContentIssue false
  • English
  • Français

STRUCTURAL RACISM AND HEALTH INEQUITIES

Old Issues, New Directions1

Published online by Cambridge University Press:  15 April 2011

Gilbert C. Gee  and
Chandra L. Ford
Gilbert C. Gee*
Affiliation:
School of Public Health, University of California, Los Angeles
Chandra L. Ford
Affiliation:
School of Public Health, University of California, Los Angeles
*
Gilbert C. Gee, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095. E-mail: gilgee@ucla.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Racial minorities bear a disproportionate burden of morbidity and mortality. These inequities might be explained by racism, given the fact that racism has restricted the lives of racial minorities and immigrants throughout history. Recent studies have documented that individuals who report experiencing racism have greater rates of illnesses. While this body of research has been invaluable in advancing knowledge on health inequities, it still locates the experiences of racism at the individual level. Yet, the health of social groups is likely most strongly affected by structural, rather than individual, phenomena. The structural forms of racism and their relationship to health inequities remain under-studied. This article reviews several ways of conceptualizing structural racism, with a focus on social segregation, immigration policy, and intergenerational effects. Studies of disparities should more seriously consider the multiple dimensions of structural racism as fundamental causes of health disparities.

Keywords

RacismDiscriminationHealth DisparityRaceEthnicityImmigrantSocial DeterminantsInequity
Type
Unpacking Racism and its Health Consequences
Information
Du Bois Review: Social Science Research on Race , Volume 8 , Issue 1: Special Issue: Racial Inequality and Health , Spring 2011 , pp. 115 - 132
Copyright
Copyright © W.E.B. Du Bois Institute for African and African American Research 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

The authors thank Kaori Fujishiro, the guest editors, and several anonymous reviewers for invaluable comments on an earlier draft of this manuscript. The authors acknowledge support from the California Center for Population Research at the University of California at Los Angeles.

