Addressing structural and systemic racism in social and health care systems to advance health equity

BACKGROUND: American Public Health Association, American Medical Association, and American Nurses Association have declared racism a public health crisis because systemic oppression harms the care of individuals and the health of populations. 

OBJECTIVE: To help increase recognition, knowledge, and action to address structural racism contributing to health inequities. 

DESIGN/APPROACH: American Public Health Association Press has published a book, Systems That Impact Population Health: Past and Present, that was written with support and coordination from the National Academy of Medicine Culture of Health Program funded by the Robert Wood Johnson Foundation. This article provides an overview of the book and its conceptual model and actionable solutions. 

KEY RESULTS: Structural and systemic racism decreases access to opportunity structures for economic vitality, education, housing, justice, and health care, and directly exposes individuals to health risks including chronic stress, discrimination, and stigma. Racism segregates communities, leading to cumulative disadvantage and worse health. Actionable solutions can address structural racism to advance health equity in health care systems and social systems such as economic infrastructure, labor and employment, education, justice and civil rights law, media, immigration and foreign policy, and data and information. 

CONCLUSIONS: Improving social and health care systems helps poor, marginalized white populations, people of color, and the nation overall.