Structural racism impacts health. Structural racism is a system in which public policies, institutional practices, cultural representations, and other norms work to perpetuate racial group inequity. It is rooted in a hierarchy that privileges one race over another, influencing institutions that govern daily life from housing policies to police profiling and incarceration. It is closely linked to the social determinants of health (SDoH) and health disparities.
Health disparities are particularly evident in maternal and child health. Black, American Indian, and Alaska Native (AI/AN) women are 2 to 3 times more likely to die from pregnancy-related causes than White women. The infant mortality rate for Black infants is 2 times the rate for Whites. Minorities also face higher rates of morbidity and mortality from chronic diseases, including cardiovascular problems, diabetes, cancer, and certain infectious diseases. The incidence and mortality rates of COVID-19 are the latest examples of racial disparities.
Public health professionals at local, state, and federal public health agencies and at academic institutions are in a unique position to address the challenges of structural racism as it contributes to poor health. In the lead article of this issue, Olivas and coauthors point out local public health departments (LHDs) can and need to address health disparities through community partnerships and multisectoral collaboration. Racial health disparities are associated with socioeconomic status, health behaviors, and health care access. Racial segregation is also a cause of these health disparities. The current study examined the extent of racial segregation in contrast to the activities of LHDs to address health disparities. LHDs with higher measures of segregation were found to engage in more activities to address disparities. These LDHs were aware of the impact of SDoH on their communities. LHDs' increased responsiveness to this challenge, by providing public health services and focusing on the SDoH, can make a measurable difference.
Other articles in this issue expand on this theme. Shiman and coauthors from the New York City Department of Health and Mental Hygiene describe the Tremont neighborhood in the Bronx. In 1937, this neighborhood was designated as “hazardous" by the Home Owners Loan Corporation through a process known as redlining. This led to disinvestment in this and similar communities throughout the nation. Housing stock deteriorated. Schools received insufficient funding, and small businesses struggled without loans. The local economy and parks deteriorated. Currently, poor health outcomes exist in the neighborhood today with higher rates of diabetes and obesity and lower life expectancy than the predominantly White neighborhood of the Upper East Side of Manhattan.
Health department staff in the Bronx developed an exhibit Undesign the Redline. Visitors included youth groups, community-based organizations, and teams from city agencies including the health department, planners, faith-based leaders, health service providers, educators, and Bronx residents. The purpose was not only education but also the design and ownership of new systems to “undesign" the consequences of redlining. The Undesign the Redline exhibit offers a concrete example of countering structural racism. The exhibit has now moved to other neighborhood venues, and profiles of health data for each community district show the impact of structural racism and public health.
Kovach writes, in an article on public health accreditation, that all communities deserve high-quality public health services. LHDs serving disadvantaged communities especially need to be accredited so as not to exacerbate health inequities. This applies to jurisdictions serving more diverse populations because of the wide health inequities between racial groups. PHAB accreditation has the potential to reduce health inequities in jurisdictions with worse health outcomes.
In early 2022, the Journal of Public Health Management and Practice will publish a supplemental issue: Public Health Interventions to Address Health Disparities Associated with Structural Racism. This issue is sponsored by the W. K. Kellogg Foundation. Mary T. Bassett, MD, MPH, Director of the FXB Center for Health and Human Rights and the FXB Professor of the Practice of Health and Human Rights at the Harvard School of Public Health, has agreed to be guest editor for this important issue. Articles culled from a nationwide search will describe how public health agencies at the local, state, or federal level or academic institutions are engaging with communities of color to address health disparities related to structural racism.
Lloyd F. Novick, MD, MPH Justin B. Moore, PhD, MS
Editor-in-Chief Associate Editor