Racism not Race as a Cause of Health Inequities

The United States is marked by profound inequities in health and healthcare. Black, Indigenous, and Latine/x populations, in particular, continue to experience sharply worse health outcomes compared to white populations across a range of metrics, including pregnancy-related morbidity and mortality, overall life expectancy, and most recently, Covid-19 related morbidity and mortality. While our system of medical education has described such inequities as consequences of personal behaviors or economic circumstances, they persist when controlling for income, wealth, education, diet, exercise, and related factors. Nor are health inequities explained by socially-contrived concepts such as race or ethnicity—socio-political categories with no basis in biology or genetics. (For more on this topic, see Module 5: Diagnostic Calculators and the Invention of Race)

Instead, a robust body of extant scientific literature has found that health inequities are rooted in racism experienced on both a systemic and individual level. Research proves the damaging health effects of redlining/housing segregation, neighborhoods devoid of healthy food, and extreme pollution found in low-income, under-resourced communities.

Unit Learning Objectives

Module Learning Objectives

 Most often these very same communities also experience violent and disproportionate over-policing, family separation, and mass incarceration. Research also establishes the profound physiological impact that experiences of persistent racism have on the bodies of those they target. The chronic stress of navigating micro-aggressions, discrimination, and other forms of interpersonal and institutional racism has been shown to sharply elevate cortisol levels and blood pressure, and inflict lasting harm on the immune, metabolic, and endocrine systems. The result is often premature aging and/or “weathering”—a consequence of persistent harms that are compounded over time and by cumulative patterns of oppression (e.g. misogyny, trans- and homophobia, disability discrimination, etc.)

This module provides a variety of resources and literature about the ways in which white supremacy and other forms of oppression generate and reproduce health inequities. The module is also meant to challenge you to examine and resist these patterns in your personal and professional life and in the communities and institutions where you live and work.

This module is part of RHEDI’s Justice & SRH Unit, which focuses on Reproductive Justice in sexual and reproductive health.The module can be used for self-study or as part of group didactic sessions. Learners have the opportunity to discuss the material with their peers in RHEDI’s Curriculum Discussion Forum, to share their responses anonymously, and to submit their answers to their instructor. The module is also available on the RHEcourse learning management system.

Zinzi Bailey Justin Feldman, Mary Bassett. How Structural Racism Works – Racist Policies as a Root Cause of U.S. Racial Health Inequities. N Engl J Med. 2021 Feb 25;384(8):768-773. doi: 10.1056/NEJMms2025396. Epub 2020 Dec 16. PMID: 33326717.

Noor Chadha, Bernadette Lim, Madeleine Kane, & Brenly Rowland.  Section 1: Racism, not Race, Causes Health Disparities.  Toward the Abolition of Biological Race in Medicine. 2020. UC Berkeley: Othering & Belonging Institute. 

Rod McCullom. What science tells us about structural racism’s health impact. Harvard Public Health. 

Yasmin Shaker et al. Redlining, racism and food access in US urban cores. Agric Human Values. 2023;40(1):101-112. doi: 10.1007/s10460-022-10340-3. Epub 2022 Jul 22. PMID: 35891801; PMCID: PMC9303837.

Alisha Haridasani Gupta. How ‘Weathering’ Contributes to Racial Health Disparities. New York Times [Digital Edition], 12 Apr. 2023,

Leo Lopez III, Louis Hart III, and Mitchell Katz. Racial and Ethnic Health Disparities Related to COVID-19. JAMA. 2021 Feb 23;325(8):719-720. doi: 10.1001/jama.2020.26443. PMID: 33480972.

Monica McLemore and Valentina D’Efilippo. To Prevent Women from Dying in Childbirth, First Stop Blaming Them. Scientific American. 2019; 5(320):48-51.

Black Mamas Matter Alliance, Issue Brief: Black Maternal Health

Brittany Chambers, Rebecca Baer, Monica McLemore, and Laura Jelliffe-Pawlowski. Using Index of Concentration at the Extremes as Indicators of Structural Racism to Evaluate the Association with Preterm Birth and Infant Mortality-California, 2011-2012. J Urban Health. 2019 Apr;96(2):159-170. doi: 10.1007/s11524-018-0272-4. PMID: 29869317; PMCID: PMC6458187.

