Structural Racism, Social Risk Factors, and Covid-19 — A Dangerous Convergence for Black Americans

Current protests throughout the United States are highlighting the history of marginalization of and discrimination against Black Americans, including 250 years of slavery, 100 years of Jim Crow laws, high rates of incarceration, and unanswered calls for action after police shootings of unarmed Black Americans. Simultaneously, disparities in Covid-19 infections and deaths are laying bare the underlying structural racism that protestors seek to disrupt.

Structural racism — the ways in which societies foster discrimination through mutually reinforcing inequitable systems — has received little attention as a determinant of population health, in part because there is a perception that limited empirical research has been done on the subject.¹ Yet a meta-analysis of 293 studies revealed that racism is significantly associated with poorer mental and physical health.² Structural racism exists because discriminatory practices in one sector reinforce parallel practices in other sectors, creating interconnected systems that embed inequities in laws and policies.¹ Consequently, education, employment, housing, credit markets, health care, and the justice system mutually reinforce practices that allow or encourage discriminatory beliefs, stereotypes, and unequal distribution of resources.^1,2