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Cited by 1,598Racial and Ethnic Identity ResearchHealth disparities and outcomesEnvironmental Justice and Health Disparities

How Structural Racism Works — Racist Policies as a Root Cause of U.S. Racial Health Inequities

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Bailey, Zinzi D., Feldman, Justin M., Bassett, Mary T.·2021·New England Journal of Medicine
DOI 10.1056/nejmms2025396PMC PMC11393777
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Abstract

In the 5 years since one of us published "#Black LivesMatter -A Challenge to the Medical and Public Health Communities" in the Journal, 1 we have seen a sea change in the recognition of racism as a durable feature of U.S. society and of its high cost in Black lives.Elected officials, corporate leaders, and academics alike use the slogan "Black Lives Matter," which has also been widely adopted by members of the public, who by the millions protested the extrajudicial killing of George Floyd. 2 With this change comes growing recognition that racism has a structural basis and is embedded in long-standing social policy.This framing is captured by the term "structural racism."There is no "official" definition of structural racism -or of the closely related concepts of systemic and institutional racism -although multiple definitions have been offered.[3][4][5][6][7] All definitions make clear that racism is not simply the result of private prejudices held by individuals, 8 but is also produced and reproduced by laws, rules, and practices, sanctioned and even implemented by various levels of government, and embedded in the economic system as well as in cultural and societal norms.3,8 Confronting racism, therefore, requires not only changing individual attitudes, but also transforming and dismantling the policies and institutions that undergird the U.S. racial hierarchy.As a legacy of African enslavement, structural racism affects both population and individual health in three interrelated domains: redlining and racialized residential segregation, mass incarceration and police violence, and unequal medical care.These examples, among others, share certain cardinal features: harms are historically grounded, involve multiple institutions, and rely on racist cultural tropes.

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  • The term structural racism has evolved over the years, with Bailey and colleagues' definition distinguishing it from racial or cultural discrimination and from systemic or institutional racism.

    “The term “structural racism” has evolved over the years, with Bailey and colleagues’ definition distinguishing it not only from racial or cultural discrimination but also from systemic or institutional racism [5,31].”

    From Structural Racism Conceptualization and Operationalization for Research for the U.S. HIV Epidemic: Findings from a Scoping Review and Implications for Advancing Research for Structural Interventions (2024) · cites this paper as [5]

    In the opening section (page not provided), Bailey and colleagues distinguish structural racism from individual prejudice and discrimination alone, and describe growing recognition of its structural basis. They do not trace the term’s evolution or distinguish structural racism from cultural discrimination; instead, they call systemic and institutional racism “closely related concepts.” (LLM, conf=0.84)

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  • These health and socioeconomic disparities are rooted in the history of discrimination against Black individuals and other people of color in the United States, including structural racism.

    “These health and socioeconomic disparities are rooted in the history of discrimination against Black individuals and other people of color in the United States, not only during interpersonal interactions, but also as enshrined in the rules, practices, and policies of U.S. banks, laws, medical systems and other institutions -that is, structural racism.”

    From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [309]

  • These health and socioeconomic disparities are rooted in the history of discrimination against Black individuals and other people of color in the U.S., including structural racism.

    “These health and socioeconomic disparities are rooted in the history of discrimination against Black individuals and other people of color in the U.S., not only during interpersonal interactions, but also as codified in the rules, practices and policies of U.S. banks, laws, health care and other systems — that is, structural racism.”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [335]

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Research works printed but not linked: 5

  1. [6]Groos M, Wallace M, Hardeman R, Theall KP. Measuring inequity: a systematic review of methods used to quantify structural racism. J Health Dispar Res Pract 2018; 11: 190– 206.
  2. [7]Jones CP. Confronting institutionalized racism. Phylon 2003; 50(1–2): 7– 22.
  3. [24]Krieger N, Kiang MV, Chen JT, Waterman PD. Trends in US deaths due to legal intervention among black and white men, age 15–34 years, by county income level. Harvard Pub Health Rev 2015; 3: 1– 5.
  4. [25]Walker S, Fridell L. Forces of change in police policy: the impact of Tennessee v. Garner. Am J Police 1992; 11: 97– 112 (https://heinonline.org/HOL/LandingPage?handle=hein.journals/ajpol11&div=27&id=&page=).
  5. [32]Jackson J, Weidman NM, Rubin G. The origins of scientific racism. J Blacks High Educ 2005; 50: 66– 79.

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Authors
Bailey, Z. D., Feldman, J. M., & Bassett, M. T.
Affiliations
Harvard University (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2021-02-25
Volume
384
Issue
8
Pages
768-773
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmms2025396
PMC
PMC11393777
OpenAlex
W3111105858
Cited by
1,598
References
33
Citations by year
2026: 145 · 2025: 232 · 2024: 304 · 2023: 348 · 2022: 384 · 2021: 182 · 2020: 1
FWCI
305.75
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Minority Health and Health Disparities (L60 MD014557)
Topics
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Sociology and Political Science › Environmental Justice and Health Disparities
Keywords
structural racism, racial disparities in health, Black Lives Matter, redlining, mass incarceration, police brutality, institutional racism, systemic racism, racial hierarchy, slavery legacy
MeSH terms
Black or African American, Civil Rights, Housing, Humans, Public Policy, Schools, Medical, United States, History, 18th Century, History, 20th Century, Racism

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