Racial inequalities in health: Framing future research

Abstract

Substantial time and resources have been devoted to the study of racial inequalities in health. Indeed, the public health and social science literatures have documented racial inequalities across numerous health behaviors, including mental and physical health outcomes (Beck et al., 2014; Bollini & Siem, 1995; Cardoso et al., 2005; Chor, 2013; Fiscella et al., 2000; Yin Paradies et al., 2008; Smith et al., 2000; David R. Williams, 2008; David. R. Williams et al., 1997; Winkleby et al., 1998). However, empirical research examining the root sources of these inequalities is still in its infancy (Phelan & Link, 2015). While a growing literature considers the link between racism – broadly conceptualized – and health inequalities, much of this work focuses on discrimination or prejudice in interpersonal interactions as the primary driver of these inequalities (Harris et al., 2006; Krieger, 2014; Lewis et al., 2015; Priest et al., 2013; David R. Williams & Mohammed, 2009). There has been and continues to be a need for more research on cultural and structural forms of racism as fundamental drivers of racial health inequalities (Bailey et al., 2017; Dressler et al., 2005; Essed & Goldberg, 2002; Gee & Ford, 2011; Mullings, 2005; Nazroo, 2003; Phelan & Link, 2015; Viruell-Fuentes et al., 2012; David R. Williams & Mohammed, 2013). This Special Issue on Racism and Health Inequalities provides a sample of innovative work and empirical evidence from Australia, Brazil, New Zealand, and the United States. The 23 papers in this collection encompass qualitative and quantitative methods and multiple scientific disciplines. Furthermore, they collectively underscore the potential for innovative public health research on cultural and structural racism, but also highlight a number of challenges to confront as we continue to advance scientific knowledge within this area. This introduction will synthesize the ways in which this collection advances understanding of the importance of cultural and structural racism for racial health inequalities. While public health scholars have also recently written on this topic (Bailey et al., 2017; Gee & Ford, 2011; Viruell-Fuentes et al., 2012), we integrate multiple social science literatures to emphasize that all research on racial health inequalities must be founded upon sound guiding frameworks. Specifically, we synthesize the evidence from conceptual and empirical models that: (a) indicate structural racism as the actualization of cultural racism (Dressler et al., 2005; Fassin, 2004; J. M. Jones, 1997; Lamont et al., 2014; Mullings, 2005; Silverstein, 2005); and (b) employ approaches consistent with critical race theory (Bell, 1987, 1992; Ford & Airhihenbuwa, 2010b). Because these components are crucial to yet often missing from racial health inequalities discourse, we outline two recommendations for future work that stem from these two areas of emphasis. These recommendations aim to continue and strengthen the shift from a biomedical/risk factor model that documents the health behaviors, experiences, and outcomes of marginalized racial groups, to a broad, systemic view that situates these inequalities within the social, economic, and political structures of societies that maintain the dominance of a single racial group. We will begin with a discussion on cultural and structural racism, including our working definitions and the processes through which they are related. We will then discuss our two recommendations for future research on racial health inequalities, using arguments from papers in this collection to support them. We will conclude with a call to action for the future of racial health inequalities research that challenges scholars to move toward a “reconstruction of knowledge” (Desmond & Emirbayer, 2010) about the root causes of these inequalities to then work toward their elimination. In this introduction, we will not emphasize individual-level factors and interpersonal processes as we wish to focus on largely-missing components of the discourse in this field and therefore direct attention to cultural racism and the ways in which cultural processes may link social structure to structural racism (Dressler, 2001; Dressler et al., 2005; Fassin, 2004; Lamont et al., 2014; Silverstein, 2005; Thomas & Clarke, 2013).