Structural Racism as a Fundamental Cause of Health Inequities in Delaware and Beyond:

Abstract

Health inequities are described as differences in health among different groups of people. These are well documented, persistent, and even increasing for some health conditions across the U.S., including in Delaware (DE). Health inequities may be viewed in the context of race, gender, sexual orientation, income, education level, disability status, or geographic location, among others. Further, when it comes to health, the oppressions associated with each of these statuses can yield compounding negative health effects based on their identity or class (e.g., “female” and “immigrant”). Because these are socially constructed categories related to social hierarchy, and related differences in health do not derive from biology or genetics, experts consider such health differences to be socially produced. As such, we can conclude that “health inequities are not only unnecessary and avoidable, but in addition, are considered unfair and unjust.”1 People of color in the U.S. experience some of the most pervasive and persistent heath inequities in our country. While it is important to recognize, examine and address health inequities that exist across various racial and ethnic groups, including Native people, Latinxs, and others, the historical context of slavery and persistent oppression among Black individuals in the U.S. warrants particular focus. This paper highlights the magnitude of health inequities experienced by Blacks in the U.S. and in Delaware. It defines structural racism, and provides an overview of the scientific literature regarding the role of structural racism in creating and perpetuating racial health inequities, with a particular focus on residential segregation, mass incarceration and implicit bias within the healthcare system. Much of its content is drawn from a policy brief, titled Structural Racism as a Fundamental Cause of Health Inequities2 produced jointly by the Division of Public Health, Delaware Department of Health and Social Services (DHSS) and the University of Delaware, Partnership for Healthy Communities; and the Health Equity Guide for Public Health Practitioners and Partners3 published by the Division of Public Health, DHSS.