References

REFERENCES

Acevedo-Garcia, D. (2000). Residential Segregation and the Epidemiology of Infectious Diseases. Social Science & Medicine, 51(8): 1143–1161.CrossRefGoogle ScholarPubMed
Almond, D. V., Chay, K. Y., and Greenstone, M. (2006). Civil Rights, the War on Poverty, and Black-White Convergence in Infant Mortality in the Rural South and Mississippi. Working Paper No. 07-04, Department of Economics, Massachusetts Institute of Technology.CrossRefGoogle Scholar
Angelon-Gaetz, K. A., Richardson, D. B., and Wing, S. (2010). Inequalities in the Nuclear Age: Impact of Race and Gender on Radiation Exposure at the Savannah River Site (1951–1999). New Solutions, 20(2): 195–210.CrossRefGoogle ScholarPubMed
Araujo, B. Y. and Borrell, L. N. (2006). Understanding the Link between Discrimination, Mental Health Outcomes, and Life Chances Among Latinos. Hispanic Journal of Behavioral Sciences, 28(2): 245–266.CrossRefGoogle Scholar
Barkan, E. R., Diner, H., and Kraut, A. M. (2008). From Arrival to Incorporation: Migrants to the US in a Global Era. New York: New York University Press.Google Scholar
Barker, D. J. P. (2002). Fetal Programming of Coronary Heart Disease. Trends in Endocrinology and Metabolism, 13(9): 364–368.CrossRefGoogle ScholarPubMed
Becker, M. H. (1986). The Tyranny of Health Promotion. Public Health Review, 14(1): 15–23.Google ScholarPubMed
Bell, J. F., Zimmerman, F. J., Almgren, G. R., Mayer, J. D., and Huebner, C. E. (2006). Birth Outcomes among Urban African American Women: A Multilevel Analysis of the Role of Racial Residential Segregation. Social Science & Medicine, 63(12): 3030–3045.CrossRefGoogle ScholarPubMed
Bobo, L. (2000). Racial Attitudes and Relations at the Close of the Twentieth Century. In Smelser, N., Wilson, W. J., and Mitchell, F. (Eds.), America Becoming: Racial Trends and Their Implications, pp. 262–299. Washington, DC: National Academy Press.Google Scholar
Bonilla-Silva, E. (1997). Rethinking Racism: Toward a Structural Interpretation. American Sociological Review, 62(3): 465–480.CrossRefGoogle Scholar
Borrell, L. N. (2005). Racial Identity among Hispanics: Implications for Health and Well-Being. American Journal of Public Health, 95(3): 379–381.CrossRefGoogle ScholarPubMed
Boswell, R. A. (2003). Racism and U.S. Immigration Law: Prospects for Reform after “9/11”? Immigration and Nationality Law Review, 7: 315–356.Google Scholar
Boyd, D. (2009). White Flight in Networked Public Places? How Race and Class Shaped American Teen Engagement with MySpace and Facebook. In Nakamura, L. and Chow-White, P. (Eds.), Digital Race Anthology. New York: Routledge Press.Google Scholar
Brave Heart, M. and DeBruyn, L. M. (1998). The American Indian Holocaust: Healing Historical Unresolved Grief. American Indian and Alaska Native Mental Health Research, 8(2): 60–82.Google ScholarPubMed
Brondolo, E., Halen, N. Brady ver, Pencille, M., Beatty, D., and Contrada, R. (2009). Coping with Racism: A Selective Review of the Literature and a Theoretical and Methodological Critique. Journal of Behavioral Medicine, 32(1): 64–88.CrossRefGoogle Scholar
Bruch, E. and Mare, R. (2006). Neighborhood Choice and Neighborhood Change. American Journal of Sociology, 112: 667–709.CrossRefGoogle Scholar
Carmichael, S. and Hamilton, C. V. (1967). Black Power: The Politics of Liberation in America. New York: Vintage Books.Google Scholar
Catanzarite, L. (2000). Brown-Collar Jobs: Occupational Segregation and Earnings of Recent-Immigrant Latinos. Sociological Perspectives, 43(1): 45–75.CrossRefGoogle Scholar
Chae Chang Ping v. United States (1889). 130 U.S. 581.Google Scholar
Chae, D. H. and Walters, K. L. (2009). Racial Discrimination and Racial Identity Attitudes in Relation to Self-Rated Health and Physical Pain and Impairment among Two-Spirit American Indians/Alaska Natives. American Journal of Public Health, 99(S1): S144–S151.CrossRefGoogle ScholarPubMed
Clarke, S. P., Davis, B. L., and Nailon, R. E. (2007). Racial Segregation and Differential Outcomes in Hospital Care. Western Journal of Nursing Research, 29(6): 739–757.CrossRefGoogle ScholarPubMed
Collins, W. J. and Margo, R. A. (2001). Race and Home Ownership: A Century-Long View. Explorations in Economic History, 38(1): 68–92.CrossRefGoogle Scholar
Daniels, J. (2010). Race, Civil Rights, and Hate Speech in the Digital Era. In Everett, A. (Ed.), Learning Race and Ethnicity: Youth and Digital Media, pp. 129–154. Cambridge, MA: MIT Press.Google Scholar
