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Race, Racism and Patient Care

Dr. Keith C. Norris, a member of the executive board of the UCLA Fielding School of Public Health’s Center for the Study of Racism, Social Justice & Health, professor of medicine, and vice chair for equity, diversity and inclusion in the UCLA Department of Medicine, wrote a commentary for UCLA Health's U Magazine on how the COVID-19 pandemic has highlighted structural inequities in society that adversely affect the health of racial and ethnic minority communities

Tuesday, March 23, 2021

The burden of most major chronic diseases in the United States falls more heavily on racial and ethnic minorities than on other populations. These disparities are not new, but the COVID-19 pandemic has highlighted many of the ways in which structural inequities in our society adversely affect the health of racial and ethnic minority communities. Together, these disparities, and the rise in racial tensions due to the heightened visibility of inequities in criminal justice, have led to a closer examination of our broader society as well as our health systems.

Health disparities are those differences in disease incidence and outcomes between groups that would not exist if our society were equitable and fair. The major societal resources that influence health — education, housing, employment, wealth, access to care and more — are commonly called the social determinants of health. Enduring adverse conditions in these areas, as well as psychosocial stress and personal mediated discrimination, lead to what is termed “weathering” — the wear and tear of belonging to a marginalized and oppressed group.

How did we get here? We got here through a prevailing system of structural racism that locks populations into a straightjacket of disadvantage. When presented with evidence of widespread discrimination and inequities in our country, many Americans say the system is broken. The system is not broken. In health care, we are very familiar with the saying, “Every system is perfectly designed to achieve the results it gets.” The design of the system that created and maintains inequities in the social determinants of health in the United States is structural racism.