The Environment That Racism Built
The conventional and individualistic recipe for good health has long been to eat right, avoid bad habits, exercise regularly, sleep enough, and have regular doctor check-ups. Yet, despite this straightforward prescription, many people in the United States struggle to achieve and maintain good health. While personal behavior and choice are certainly core components of one’s health, they cannot fully explain or account for all that it takes to become and remain healthy.
The reality in this nation is that while people can self-regulate some aspects of their health–such as by following the practices listed above—many other factors that determine health are beyond individual control. These factors include the environments in which people are born, live, learn, work, and play—known as the social determinants of health. These determinants substantially affect and shape health and quality of life—for better or for worse.
Health inequities—defined as disparities that are modifiable, associated with social disadvantage, and considered ethically unfair—are preventable health problems that research has shown result from a toxic relationship between how people live their lives and the socioeconomic and physical environments that surround them. An inequity that has long held the attention of public health researchers, and that was recently catapulted into the national spotlight, are the longstanding, severe, and preventable race-based differences in the survival rates of black mothers and their infants.
Longstanding place-based inequities for black mothers and infants
As studies have shown, these longstanding inequities are centrally caused by racism—a system of power that unjustly hoards vital, life-building opportunities and resources for a category of people who are artificially deemed as racially superior, while disempowering and denying those assets to groups devalued as racially inferior. This system creates a racialized landscape in which people of color tend to experience worse health outcomesthan white people, with black and Native American communities facing some of the steepest environmental barriers to socioeconomic well-being. These barriers include but are not limited to: segregated communities with substandard healthy food options and hazardous housing conditions; and unwalkable neighborhoods that are systematically polluted and isolated from the quality of life levers needed to meaningfully participate in society. Such levers include equitably resourced health care and school systems as well as accessible public transportation that connects people to gainful job opportunities.
There is perhaps no time in a woman’s life when her health matters more than when she decides to become a mother. Yet, no matter how hard women work to have the best pregnancy and birth outcomes possible, black mothers in the United States—regardless of wealth or educational background—are still three to four times more likely to die during and after childbirth. Their babies share this fate, and are twice as likely to die in infancy as their white, non-Hispanic counterparts. To meaningfully rectify this inequity will require a fight-fire-with-fire systems approach—in which all stakeholders, sectors, and political structures are engaged to tackle racism first and foremost. This includes identifying and acknowledging the cumulative and compounded effects of this historical system of oppression; the full extent to which it is embedded within U.S. society; and chiefly, how racism manifests not just in black women’s everyday environments but also in those of their families and larger communities.