Darity, W. A. Jr. (2003). Employment Discrimination, Segregation, and Health. American Journal of Public Health, 93(2): 226–231.CrossRefGoogle ScholarPubMed
Darity, W., Dietrich, J. and Guilkey, D. K. (2003). Persistent Advantage or disadvantage?: Evidence in Support of the Intergenerational Drag Hypothesis. American Journal of Economics and Sociology, 60(2): 435–470.CrossRefGoogle Scholar
de Castro, A. B., Fujishiro, K., Schweitzer, E., and Olivia, J. (2006). How Immigrant Workers Experience Workplace Problems: A Qualitative Study. Archives of Environmental and Occupational Health: An International Journal, 61(6): 249–258.CrossRefGoogle ScholarPubMed
Du Bois, W. E. B. (2003). The Health and Physique of the Negro American. American Journal of Public Health, 93: 272–276.CrossRefGoogle ScholarPubMed
Elliott, J. R. and Smith, R. A. (2001). Ethnic Matching of Supervisors to Subordinate Work Groups: Findings on “Bottom-Up” Ascription and Social Closure. Social Problems, 48: 258–276.CrossRefGoogle Scholar
Finch, B. K., Frank, R., and Vega, W. A. (2004). Acculturation and Acculturation Stress: A Social-Epidemiological Approach to Mexican Migrant Farmworkers' Health. International Migration Review, 38(1): 236–262.CrossRefGoogle Scholar
Ford, C. L. and Airhihenbuwa, C. O. (2010). The Public Health Critical Race Methodology: Praxis for Antiracism Research. Social Science & Medicine, 71(8): 1390–1398.CrossRefGoogle ScholarPubMed
Ford, C. L. and Harawa, N. T. (2010). A New Conceptualization of Ethnicity for Social Epidemiologic and Health Equity Research. Social Science & Medicine, 71(2): 251–258.CrossRefGoogle ScholarPubMed
Freeman, L. C. (1978). Segregation in Social Networks. Sociological Methods and Research, 6(4): 411–429.CrossRefGoogle Scholar
Gaskin, D. J., Price, A., Brandon, D. T., and LaVeist, T. A. (2009). Segregation and Disparities in Health Services Use. Medical Care Research and Review, 66(5): 578–589.CrossRefGoogle ScholarPubMed
Gee, G. C. (2002). A Multilevel Analysis of the Relationship between Institutional and Individual Racial Discrimination and Health Status. American Journal of Public Health, 92(4): 615–623.CrossRefGoogle ScholarPubMed
Gee, G. C. and Payne-Sturges, D. C. (2004). Environmental Health Disparities: A Framework Integrating Psychosocial and Environmental Concepts. Environmental Health Perspectives, 112(17): 1645–1653.CrossRefGoogle ScholarPubMed
Gee, G. C., Ro, A., Shariff-Marco, S., and Chae, D. H. (2009). Racial Discrimination and Health among Asian Americans: Evidence, Assessment, and Directions for Future Research. Epidemiologic Reviews, 31(1): 130–151.CrossRefGoogle ScholarPubMed
Goldman, D. P., Smith, J. P., and Sood, N. (2005). Legal Status and Health Insurance among Immigrants. Health Affairs, 24(6): 1640–1653.CrossRefGoogle ScholarPubMed
Heckler, M. M. (1985). Report of the Secretary's Task Force on Black and Minority Health. Washington, DC: U.S. Department of Health and Human Services.Google Scholar
Heckman, J. J. and Payner, B. S. (1989). Determining the Impact of Federal Antidiscrimination Policy on the Economic Status of Blacks: A Study of South Carolina. The American Economic Review, 79(1): 138–177.Google Scholar
Institute of Medicine (2009). Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement. Washington, DC: The National Academies Press.Google Scholar
James, S. A. (2008). Confronting the Moral Economy of US Racial/Ethnic Health Disparities. American Journal of Public Health, 98(Supplement 1): S16.CrossRefGoogle ScholarPubMed
Jones, C. P. (2000). Levels of Racism: A Theoretic Framework and a Gardener's Tale. American Journal of Public Health, 90(8): 1212–1215.Google Scholar
Kaushal, N. and Kaestner, R. (2005). Welfare Reform and Health Insurance of Immigrants. Health Services Research, 40(3): 697–722.CrossRefGoogle ScholarPubMed
Kelaher, M. and Jessop, D. J. (2002). Differences in Low-Birthweight among Documented and Undocumented Foreign-Born and US-born Latinas. Social Science and Medicine, 55: 2171–2175.CrossRefGoogle ScholarPubMed
Kramer, M. R. and Hogue, C. R. (2009). Is Segregation Bad for Your Health? Epidemiologic Reviews, 31(1): 178–194.CrossRefGoogle ScholarPubMed
Krieger, N. (1999). Embodying Inequality: A Review of Concepts, Measures, and Methods for Studying Health Consequences of Discrimination. International Journal of Health Services, 29(2): 295–352.CrossRefGoogle ScholarPubMed