Linda Villarosa, Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis. The New York Times Magazine,  11 Apr. 2018.

Patrick Nana-Sinkam et al.  Health disparities and equity in the era of COVID-19. J Clin Transl Sci. 2021 Mar 16;5(1):e99. doi: 10.1017/cts.2021.23. PMID: 34192054; PMCID: PMC8167251.

Jamila Taylor. Structural Racism and Maternal Health Among Black Women. J Law Med Ethics. 2020 Sep;48(3):506-517. doi: 10.1177/1073110520958875. PMID: 33021163.

Ichiro Kawachi. COVID-19 and the ‘rediscovery’ of health inequities. Int J Epidemiol. 2020 Oct 1;49(5):1415-1418. doi: 10.1093/ije/dyaa159. PMID: 32974663; PMCID: PMC7543525.

 

How Racism Makes Us Sick,  David R. Williams, TED

Allegories on race and racism, Camara Jones, TEDxEmory

Black Mothers Matter: Racism and Childbirth in America (highlights), Amy Holden Jones, Dr. Karen A. Scott,  Monica R. McLemore,  and Charles Johnson; USC Annenberg

Black Maternal Health the U.S. Covid-19 Response

Monica McLemore (10:30–27:35)
Jamila Perritt (27:40–45:10)
Ifeyinwa Asiodu (45:35–1:09:00) Chanel Porchia-Albert (1:10:00–1:21:00) Nastassia Davis (1:21:00–1:41:00) Q&A (1:41:00–1:51:26)

Health Inequities and the Making of Race: A Short History, Rana Hogarth, New York Academy of Medicine

Black Mothers Matter: Racism and Childbirth in America (full), Amy Holden Jones, Dr. Karen A. Scott,  Monica R. McLemore,  and Charles Johnson; USC Annenberg

Racism has a cost for everyone, Heather McGhee, TEDWomen

The Inequitable Impact of the Environment on Health,
Population Healthy, University of Michigan School of Public Health

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Black Women’s Health Through the Twin Pandemics, Kimberlé Crenshaw, Dr. Karen Scott, Dr. Gail Wyatt, Dr. Alisha Liggett, Dr. Joia Crear Perry; Intersectionality Matters!

Reflection questions:

1. Describe harmful health effects that have been directly linked to practices and policies such as redlining (and other forms of housing segregation), overpolicing and mass incarceration, as well as the inequitable distribution of pollution burdens and healthy food access. (Please identify 2–3 effects)

2. Compared to other high resource nations, the U.S. is an outlier when it comes to its high and rising rate of maternal mortality, particularly among Black pregnant people. While it is common to attribute this inequity to maternal age, comorbidities, and/or health behaviors, disparities persist in studies controlling for these factors, and in comparison to other countries with increased rates of cardiovascular disease, obesity, diabetes and other conditions. What preventable factors likely contribute to inequitable rates of maternal mortality in the U.S.?(Please identify 2–3 factors)

3. Describe the process of “weathering” and explain why income, education, and upward mobility often fail to erase its effects on health indicators and outcomes.

4. Describe the impact that COVID-19 has had on health outcomes in the U.S. and consider why the impact has been substantially worse for many communities of color. Should we be surprised? Why/why not?

Submit your reflections directly to your instructor or share at: https://rhedicommunities.org/discuss

Racism not Race as a Cause of Health Inequities

Module Learning Objectives:

  1. Consider how structural racism permeates many socio-political facets of society (environmental justice, housing, family separation, covid) with ramifications that result in health injustices and inequities in SRH and beyond.
  2. Describe the impacts of structural racism across a variety of SRH health outcomes.
  3. Discuss strategies and actions for moving toward improved SRH health outcomes and equity for the most marginalized and disadvantaged.

Racism not Race as a Cause of Health Inequities

Unit Learning Objectives:

  1. Examine the roots of U.S medical research and clinical practice in white supremacist experimentation and violence.
    Understand the racist structures that perpetuate and sustain contemporary health inequities
  2. Analyze how and why existing health, income, housing, and SRH access inequities are aggravated by events such as the COVID-19 pandemic
  3. Recognize patterns of micro- and macroaggression in SRH education and clinical practice, and develop strategies for disrupting and resisting