Chapter 6: Structural Racism and Systemic InequitiesContent check — Population Health, Chapter 6: Structural Racism and Systemic Inequities

Racism refers to the unfair treatment of individuals based on race. Race is a social construct, a way of categorizing or dividing individuals based on physical traits, social factors, and cultural backgrounds; it is not biologically based. Structural racism, also called institutional racism, is a process resulting in a gap in access to societal opportunities based on race, including differential access to quality education, housing, employment, medical care, and limited power and voice.

Microaggressions are common, everyday slights, snubs, or insults directed toward minorities that may be intentional or not, but they communicate derogatory or negative messages to individuals based upon their minority group status, such as complimenting an Asian client on their English.

Racial profiling refers to assuming or suspecting a person of criminal behavior based on race alone.

While many safety-net programs were developed for underrepresented and vulnerable populations such as older adults, children, individuals with limited income, or individuals with disabilities, some government policies have been written in a way that locks out many individuals who would otherwise qualify. For example, some states have attempted to impose eligibility restrictions on Medicaid expansion, including work-reporting requirements rooted in racist assumptions about the work ethic of Black individuals.

Allostatic load is the body’s physiologic “wear and tear” due to an individual’s exposure to stressors that accumulate throughout the lifespan. Allostatic load has been studied extensively in the setting of structural discrimination and racism and can be measured from biomarkers such as blood pressure, albumin, hormone levels, cholesterol levels, and C-reactive protein levels among others. High allostatic load is associated with increased adverse cardiac outcomes and chronic diseases, such as hypertension.

Red lines were often drawn around communities with large Black populations, effectively labeling them as hazardous investment areas. The term redlining came to mean a system of denying borrowers access to mortgage loans based on the location of properties in disadvantaged neighborhoods that were often comprised of minority populations. Such changes paved the way for industry to move in with coal-fired power plants, bus garages, and hazardous waste disposal plants, mostly in low-income BIPOC communities. Most redlined neighborhoods were in urban areas where widespread community disinvestment resulted in less green space and tree canopies and increased urban heat exposure.

Historically, BIPOC communities distrust health care systems due to the egregious harms they have experienced throughout history.

Implicit bias refers to an unconscious bias, or negative attitude against a specific individual or group based on race. It often manifests as nurses administering less pain medication to their BIPOC clients in comparison to their White clients. The nurse is treating the pain and not ignoring it but is letting the unconscious bias that Black individuals experience less pain than White individuals interfere with appropriate and equitable care.

Food deserts are often located in lower-income neighborhoods due to factors such as redlining and the marginalization of BIPOC and low-income communities. Redlining is a prime example of the structural nature of racism.

While health insurance coverage and access and income level are implicated in health care disparities, studies have demonstrated that when these items are controlled for (or considered equal), studies have continued to demonstrate BIPOC women are less likely to receive routine medical care and overall experience a lower quality of care, highlighting the prominent role of provider discrimination.