Krieger, N., Williams, D. R., and Moss, N. E. (1997). Measuring Social Class in US Public Health Research: Concepts, Methodologies, and Guidelines. Annual Review of Public Health, 18: 341–378.CrossRefGoogle ScholarPubMed
Lauderdale, D. S. (2006). Birth Outcomes for Arabic-Named Women in California Before and After September 11. Demography, 43(1): 185–201.CrossRefGoogle ScholarPubMed
Lauderdale, D. S., Wen, M., Jacobs, E. A., and Kandula, N. R. (2006). Immigrant Perceptions of Discrimination in Health Care: the California Health Interview Survey 2003. Medical Care, 44(10): 914–920.CrossRefGoogle ScholarPubMed
Laumann, E. O. and Youm, Y. (1999). Racial/Ethnic Group Differences in the Prevalence of Sexually Transmitted Diseases in the United States: A Network Explanation. Sexually Transmitted Diseases, 26: 250–261.CrossRefGoogle ScholarPubMed
LaVeist, T. A. (1994). Beyond Dummy Variables and Sample Selection: What Health Services Researchers Ought to Know about Race as a Variable. Health Services Research, 29(1): 1–16.Google Scholar
Lee, B. A., Reardon, S. F., Firebaugh, G., Farrell, C. R., Matthews, S. A., and O'Sullivan, D. (2008). Beyond the Census Tract: Patterns and Determinants of Racial Residential Segregation at Multiple Scales. American Sociological Review, 73: 766–791.CrossRefGoogle Scholar
Leonard, D. (2009). Young, Black (& Brown) and Don't Give a Fuck. Cultural Studies Gåö Critical Methodologies, 9(2): 248–272.CrossRefGoogle Scholar
Link, B. G. and Phelan, J. (1995). Social Conditions as Fundamental Causes of Disease. Journal of Health and Social Behavior, 35(extra issue): 80–94.CrossRefGoogle Scholar
Margo, R. A. (1990). Race and Schooling in the South: 1880–1950: An Economic History. Chicago, IL: University of Chicago Press.CrossRefGoogle Scholar
Mays, V. M., Cochran, S. D., and Barnes, N. W. (2006). Race, Race-Based Discrimination, and Health Outcomes among African Americans. Annual Review of Psychology, 58: 201–225.CrossRefGoogle Scholar
Molina, N. (2006). Fit to Be Citizens. Berkeley, CA: University of California Press.Google Scholar
Morello-Frosch, R. and Jesdale, B. M. (2006). Separate and Unequal: Residential Segregation and Estimated Cancer Risks Associated with Ambient Air Toxics in U.S. Metropolitan Areas. Environmental Health Perspectives, 114(3): 386–393.CrossRefGoogle ScholarPubMed
Nacos, B. L. and Torres-Reyna, O. (2006). Fueling Our Fears: Stereotyping, Media Coverage, and Public Opinion of Muslim Americans. Lanham, MD: Rowman and Littlefield.Google Scholar
Nevins, J. (2002). Operation Gatekeeper: The Rise of the “Illegal Alien” and the Making of the US-Mexico boundary. New York: Routledge.Google Scholar
Office of Management and Budget (OMB) (1997). Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Federal Register, 62: 58781–58790.Google Scholar
Ortega, A. N., Fang, H., Perez, V. H., Rizzo, J. A., and Carter-Pokras, O. (2007). Health Care Access, Use of Services, and Experiences among Undocumented Mexicans and Other Latinos. Archives of Internal Medicine, 167(21): 2354–2360.CrossRefGoogle ScholarPubMed
Padela, A. I. and Heisler, M. (2010). The Association of Perceived Abuse and Discrimination after September 11, 2001, with Psychological Distress, Level of Happiness, and Health Status among Arab Americans. American Journal of Public Health, 100(2): 284–291.CrossRefGoogle ScholarPubMed
Park, J. S. W. (2004). Elusive Citizenship: Immigration, Asian Americans, and the Paradox of Civil Rights. New York: New York University Press.Google Scholar
Pembrey, M. E., Bygren, L. O., Kaati, G., Edvinsson, S., and Northstone, K. (2005). Sex-specific, Male-line Transgenerational Responses in Humans. European Journal of Human Genetics, 14(2): 159–166.CrossRefGoogle Scholar
Powell, J. A. (2008). Structural Racism: Building upon the Insights of John Calmore. North Carolina Law Review, 86: 791–816.Google Scholar
Quadagno, J. (2000). Promoting Civil Rights through the Welfare State: How Medicare Integrated Southern Hospitals. Social Problems, 47(1): 68–89.CrossRefGoogle ScholarPubMed
Reardon, S. F., Farrell, C. R., Matthews, S. A., O'Sullivan, D., Bischoff, K., and Firebaugh, G. (2009). Race and Space in the 1990s: Changes in the Geographic Scale of Racial Residential Segregation, 1990–2000. Social Science Research, 38(1): 55–70.CrossRefGoogle ScholarPubMed
Ross, S. L. and Turner, M. A. (2005). Housing Discrimination in Metropolitan America: Explaining Changes between 1989 and 2000. Social Problems, 52(2): 152–180.CrossRefGoogle Scholar
