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Is Racism a Fundamental Cause of Inequalities in Health?
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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“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“According to ecosocial theory, structural racism erodes the health of Black individuals by exposing them to economic injustice, poor living conditions, and political exclusion [10], all of which pose health risks and limit their access to resources [11,12].”
From Intersections of Structural State-Level Racism and Neighborhood Deprivation on Nutrition and Obesity for Black Adolescents (2025) · cites this paper as [11]
In the citing paper
“By creating unequal access to resources and opportunity, racism is a fundamental cause of racial inequities in health [10,11].”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [10]
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Cole, H. V. S., Reed, H. E., Tannis, C., Trinh‐Shevrin, C., & Ravenell, J. E. (2018) · Preventing Chronic Disease · doi:10.5888/pcd15.170570 · Cited by 12
Costa, C. D. S., Assunção, M. C. F., Vaz, J. D. S., Rauber, F., Bierhals, I. O., Matijasevich, A., Horta, B. L., Gonçalves, H., Wehrmeister, F. C., & Santos, I. S. (2020) · Public Health Nutrition · doi:10.1017/s1368980019004245 · Cited by 15
Demographic Correlates of Veterans’ Adverse Social Determinants of Health
Montgomery, A. E., Tsai, J., & Blosnich, J. R. (2020) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2020.05.024 · Cited by 14
Psychological Distress among Black Immigrants by Region of Birth
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Rosario, C., Al Amin, S., & Parker, C. (2022) · Journal of Public Health Management and Practice · doi:10.1097/phh.0000000000001432 · Cited by 12
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Metadata
- Authors
- Phelan, J. C., & Link, B. G.
- Affiliations
- Columbia University (US)
- New York State Psychiatric Institute (US)
- 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
- 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
- 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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