Is Racism a Fundamental Cause of Inequalities in Health?

TLDR

Socioeconomic status is a fundamental cause of health inequalities that persist over time, and race in the United States similarly has an enduring link to health and mortality. The study aims to determine whether systemic racism is a fundamental cause of health inequalities by reviewing empirical data on racial differences in health outcomes, risks, and resources. The authors review a wide range of empirical data on racial disparities in health outcomes, risks, and resources—including money, knowledge, power, prestige, freedom, and social connections. They conclude that racial health inequalities endure primarily because racism is a fundamental cause of racial differences in SES and because SES is a fundamental cause of health inequalities, and that racism also has a fundamental association with health independent of SES through inequalities in power, prestige, freedom, neighborhood context, and health care.

Abstract

We previously proposed that socioeconomic status (SES) is a fundamental cause of health inequalities and, as such, that SES inequalities in health persist over time despite radical changes in the diseases, risks, and interventions that happen to produce them at any given time. Like SES, race in the United States has an enduring connection to health and mortality. Our goals here are to evaluate whether this connection endures because systemic racism is a fundamental cause of health inequalities and, in doing so, to review a wide range of empirical data regarding racial differences in health outcomes, health risks, and health-enhancing resources such as money, knowledge, power, prestige, freedom, and beneficial social connections. We conclude that racial inequalities in health endure primarily because racism is a fundamental cause of racial differences in SES and because SES is a fundamental cause of health inequalities. In addition to these powerful connections, however, there is evidence that racism, largely via inequalities in power, prestige, freedom, neighborhood context, and health care, also has a fundamental association with health independent of SES.