Racial inequalities in health: Framing future research
Introduction
Substantial time and resources have been devoted to the study of racial inequalities in health. Indeed, the public health and social science literatures have documented racial inequalities across numerous health behaviors and mental and physical health outcomes (Beck et al., 2014, Bollini and Siem, 1995, Cardoso et al., 2005, Chor, 2013, Fiscella et al., 2000; Yin Paradies et al., 2008, Smith et al., 2000; David R. Williams, 2008; David. R. Williams et al., 1997, Winkleby et al., 1998). However, empirical research examining the root sources of these inequalities is still in its infancy (Phelan and Link, 2015). While a growing literature considers the link between racism – broadly conceptualized – and health inequalities, much of this work focuses on discrimination or prejudice in interpersonal interactions as the primary driver of these inequalities (Harris et al., 2006, Krieger, 2014, Lewis et al., 2015, Priest et al., 2013; David R. Williams and Mohammed, 2009). There has been and continues to be a need for more research on cultural and structural forms of racism as fundamental drivers of racial health inequalities (Bailey et al., 2017, Dressler et al., 2005, Essed and Goldberg, 2002, Gee and Ford, 2011, Mullings, 2005, Nazroo, 2003, Phelan and Link, 2015, Viruell-Fuentes et al., 2012; David R. Williams and Mohammed, 2013).
This Special Issue on Racism and Health Inequalities provides a sample of innovative work and empirical evidence from Australia, Brazil, New Zealand, and the United States. The 23 papers in this collection encompass qualitative and quantitative methods and multiple scientific disciplines. Furthermore, they collectively underscore the potential for innovative public health research on cultural and structural racism, but also highlight a number of challenges to confront as we continue to advance scientific knowledge within this area.
This introduction will synthesize the ways in which this collection advances understanding of the importance of cultural and structural racism for racial health inequalities. While public health scholars have also recently written on this topic (Bailey et al., 2017, Gee and Ford, 2011, Viruell-Fuentes et al., 2012), we integrate multiple social science literatures to emphasize that all research on racial health inequalities must be founded upon sound guiding frameworks based on cultural and structural racism. Specifically, we synthesize the evidence from conceptual and empirical models that: (a) indicate structural racism as the actualization of cultural racism (Dressler et al., 2005, Fassin, 2004; J. M. Jones, 1997, Lamont et al., 2014, Mullings, 2005, Silverstein, 2005); and (b) employ approaches consistent with critical race theory (Bell, 1987, Bell, 1992, Ford and Airhihenbuwa, 2010b). Because these components are crucial to yet often missing from racial health inequalities discourse, we outline two recommendations for future work that stem from these two areas of emphasis. These recommendations aim to continue and strengthen the shift from a biomedical/risk factor model that documents the health behaviors, experiences, and outcomes of marginalized racial groups, to a broad, systemic view that situates these inequalities within the social, economic, and political structures of societies that maintain the dominance of a single racial group.
We will begin with a discussion on cultural and structural racism, including our working definitions and the processes through which they are related. We will then discuss our two recommendations for future research on racial health inequalities, using arguments from papers in this collection to support them. We will conclude with a call to action for the future of racial health inequalities research that challenges scholars to move toward a “reconstruction of knowledge” (Desmond and Emirbayer, 2010) about the root causes of these inequalities to then work toward their elimination. In this introduction, we will not emphasize individual-level factors and interpersonal processes as we wish to focus on largely-missing components of the discourse in this field and therefore direct attention to cultural racism and the ways in which cultural processes may link social structure to structural racism (Dressler, 2001, Dressler et al., 2005, Fassin, 2004, Lamont et al., 2014, Silverstein, 2005, Thomas and Clarke, 2013).
Section snippets
Racial inequalities in health as the embodiment of cultural racism
The importance of structural racism to racial health inequalities has been described in the public health literature (Gee and Ford, 2011, Viruell-Fuentes et al., 2012). We build on this to integrate notions of cultural racism, which at once dynamically maintains structural racism over time and serves as a “cloak of invisibility” that renders racialized and racially-hierarchical structures as racially-neutral and rational (Dressler et al., 2005, Lamont et al., 2014, Silverstein, 2005). Consider
Recommendation 1: develop guiding frameworks and empirical models based on cultural and structural racism
Based on an understanding that the root causes of racial health inequalities stem are founded upon cultural and structural racism (Dressler, 2001, Dressler et al., 2005, Geronimus and Thompson, 2004, Phelan and Link, 2015), we recommend that all work on racial health inequalities be situated within a framework of cultural and structural racism. While the specific conceptual and empirical models that guide specific research questions may not make cultural and/or structural racism explicit, we
Recommendation 2: employ critical race theory approaches
In addition to applying a framework of structural racism, we recommend that scholars studying racial health inequalities use a critical race lens when developing their framework and conceptual and analytic models. Critical race theory (CRT), developed in law studies (Crenshaw, 1995), is a constellation of principles that form an approach to the interpretation of structural factors, and more recently, to scientific inquiry of racial inequities, including health inequities (Ford and Airhihenbuwa,
A call to action
In this introduction to the Special Issue on Racism and Health Inequalities, we have discussed a part of a framework linking cultural and structural racism and health inequalities that is too often ignored in public health, particularly epidemiology and biomedical, discussions. Specifically, we discussed the ways in which cultural racism drives structural racism to maintain the privileged positionality of the dominant racial group. Finally, we provided two foundational recommendations for all
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