Longstanding racial and ethnic disparities in health care experiences contribute to profoundly inequitable health and life outcomes in the United States. Researchers, policymakers, practitioners, advocates, and communities seeking to eradicate these disparities must understand and intervene in their root causes. In this brief, we develop a conceptual map of structural racism in health care that demonstrates the connections between (1) mental models that, in often unnoticed ways, guide how society thinks and acts; (2) inequitable structures, including laws and policies that codify the distribution of and access to resources; and (3) racial and ethnic disparities in health care experiences and outcomes.

WHY THIS MATTERS

With greater clarity around structural racism, advocates can more compellingly call for root-cause interventions, policymakers can more effectively develop and implement them, funders can more sustainably support them, and researchers can more rigorously evaluate them.

WHAT WE FOUND

The map shows that the present-day legacy of structural racism is potent, perpetuated not only by historical and contemporary race-based laws and policies but also by policies that are race-neutral at face value but do not adequately consider and correct for racially inequitable preconditions. The durability of structural racism in the health care system and beyond is partly attributable to its web-like, reinforcing nature. The extended example of how occupational segregation contributes to health care disparities illustrates these points with greater detail and texture. Considering the possible health care policy and practice solutions that counteract racist structures can be both incremental and transformational. 

HOW WE DID IT

We used three sets of inputs to generate the conceptual map: a literature scan, feedback conversations, and a crude round of “validating” the map using media reports from major news outlets. We built from existing theoretical bodies of work related to systems thinking (i.e., the iceberg model) and linking structural racism to health.