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Cited by 1,363Health disparities and outcomesRacial and Ethnic Identity ResearchPublic Health and Social Inequalities

Is Racism a Fundamental Cause of Inequalities in Health?

Phelan, Jo C., Link, Bruce G.·2015·Annual Review of Sociology
DOI 10.1146/annurev-soc-073014-112305
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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.

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Crossref · 10.1146/annurev-soc-073014-112305

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122 of 122 references verified0 citation errors · 0 not checkable

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  • In fundamental cause theory, the mechanisms enacted by a dominant group to suppress access to flexible resources must be replaceable over time.

    “In fundamental cause theory, the mechanisms enacted by a dominant group to suppress access to flexible resources must be replaceable over time (Link and Phelan, 1995; Phelan and Link, 2015).”

    From Cultural trauma as a fundamental cause of health disparities (2022) · cites this paper as Phelan and Link, 2015

  • To comprise a fundamental cause, a social factor must satisfy three criteria: impact multiple health outcomes through multiple risk factors; embody access to flexible resources; and have its production of health disparities reinforced over time through multiple replaceable mechanisms.

    “To comprise a fundamental cause, a social factor must satisfy three criteria (Link and Phelan, 1995; Phelan et al., 2010).”

    From Cultural trauma as a fundamental cause of health disparities (2022) · cites this paper as Phelan and Link, 2015

  • Several fundamental causes-e.g., socioeconomic status, stigma, racism/racial segregation-have been codified in the literature.

    “To date, several fundamental causes—e.g., socioeconomic status (SES; Link and Phelan, 1995), stigma (Hatzenbuehler et al., 2013), racism/racial segregation (Phelan and Link, 2015; Williams and Collins, 2016)—have been codified in the literature.”

    From Cultural trauma as a fundamental cause of health disparities (2022) · cites this paper as Phelan and Link, 2015

  • When new opportunities to reinforce the effect of a fundamental cause on health disparities materialize, new mechanisms will reliably emerge to support or strengthen the relationship.

    “when new opportunities to reinforce the effect of a fundamental cause on health disparities materialize, new mechanisms will reliably emerge to support or strengthen the relationship”

    From Cultural trauma as a fundamental cause of health disparities (2022) · cites this paper as Phelan and Link, 2015

  • Cultural trauma may perpetuate health disparities by decreasing affected groups' access to flexible resources through cultural resource loss and stigma-related minority stress and disadvantaging.

    “In our model’s second indirect mechanism, cultural trauma may perpetuate health disparities by decreasing affected groups’ access to flexible resources (e.g., money, power, prestige) (Link and Phelan, 1995; Phelan and Link, 2015) through (1) cultural resource loss; and (2) stigma-related minority stress and disadvantaging.”

    From Cultural trauma as a fundamental cause of health disparities (2022) · cites this paper as Phelan and Link, 2015

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Authors
Phelan, J. C., & Link, B. G.
Affiliations
  • Columbia University (US)
  • New York State Psychiatric Institute (US)
ORCID
Venue
Annual Review of Sociology
Publisher
Annual Reviews
Published
2015-08-14
Volume
41
Issue
1
Pages
311-330
ISSN
  • 0360-0572 (ISSN-L)
  • 1545-2115
DOI
10.1146/annurev-soc-073014-112305
OpenAlex
W2107916612
Cited by
1,363
References
122
Citations by year
2026: 94 · 2025: 173 · 2024: 192 · 2023: 196 · 2022: 192 · 2021: 205 · 2020: 119 · 2019: 64 · 2018: 51 · 2017: 50 · 2016: 21 · 2015: 1 · 2014: 1
FWCI
7.25
Type
journal article
Language
en
Open access
closed
Locations
Annual Review of Sociology (publishedVersion)
Funders
Sage Foundation
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
systemic racism, racial disparities in health, fundamental cause theory, socioeconomic status, racial disparities in health outcomes, power and prestige, neighborhood context, health care disparities

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