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

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 and Jerel Ezell
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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

IJERPH, 2022, vol. 19, issue 12, 1-19

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.

Keywords: racism; people who use drugs; HIV; substance use; capitalism; scapegoat (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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