How structural racism works — racist policies as a root cause of U.S. racial health inequities

In the 5 years since one of us published “#BlackLivesMatter — A Challenge to the Medical and Public Health Communities” in the Journal,1 we have seen a sea change in the recognition of racism as a durable feature of U.S. society and of its high cost in Black lives. Elected officials, corporate leaders, and academics alike use the slogan “Black Lives Matter,” which has also been widely adopted by members of the public, who by the millions protested the extrajudicial killing of George Floyd.2 With this change comes growing recognition that racism has a structural basis and is embedded in long-standing social policy. This framing is captured by the term “structural racism.”
There is no “official” definition of structural racism — or of the closely related concepts of systemic and institutional racism — although multiple definitions have been offered.3-7 All definitions make clear that racism is not simply the result of private prejudices held by individuals,8 but is also produced and reproduced by laws, rules, and practices, sanctioned and even implemented by various levels of government, and embedded in the economic system as well as in cultural and societal norms.3,8 Confronting racism, therefore, requires not only changing individual attitudes, but also transforming and dismantling the policies and institutions that undergird the U.S. racial hierarchy.
As a legacy of African enslavement, structural racism affects both population and individual health in three interrelated domains: redlining and racialized residential segregation, mass incarceration and police violence, and unequal medical care. These examples, among others, share certain cardinal features: harms are historically grounded, involve multiple institutions, and rely on racist cultural tropes. (author introduction) #P4HEwebinarSeptember2024