The Health Impacts of Racism

There has been growing evidence in recent years of the impact racism has on the health of racial and ethnic minority groups.1 From general life expectancy to the prevalence of obesity, hypertension, and diabetes, the wellness gaps and health disparities within the U.S. population are significant — and many of these concerns can be linked back to various forms of racism and discrimination.

Read on to learn more about racism and its connection to prominent health conditions affecting minority populations, along with information on related topics, such as the importance of diversity in the healthcare workforce. We’ve also included a selection of hand-picked resources to help you find the mental or physical healthcare you need.

Different from racial prejudice, racism involves one group having the power to carry out systematic discrimination over another; it is ultimately a form of oppression.2 This happens through institutional policies, practices, and societal norms and by shaping cultural beliefs and values that support racist policies. The result is the unfair advantage of resources and opportunities for some groups of people at the disadvantage of others.

To better understand the impact of racism and how it affects healthcare, we’ve broken down some key terms below.

• Structural racism: This type of racism is the most pervasive form, embedding itself within the social, economic, and political systems that we live within to further perpetuate racial inequity. Structural racism isn’t the prejudiced views of one group of individuals but the history, culture, and current reality of racism across institutions.3
• Internalized racism: When a person’s worldview incorporates racist ideologies, attitudes, and behaviors.3
• Interpersonal racism: This type of racism occurs between individuals when a person’s internal beliefs are brought into how they interact with others, whether intentionally or not. This type of racism can range from unconscious bias to violence and hate speech.4
• Institutional racism: When the policies, practices, and culture of a system work against people of color, whether inadvertently or not.4

These and other forms of racism continue to negatively impact the health of people across the globe. Leading organizations such as the American Heart Association,5 American Medical Association,6 and Centers for Disease Control have all stepped forward to acknowledge the effect structural racism has had on health disparities in the U.S. healthcare system.7

The CDC and the World Health Organization (WHO) identify Social Determinants of Health (SDOH), which are nonmedical factors that strongly influence health outcomes, as a particular area of focus. These factors have a profound effect on the physical and mental health of individuals, and the long history of racism in the U.S. has only served to further exacerbate their impact upon communities of color.

Examples of social determinants of health include:8

• Unemployment
• Income
• Food insecurity
• Housing
• Education
• Working life conditions
• Social inclusion
• Access to affordable healthcare

The statistics below give an idea of how current health disparities affect Black, Indigenous, and People of Color (BIPOC) in the U.S.

• In 2022, 13.1% of Black or African American people did not have health insurance, compared to 10.3% of White Americans.9
• The mortality rates of Black American infants (10.8 deaths per 1,000 live births) are nearly twice that of the national average.10
• Pregnancy-related deaths are three times as likely for Black women than White women.10
• Only 13.6% of White Americans consider their health status “fair or poor,” compared to 18.8% of Black or African Americans.11

When viewing racism through the lens of healthcare, several factors ultimately lead to greater racial and ethnic health disparities.12

• Differences in healthcare access (including health insurance)
• Differences in the quality of healthcare received
• Differences in health-seeking behavior
• Differences due to social determinants of health (SDOH)

Research published in 2020 examined the frequency with which healthcare patients experienced discrimination.13 Results revealed that 21.4% of survey respondents experienced discrimination in the healthcare system, with racial and ethnic racism being the most common. BIPOC can also face discriminatory educational and employment practices, further driving levels of poverty in their communities. This, in turn, exacerbates issues of food insecurity, lesser access to health insurance and healthcare, financial strain, and mental health ramifications.13 14

Differences in life expectancy

CDC data reports that Black adults (between the ages of 18 and 64) are at a higher risk of early death than White persons.15 In addition, the 2022 National Vital Statistics report states that the average life expectancy of those who are Black (74.8 years) is shorter than that of Asians (85.6 years), Hispanics (81.9 years), and non-Hispanic White people (78.8 years).16 This difference in life expectancy for Black Americans is largely due to the chronic health conditions plaguing this population group. In the following section, we cover some of the most common health issues experienced by BIPOC.

In the sections below, we’ll cover a few of the health conditions impacted by racism. These are far from all of the medical concerns significantly impacting the BIPOC community, but they are some of the most prevalent.

