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Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism: Looking Upstream from Disease Inequities among People Who Use Drugs

Author

Listed:
  • Samuel R. Friedman

    (Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA)

  • Leslie D. Williams

    (Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA)

  • Ashly E. Jordan

    (Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA)

  • Suzan Walters

    (Department of Epidemiology, New York University School of Global Public Health, New York, NY 10003, USA)

  • David C. Perlman

    (Icahn School of Medicine at Mount Sinai, New York, NY 10003, USA)

  • Pedro Mateu-Gelabert

    (Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA)

  • Georgios K. Nikolopoulos

    (Medical School, University of Cyprus, 2029 Aglantzia, Nicosia 1678, Cyprus)

  • Maria R. Khan

    (Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA)

  • Emmanuel Peprah

    (Department of Epidemiology, New York University School of Global Public Health, New York, NY 10003, USA)

  • Jerel Ezell

    (Africana Studies and Research Center, Cornell University, Ithaca, NY 14850, USA)

Abstract

Structural racism is increasingly recognized as a key driver of health inequities and other adverse outcomes. This paper focuses on structural racism as an “upstream” institutionalized process, how it creates health inequities and how structural racism persists in spite of generations of efforts to end it. So far, “downstream” efforts to reduce these health inequities have had little success in eliminating them. Here, we attempt to increase public health awareness of structural racism and its institutionalization and sociopolitical supports so that research and action can address them. This paper presents both a theoretic and an analytic approach to how structural racism contributes to disproportionate rates of HIV/AIDS and related diseases among oppressed populations. We first discuss differences in disease and health outcomes among people who use drugs (PWUD) and other groups at risk for HIV from different racial and ethnic populations. The paper then briefly analyzes the history of racism; how racial oppression, class, gender and other intersectional divisions interact to create health inequities; and how structural racism is institutionalized in ways that contribute to disease disparities among people who use drugs and other people. It examines the processes, institutions and other structures that reinforce structural racism, and how these, combined with processes that normalize racism, serve as barriers to efforts to counter and dismantle the structural racism that Black, indigenous and Latinx people have confronted for centuries. Finally, we discuss the implications of this analysis for public health research and action to undo racism and to enhance the health of populations who have suffered lifetimes of racial/ethnic oppression, with a focus on HIV/AIDS outcomes.

Suggested Citation

  • Samuel R. Friedman & Leslie D. Williams & Ashly E. Jordan & Suzan Walters & David C. Perlman & Pedro Mateu-Gelabert & Georgios K. Nikolopoulos & Maria R. Khan & Emmanuel Peprah & Jerel Ezell, 2022. "Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism: Looking Upstream from Disease Inequities among People Who Use Drugs," IJERPH, MDPI, vol. 19(12), pages 1-19, June.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:12:p:7453-:d:841446
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    References listed on IDEAS

    as
    1. Collins, Alexandra B. & Boyd, Jade & Cooper, Hannah L.F. & McNeil, Ryan, 2019. "The intersectional risk environment of people who use drugs," Social Science & Medicine, Elsevier, vol. 234(C), pages 1-1.
    2. Alesina, Alberto & Dollar, David, 2000. "Who Gives Foreign Aid to Whom and Why?," Journal of Economic Growth, Springer, vol. 5(1), pages 33-63, March.
    3. Mizruchi, Mark S., 2013. "The Fracturing of the American Corporate Elite," Economics Books, Harvard University Press, number 9780674072992, Spring.
    4. Hallfors, D.D. & Iritani, B.J. & Miller, W.C. & Bauer, D.J., 2007. "Sexual and drug behavior patterns and HIV and STD racial disparities: The need for new directions," American Journal of Public Health, American Public Health Association, vol. 97(1), pages 125-132.
    5. Grier, S.A. & Kumanyika, S.K., 2008. "The context for choice: Health implications of targeted food and beverage marketing to African Americans," American Journal of Public Health, American Public Health Association, vol. 98(9), pages 1616-1629.
    6. Aggie J. Yellow Horse & Karen Kuo & Eleanor K. Seaton & Edward D. Vargas, 2021. "Asian Americans’ Indifference to Black Lives Matter: The Role of Nativity, Belonging and Acknowledgment of Anti-Black Racism," Social Sciences, MDPI, vol. 10(5), pages 1-19, May.
    7. Heeju Sohn, 2017. "Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 36(2), pages 181-201, April.
    8. Hilmers, A. & Hilmers, D.C. & Dave, J., 2012. "Neighborhood disparities in access to healthy foods and their effects on environmental justice," American Journal of Public Health, American Public Health Association, vol. 102(9), pages 1644-1654.
    9. Saha, S. & Arbelaez, J.J. & Cooper, L.A., 2003. "Patient-Physician Relationships and Racial Disparities in the Quality of Health Care," American Journal of Public Health, American Public Health Association, vol. 93(10), pages 1713-1719.
    10. Friedman, S.R. & Cooper, H.L.F. & Osborne, A.H., 2009. "Structural and social contexts of HIV risk among African Americans," American Journal of Public Health, American Public Health Association, vol. 99(6), pages 1002-1008.
    11. Hahn, R.A. & Magder, L.S. & Aral, S.O. & Johnson, R.E. & Larsen, S.A., 1989. "Race and the prevalence of syphilis seroreactivity in the United States population: A national sero-epidemiologic study," American Journal of Public Health, American Public Health Association, vol. 79(4), pages 467-470.
    12. Shariff-Marco, S. & Klassen, A.C. & Bowie, J.V., 2010. "Racial/ethnic differences in self-reported racism and Its association with cancer-related health behaviors," American Journal of Public Health, American Public Health Association, vol. 100(2), pages 364-374.
    13. Frank Edwards & Hedwig Lee & Michael Esposito, 2019. "Risk of being killed by police use of force in the United States by age, race–ethnicity, and sex," Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, vol. 116(34), pages 16793-16798, August.
    14. Buchmueller, T.C. & Levinson, Z.M. & Levy, H.G. & Wolfe, B.L., 2016. "Effect of the affordable care act on racial and ethnic disparities in health insurance coverage," American Journal of Public Health, American Public Health Association, vol. 106(8), pages 1416-1421.
    15. Friedman, S.R. & Cooper, H.L.F. & Osborne, A.H., 2009. "Structural and social contexts of HIV risk among African Americans (American Journal of Public Health (2009) 99, (1002-1008) doi: 10.2105/AJPH.2008.140327)," American Journal of Public Health, American Public Health Association, vol. 99(8), pages 1352-1352.
    16. Neaigus, Alan & Friedman, Samuel R. & Curtis, Richard & Des Jarlais, Don C. & Terry Furst, R. & Jose, Benny & Mota, Patrice & Stepherson, Bruce & Sufian, Meryl & Ward, Thomas & Wright, Jerome W., 1994. "The relevance of drug injectors' social and risk networks for understanding and preventing HIV infection," Social Science & Medicine, Elsevier, vol. 38(1), pages 67-78, January.
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