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Tuesday, September 1, 2020

Systemic racism and U.S. health care

J. Feagin & Z. Bennefield
Social Science & Medicine
Volume 103, February 2014, Pages 7-14


This article draws upon a major social science theoretical approach–systemic racism theory–to assess decades of empirical research on racial dimensions of U.S. health care and public health institutions. From the 1600s, the oppression of Americans of color has been systemic and rationalized using a white racial framing–with its constituent racist stereotypes, ideologies, images, narratives, and emotions. We review historical literature on racially exploitative medical and public health practices that helped generate and sustain this racial framing and related structural discrimination targeting Americans of color. We examine contemporary research on racial differentials in medical practices, white clinicians' racial framing, and views of patients and physicians of color to demonstrate the continuing reality of systemic racism throughout health care and public health institutions. We conclude from research that institutionalized white socioeconomic resources, discrimination, and racialized framing from centuries of slavery, segregation, and contemporary white oppression severely limit and restrict access of many Americans of color to adequate socioeconomic resources–and to adequate health care and health outcomes. Dealing justly with continuing racial “disparities” in health and health care requires a conceptual paradigm that realistically assesses U.S. society's white-racist roots and contemporary racist realities. We conclude briefly with examples of successful public policies that have brought structural changes in racial and class differentials in health care and public health in the U.S. and other countries.


• A full-fledged theory of structural (systemic) racism for interpreting health care data.

• A full-fledged developed theory of structural (systemic) racism for interpreting public health data.

• Focus on powerful white decision makers central to health-related institutions.

• Importance of listening to patients and physicians of color on health issues.

• Implications of systemic racism theory and data for public policies regarding medical care and public health.

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