Unveiling Inequity: Racism's Grip on Public Health

Written By The Public Health Record

Written by: Lauryn Perpall, MPH

“Racial equity is the condition that will be achieved when racial identity no longer predicts how a person fares in society. Racial equity is central to health equity which is the assurance of the conditions that allow everyone the opportunity to reach their best health. Health inequities result in health disparities, which are differences in health status that are closely linked with social, economic and/or environmental disadvantage.”

- American Public Health Association

Racism and Public Health

Racism in public health manifests in disparities that disproportionately affect marginalized communities. These disparities, deeply rooted in historical injustices and systemic biases, lead to unequal access to healthcare and poorer health outcomes among racial and ethnic minorities. Addressing racism in public health requires dismantling structural barriers and advocating for equitable policies and healthcare practices.

In this blog you will read about some of the ways racism intersects with public health:

**Health Disparities**

Racism contributes to health disparities, which are differences in health outcomes between different groups of people. Marginalized racial and ethnic groups often experience poorer health outcomes compared to their white counterparts. This can be attributed to a range of factors including limited access to healthcare, socioeconomic disparities, environmental racism, and discrimination within healthcare systems.

**Social Determinants of Health**

(see section below for more info)

Racism operates through social determinants of health, which are the conditions in which people are born, grow, live, work, and age. Discrimination, segregation, poverty, and unequal access to resources all contribute to health inequities experienced by racial and ethnic minorities. For example, communities of color are more likely to live in neighborhoods with poor air quality, limited access to healthy foods, and inadequate healthcare facilities.

**Mental Health Impacts**

Racism also has significant mental health impacts. Racial discrimination can lead to stress, anxiety, depression, and trauma among individuals who experience it. These mental health effects can further exacerbate physical health problems and contribute to disparities in healthcare utilization and outcomes.

**Access to Healthcare**

Racism can manifest within healthcare systems, leading to disparities in access to care, quality of care, and health outcomes. Minority populations often face barriers such as lack of health insurance, language barriers, cultural insensitivity among healthcare providers, and implicit bias in diagnosis and treatment.

**COVID-19 Pandemic**

The COVID-19 pandemic highlighted existing racial disparities in health outcomes.

Communities of color, particularly Black, Hispanic, and Indigenous populations, experienced higher rates of infection, hospitalization, and mortality compared to white populations. These disparities are driven by systemic racism, including unequal access to healthcare, higher rates of underlying health conditions, and occupational and residential segregation.

**Policy Implications**

Addressing racism as a public health issue requires multifaceted approaches at the policy level. Policies aimed at promoting health equity should address structural racism and its root causes, including housing discrimination, unequal educational opportunities, and economic disparities. Additionally, anti-racist policies within healthcare systems, such as cultural competency training for healthcare providers and initiatives to diversify the healthcare workforce, are essential for improving health outcomes for marginalized communities.

How can we achieve Racial Equity in Health?

  • Examine the social determinants of health to better understand how to promote and improve health equity

Photo Source: Center for Disease Control and Prevention

Social Determinants of Health 

SDOH are non-medical factors that influence health outcomes. They are the conditions that individuals are born, grow, work, live, age. They affect a wide range of health, functioning, and quality-of-life outcomes and risks.

  1. Economic Stability

  2. Education Access and Quality

  3. Healthcare Access and Quality

  4. Neighborhood and Built Environment

  5. Social and Community Context

  • Address health inequities (uneven distribution of social and economic resources that impacts an individual’s health).

  • Support and commit to actions at all levels to ensure equal opportunity for all. It is important to start shifting organizational norms by learning. Get a handle on system-wide data to help develop clear, shared vision and goals. This will help with launching targeted improvement efforts across the system.

Examples of the Impact of Racism in Public Health

  • Up to 7 year difference in life expectancy exists between racial and ethnic populations

  • Black women are 3x more likely than white women to die within 1 year old childbirth

  • Black, American Indian/Alaskan Native and Hispanic Americans all have a COVID-19 death rate that is 3x more than White Americans

Indications are that 1 in 1,000 Black men/boys will be killed by police in their lifetime, resulting in higher rates of PTSD, depression, anxiety, anger, fear, lack of trust, and other psychological problems

Racism - A Public Health Crisis

Over 300 Cities, Counties, Leaders declared Racism a Public Health Crisis.

Here are some of the previously racist areas who have made the declaration:

  • Boston, Massachusetts 

    • Population: 675,000+ (45% White, 22% Black, 20% Hispanic/Latino, 10% Asian)

  • Buncombe County, North Carolina

    • Population: 261,000 (83% White, 6% Black, 7% Hispanic/Latino, 1% Asian)

  • Milwaukee County, Wisconsin

    • Population: 939,000+ (51% White, 26% Black, 15% Hispanic/Latino, 4% Asian)

  • Minneapolis, Minnesota

    • Population: 420,000+ (60% White, 19% Black, 10% Hispanic/Latino, 5% Asian)

  • Austin, Texas

    • Population: 961,800+ (49% White, 7% Black, 33% Hispannic/Latino, 8% Asian)

  • Multnomah County, Oregon

    • Population: 815,000+ (69% White, 5% Black, 12% Hispanic/Latino, 7% Asian)

Thank you for reading!

Racism profoundly impacts public health outcomes by perpetuating disparities in access to healthcare, socioeconomic resources, and environmental conditions. Addressing racism as a public health issue requires comprehensive strategies that dismantle systemic inequalities and promote health equity for all individuals and communities.

The Public Health Record
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