6.5: Chapter Summary
Structural racism is a deeply rooted, persistent, normative process of institutional policies, systems, laws, and practices that limit opportunities, resources, and the power of individuals based on race. It ensures differential access to quality education, housing, employment, and medical care. Forms of racism include personally mediated racism, internalized racism, eugenics, and scientific racism.
Structural racism in the United States can be traced back to British Colonial America, prior to the country’s founding, with the ill treatment and forced removal of Native Americans from their lands and the terrible history of slavery. Though it has changed and evolved from the era of slavery and the Civil War, through Reconstruction and the Jim Crow era, in the internment of Japanese Americans and the boarding school policy for Native American and Alaskan children, in the redlining and racially restrictive covenants of the 1950s, the War on Crime and War on Drugs, and the current epidemic of police violence and unequal access to health care, structural racism has persisted.
Despite some policies aimed at addressing structural racism and systemic inequities, their existence and effects remain. Differences in homeownership, home values, and credit scores by race persist in those areas that were formerly redlined. Many of these formerly redlined, majority-BIPOC neighborhoods also suffer environmental injustices as most of these redlined neighborhoods were in urban areas where there was widespread community disinvestment resulting in less green space, less tree canopies, and increased urban heat exposure. In addition, the Federal-Aid Highway Act built highways that cut through neighborhoods, disrupted green spaces, worsened air quality, increased pollutants, and sank property values. These environmental injustices are linked to adverse health outcomes such as asthma, adverse birth outcomes, and cancer.
Structural racism and systemic inequities have many manifestations in health care. Racism and implicit bias, discriminatory policies in health insurance access and coverage, the effects of discriminatory mass incarceration, and the lasting impact from discriminatory policies in residential segregation all negatively impact health incomes for BIPOC populations. Residential segregation has lasting harmful effects on BIPOC communities, resulting in lower wealth accumulation, educational inequities driving employment disparities, the disproportionate burden of environmental hazards, and decreased access to quality foods and transportation. Structural racism intersects with health disparities and the social determinants of health, resulting in stark health inequities. The COVID-19 pandemic highlighted these existing inequities. The role of the nurse in addressing structural racism begins with conducting a critical evaluation of nursing education curricula, displaying a commitment to developing workforce diversity, speaking out against structural racism by naming it and discussing it, including the SDOH in all nursing assessments and plans, and advocating for a more equitable health system.