Sacerdote, B. (2005). Slavery and the Intergenerational Transmission of Human Capital. Review of Economics and Statistics, 87(2): 217–234.CrossRefGoogle Scholar
Seckl, J. R. and Holmes, M. C. (2007). Mechanisms of Disease: Glucocorticoids, their Placental Metabolism and Fetal ‘Programming’ of Adult Pathophysiology. Nature Clinical Practice Endocrinology & Metabolism, 3(6): 479–488.CrossRefGoogle ScholarPubMed
Smith, Aaron (2010). Technology Trends Among People of Color. Pew Internet & American Life Project, September 17. ⟨http://www.pewinternet.org/Commentary/2010/September/Technology-Trends-Among-People-of-Color.aspx⟩ (accessed December 17, 2010).Google Scholar
Smith, D. B. (2005). Racial and Ethnic Health Disparities and the Unfinished Civil Rights Agenda. Health Affairs, 24(2): 317–324.CrossRefGoogle ScholarPubMed
Smith, D. B., Feng, Z., Fennell, M. L., Zinn, J. S., and Mor, V. (2007). Separate and Unequal: Racial Segregation and Disparities in Quality across U.S. Nursing Homes. Health Affairs, 26(5): 1448–1458.CrossRefGoogle ScholarPubMed
Sommers, B. D. (2010). Targeting in Medicaid: The Costs and Enrollment Effects of Medicaid's Citizenship Documentation Experiment. Journal of Public Economics, 94(1-2): 174–182.CrossRefGoogle Scholar
Sondik, E. J., Huang, D. T., Klein, R. J., and Satcher, D. (2010). Progress toward the Healthy People: 2010 Goals and Objectives. Annual Review of Public Health, 31(1): 271–281.CrossRefGoogle ScholarPubMed
Subramanian, S. V., Acevedo-Garcia, D., and Osypuk, T. L. (2005). Racial Residential Segregation and Geographic Heterogeneity in Black/White Disparity in Poor Self-Rated Health in the US: A Multilevel Statistical Analysis. Social Science & Medicine, 60(8): 1667–1679.CrossRefGoogle Scholar
Turner, M. A., Freiberg, F., Godfrey, E., Herbig, C., Levy, D. K., and Smith, R. R. (2002). All Other Things Being Equal: A Paired Testing Study of Mortgage Lending Institutions. Washington, DC: U.S. Department of Housing and Urban Development.Google Scholar
Vanderbilt, D. and Augustyn, M. (2010). The Effects of Bullying. Paediatrics and Child Health, 20(7): 315–320.CrossRefGoogle Scholar
Viruell-Fuentes, E. A. (2007). Beyond Acculturation: Immigration, Discrimination, and Health Research among Mexicans in the United States. Social Science & Medicine, 65(7): 1524–1535.CrossRefGoogle ScholarPubMed
Wakefield, S. and Uggen, C. (2010). Incarceration and Stratification. Annual Review of Sociology, 36: 387–406.CrossRefGoogle Scholar
Walsemann, K. M. and Bell, B. A. (2010). Integrated Schools, Segregated Curriculum: Effects of Within-School Segregation on Adolescent Health Behaviors and Educational Aspirations. American Journal of Public Health, 100(9): 1687–1695.CrossRefGoogle ScholarPubMed
Wang, J., Iannotti, R. J., and Nansel, T. R. (2009). School Bullying among Adolescents in the United States: Physical, Verbal, Relational, and Cyber. Journal of Adolescent Health, 45(4): 368–375.CrossRefGoogle ScholarPubMed
White, T. K. (2007). Initial Conditions at Emancipation: The Long-Run Effect on Black-White Wealth and Earnings Inequality. Journal of Economic Dynamics and Control, 31: 3370–3395.CrossRefGoogle Scholar
Williams, D. R. and Collins, C. A. (2001). Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health. Public Health Reports, 116: 404–416.CrossRefGoogle ScholarPubMed
Williams, D. R., Costa, M. V., Odunlami, A. O., and Mohammed, S. A. (2008). Moving Upstream: How Interventions That Address the Social Determinants of Health Can Improve Health and Reduce Disparities. Journal of Public Health Management and Practice, 14(6): S8–S17.CrossRefGoogle ScholarPubMed
Williams, D. R. and Mohammed, S. A. (2009). Discrimination and Racial Disparities in Health: Evidence and Needed Research. Journal of Behavioral Medicine, 32: 20–47.CrossRefGoogle ScholarPubMed
Wright, R. O. (2008). Chronology of Immigration in the United States. Jefferson, NC: McFarland & Company, Inc.Google Scholar
Yoo, H. C., Gee, G. C., and Takeuchi, D. (2009). Discrimination and Health among Asian American Immigrants: Disentangling Racial from Language Discrimination. Social Science & Medicine, 68(4): 726–732.CrossRefGoogle ScholarPubMed
Yu, S. M., Huang, Z. J., Schwalberg, R. H., and Nyman, R. M. (2006). Parental English Proficiency and Children's Health Services Access. American Journal of Public Health, 96(8): 1449–1455.CrossRefGoogle ScholarPubMed