Hypertension

Untreated hypertension (high blood pressure) can have fatal consequences, including heart attack, stroke, kidney damage, and metabolic syndrome.17 The CDC reports that Black persons between ages 35 and 64 are 50% more likely to have high blood pressure than White persons of the same age group.15 In data from 2015-2018, 57.5% of male and female Black Americans suffered from hypertension.18

Family history, obesity, diabetes, and an unhealthy diet are all risk factors for hypertension. In addition, it is no secret that stress directly correlates to elevated blood pressure. Racial discrimination, alongside struggles with income, housing, and food insecurity, can cause tremendous stress for members of the BIPOC community, further impacting their risk of hypertension, heart disease, and stroke.19

Diabetes

Diabetes is a chronic condition that occurs when your blood sugar is too high due to either your pancreas not producing enough insulin or your body not responding to insulin as it should.20 Risk factors for diabetes include obesity, poor diet, hormonal imbalances, genetics, and a lack of physical activity. The U.S. Department of Health and Human Services reports that in 2018, African American adults were 60% more likely to be diagnosed with diabetes than their White counterparts. They are also twice as likely to die from complications of diabetes.21

A 2017 research study revealed that biological risk factors like weight and abdominal fat were the predominant explanations for the disproportionate number of Black Americans affected by diabetes compared to White persons.22 However, these risk factors themselves are influenced by social determinants of health, bringing attention to the core issues at hand — poverty, a lack of healthy food options, and limited healthcare access in racial and ethnic minority neighborhoods.

Obesity

Childhood obesity is a significant public health issue in the U.S., with a disproportionate prevalence among non-Hispanic Black and Hispanic children.23 A 2023 research study examined the relationship between obesity and children exposed to interpersonal racial discrimination. The results revealed that higher levels of exposure to racism were significantly associated with increased Body Mass Index (BMI) and waist circumference, which are markers of obesity.24

The CDC also reported that, in 2018, Black or African American persons (38.0%) and American Indian or Alaska Native persons (48.1%) had the highest rates of obesity (a BMI of 30 or higher) of all groups surveyed. Black women were also 50% more likely to have obesity than White women.25 Individuals struggling with overweight or obesity have a greater likelihood of high blood pressure, high LDL cholesterol, and diabetes, which are known risk factors for heart disease and stroke.

Evidence indicates that systemic racism plays a part in the obesity epidemic among Black and African Americans. This includes a healthcare practitioner’s unconscious racial bias, as well as limited access to health insurance, healthy foods, and safe places to exercise.26

COVID-19

Black and Latinx Americans experienced a disproportionate number of infections and deaths from COVID-19, especially during the initial wave of the pandemic before the virus spread to a larger geographical area of the U.S. to include more rural communities.27 28 During the first six months of the pandemic, the COVID-19 mortality rate for Black Americans was more than double that of White and Asian Americans.29 Obesity and diabetes, which are both prevalent in Black Americans (as detailed above), serve as risk factors for more severe cases of COVID-19, leading to more hospitalizations and deaths.

Upon reflection, this unprecedented health crisis exposed elements of structural racism in the U.S.; inequalities resulted in Black Americans having greater exposure to the virus and an increased risk of mortality for those who were infected.12 For example, a significant portion of the essential workforce during the COVID-19 pandemic included racial and ethnic minority groups, keeping them at a higher risk of infection as they were exposed to the public while working for necessary income.30

It may come as no surprise that some patients prefer their physician to be of the same race or ethnicity as themselves.31 This connection between patient and provider has demonstrated increased satisfaction in care. Unfortunately, the healthcare workforce in the U.S. does not accurately represent the country’s diverse population. While the number of POC in healthcare is increasing, the Association of American Medical Colleges reported that in 2018, only 5% of active physicians in the U.S. were Black or African American.32 In addition, for the 2018-19 academic year, only 8.4% of applicants to U.S. medical schools were Black, while 46.8% were White.33

It’s also notable that in zip codes where the majority of residents are Black, research has shown there are significantly greater odds of a primary care physician shortage, reinforcing the impact of residential segregation on healthcare access.34 So, while it is easy to acknowledge the need for a more diverse network of healthcare providers in all zip codes, it’s not as simple to implement this idea. Efforts to dismantle structural racism in this regard are complex and will require the cooperation of academic, governmental, and professional institutions along with the U.S. healthcare system at large.35 36

Whether you’re interested in learning more about racism and health disparities or you’re a member of the BIPOC community seeking a more diverse care team, we’ve gathered a collection of resources that may be able to help you.

Support and crisis lines:

• Racial Equity Support Line: A support line led and staffed by individuals who have experienced racism. Call 503-575-3764 (available weekdays from 10am to 7pm PT).
• BlackLine: A crisis line that prioritizes BIPOC; call 1 (800) 604-5841 or download the iOS or Android app.

Find healthcare providers:

• BlackDoctor.org: Find a culturally sensitive doctor, as well as information on health and wellness.
• Inclusive Therapists: A directory of inclusive therapists serving marginalized communities.

Other resources:

• African American Diabetes Association: A non-profit organization with BIPOC-focused information on diabetes.
• African American Wellness Project: An organization dedicated to helping the BIPOC community respond to healthcare disparities.
• Black Women’s Health Imperative: A non-profit focused on health equity for Black women and girls worldwide.
• The Center for Black Health and Equity: A public health entity dedicated to facilitating programs and services to benefit Black and African American communities.
• Our guide to mental health resources for the BIPOC community