Global Health Blogs with Professor Swahn

Student Reflections on Topics Covered in our Class

Global Health Blogs with Professor Swahn

Social Determinants of Health: A Catalyst between Systemic Racism and Public Health?

October 22, 2020 · 2 Comments · BLM, Uncategorized


Racism, in simpler terms, is any kind of prejudice or discrimination against anyone based on their membership in a particular racial or ethnic group, mostly a group that is marginalized.

As defined by Camara Phyllis Jones, past-president of American Public Health Association, “Racism is a system of structuring opportunity and assigning value based on the social interpretations of how one looks (race), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through a waste of human resources”.

This brings me to another essential term, systemic racism, or institutional racism. Systemic racism is a form of racism that rooted in society as normal practice. Systemic racism, unlike individual or personally mediated racism, is often subtle and hidden, making it far less perceivable. Persistent negative stereotypes further aggravate institutional racism. An article by NCBI “STRUCTURAL RACISM AND HEALTH INEQUITIES” makes a noteworthy comparison between racism and an iceberg. The tip of the iceberg is the most obvious acts of racism which are in most cases personally mediated and easily perceivable. However, the part of the iceberg that is below the surface of the water, not visible to the naked eye, is systemic racism. It is dangerous, pervasive, and harder to eliminate. An obvious example of systemic racism is racial profiling by police or residential segregation.

The presence of racism in the healthcare sector, unfortunately, leads to health disparities. Like the right to freedom of speech and expression, freedom from torture and cruelty, the right to lead a healthy life, and make use of healthcare resources to reach their full potential is a basic human right. Denying this right to healthcare resources is the biggest barrier to achieving health equity. When we think of the prevailing health disparities, we immediately think of mediating policies pertaining to medical, dental, and mental health. However, we underestimate the risk posed by non-medical factors such as social segregation, be it residential segregation, segregation within schools, or at workplaces. Public schools in different neighborhoods are the perfect example of this. Typically, white neighborhoods are considered ‘rich neighborhoods’ and have better public schooling systems than poorer neighborhoods. Studies have found correlations between public school curriculum, lack of qualified teachers, and the resulting decreased educational aspirations between kids of color and health disparities. Similarly, segregation of workers at workplaces with greater health risks such as nuclear power plants, or mines constantly exposes African American workers and immigrants to dangerous environments. These actions not only are health hazards but stressors that are associated with innumerable health problems, heart disease being the most important of all.

A recent news article published in Colorado Politics “Denver Health joins hospital systems in declaring racism a publish health crisis” further strengthens the fact that factors like unemployment, poverty, substandard housing, and mass incarcerations are a threat to health equity. A similar article in U.S.News ” Experts: Tackling Poverty and Racism as Public Health Crises Requires Rapid Action” affirms the belief that zip code is more important than genetic code in life expectancy, thus stressing the fact that structural segregation on the basis of race is a public health crisis. People of color overall have been subjected to a lack of resources, additional stressors, and external constraints that strengthen the existing health disparities.

Maternal and child health have largely suffered owing to these inequalities. The infant mortality rate for African American babies is more than twice the rate of white babies. Black babies are more than three times as likely to die from complications related to low birth weight as compared to white babies in the U.S. U.S. maternal mortality rate for African American women are three to four times higher than rates for white women. Such health inequities owing to unequal access to resources dates to 1935 when the Social Security Act was passed. The act promised the welfare benefits of unemployment and social security. However, the act then was flawed because it excluded people who worked on farms, or as nurses or teachers or held menial jobs such as house-helps, jobs mostly held by women, and African Americans in the 1930s. This encouraged a government system that predominantly aided white babies. Of course, the act and the government system have evolved over the years, but the ripple effects are experienced in the present day.

Furthermore, beginning in the 1930s, the government started redlining neighborhoods based on investment security. Most of these neighborhoods were occupied by minorities. This led to the depletion of resources in redlined communities, with the closure of hospitals, the disappearance of grocery stores, the absence of physical activity areas, and substandard housing and schools. Though the practice was shunned 50 years ago, 3 out of 4 once redlined neighborhoods still struggle economically.

What else does systemic racism lead to? Chronic diseases. Science has proved time and again that simple environmental interventions can, if not cure or prevent, at the very least decrease the disabilities caused due to chronic diseases. The presence of sidewalks, safe neighborhoods, access to health-promoting foods, affordable fruits and vegetables, and decreased stressors are just some of these environmental interventions. The absence of such a health-promoting environment or community amenities leads to innumerable problems such as high blood pressure, hyperlipidemia, heart diseases, and diabetes. African Americans and minorities have a higher proportion of chronic diseases as compared to whites. COVID-19, for instance, has affected minorities and people of color more than whites. Is there not an obvious connection?

To curb the effects of systemic racism in public health requires efforts from all sectors, not just healthcare. As said Dr. Martin Luther King Jr. “Moral arc of the universe doesn’t bend towards justice because of gravity; it bends towards justice because we force it there.”








  • jshah13

    I totally agree with you that racism is like an iceberg. We think it is just a small piece that is visible on top of water and the rest 90% is submerged.

  • ktroka1

    I really liked that you wrote about systemic racism, as most of the times is an issue under-looked. This line “zip code is more important than genetic code in life expectancy, thus stressing the fact that structural segregation on the basis of race is a public health crisis.” should serve as a wake up call for everyone

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