Top Things to Know: Call to Action: Structural Racism as a Fundamental Driver of Health Disparities
Published: November 10, 2020
Prepared by Radhika Rajgopal Singh, PhD, Vice President, Science, Medicine and Health
- Detailing the ways in which structural racism has long persisted as major driver of health disparities and the impact on health outcomes due to the COVID-19 pandemic and civil unrest resulting from the killings of George Floyd, Breanna Taylor and others, this Advisory is a call to action to eliminate structural racism.
- CVD and stroke mortality rates have declined over the past two decades with a recent plateau; these gains however, have not been equitably shared across racial and ethnic groups (non-Hispanic White, Black, Asian, American Indian/Alaska Native, and Hispanic/Latino). With almost 30% higher CVD mortality and 45% higher stroke mortality compared with non-Hispanic White Americans, Black Americans continue to experience the highest mortality rates due to CVD and stroke.
- Structural racism inequitably limits opportunities for social, economic, and financial advancement, resulting in a complex interplay among race, social determinants, and health that has negative consequences.
- Experienced racism has a severe, long-lasting health impact; stress and stress hormones cause structural and functional changes in the brain, and deteriorating health in early adulthood among Black population.
- The Advisory details the historical context experienced by Black people, indigenous people of the U.S., people of Hispanic/Latino descent, and people of Asian descent in the U.S. and the culture of racism that pervades social, economic and political institutions where structural racism persists today.
- For future AHA scientific statements and advisories focused on health disparities, the Advisory notes vital gaps that must be addressed: a) ensure inclusion of the present-day impact of structural racism that leads to poor CV outcomes among historically marginalized racial and ethnic groups; b) clearly acknowledge that racism is experienced, and c) ensure that the burden of mitigating the impact of structural racism on social and health inequities is not limited to patients, but instead examines the broader impact of discriminatory practices within our healthcare systems and the role of institutionalized racism and implicit bias on patient care and health outcomes.
- Contemporary examples describe the significance of structural racism on health inequities and its effects as a principal driver of current inequities across multiple systems in the U.S: housing, education, criminal justice, health and healthcare, and economic systems.
- Structural racism has been exposed as a principal driver of disproportionately higher morbidity and mortality rates for COVID-19 for Black persons, Indigenous persons, Pacific Islander persons, and Hispanic/Latino persons compared with White persons in the U.S.
- To address racial inequities, we must: 1) transform aspects of adversely affected communities, 2) establish policies that improve the quality of education and outcomes 3) establish policies that improve the quality of housing and neighborhood environments , especially in residentially segregated areas; 4) establish policies that eliminate inequities in access to and the quality of healthcare, and 5) foster allyship between racial and ethnic groups to transform changes in individual cultural attitudes, garner political support for change, and grow public empathy that change needs to occur. Future research on racism must investigate the joint effects of multiple domains of racism (structural, interpersonal, cultural, and anti-Black) and their effects on health outcomes and health inequities.
- For the American Heart Association (AHA) to continue to be a relentless force for longer, healthier lives for all people in all communities, in the U.S. and globally, the call to action from this Advisory prompts a bold response to structural racism including review of its own organizational practices and processes, to embrace antiracism within the AHA and externally to better account for its interactions with its partners and other organizations in the name of antiracism.
Citation
Churchwell K, Elkind MSV, Benjamin RM, Carson AP, Chang EK, Lawrence W, Mills A, Odom TM, Rodriguez CJ, Rodriguez F, Sanchez E, Sharrief AZ, Sims M, Williams O; on behalf of the American Heart Association. Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association [published online ahead of print November 10, 2020]. Circulation. doi: 10.1161/CIR.0000000000000936.