Structural Racism and Population Health: The Role of Race, Socioeconomic Status and Context

Racism is associated with poor health outcomes among African Americans, but most of this research focuses on interpersonal-level experiences of discrimination. The effects of macro-level structural racism on population health is understudied. Though the literature has examined structural racism in the form of racial residential segregation, the health effects of another indicator of structural racism, racial inequalities in socioeconomic status, is not well-understood. Preliminary work suggests that living in contexts with larger racial inequalities in SES is associated with rates of obesity and poor self-rated health, and associations vary by contextual factors like urbanization. However, the mechanisms of these associations are unknown. This proposal will examine race, individual-level SES and county-level urbanization as moderators of the association between county-level racial inequalities in SES with obesity and self-rated health. Racial segregation will also be examined as a mediator, and thus determine how these indicators of structural racism are interrelated with regard to health. These studies will link the National Health Interview Survey to a county-level data set of racial inequalities in SES and racial segregation derived from the American Communities Survey. The results of these studies will combine the research areas of Health in Social Context and Social and Economic Inequality to advance our understanding of structural racism effects with potential for intervention and future research.