Eradicating Racial Disparities in Public Health
In a new article, Professor Courtney Cogburn argues that public health policy making should take the health impacts of cultural racism into account.
For some time, the discipline of public health has been concerned with the effects of race and socioeconomic status on an individual’s health and well-being. Policymakers, in the meantime, tend not to place priority on the social determinants of health when developing public health policies and programs. For a long time, the assumption has been that by adopting race-neutral, “one-size-fits all” policies, the United States can improve health outcomes population-wide.
Professor Courtney Cogburn, in a new article for The Milbank Quarterly, asserts that this race-neutral approach is insufficient if the goal is truly to address the health needs of all sectors of the population. Instead, public health policy makers should study health disparities within our population and their causes. Then, using this knowledge, they can build a more effective agenda for improving the nation’s health—one that addresses race, and the health effects of cultural racism, explicitly. She cites recent research showing that even when Blacks achieve the same socioeconomic status as White Americans, differences in the health outcomes they experience remain.
“To adequately address health inequities rooted in systemic racism,” Cogburn writes, “it is imperative to discuss the function of cultural racism in shaping population health in the United States.”
She goes on to present recommendations across three specific areas for improvement in policy and research:
- Health Policy and Institutions
Health professionals must reorient themselves away from a push for “cultural competence” toward one of “structural competence.” The former ties the roots of health disparities to the behavior of individual patients, while the latter fosters an awareness of the larger systems that produce inequities and enhances our ability to challenge the structural causes of racial health disparities.
- Psychosocial Stress
“Cultural racism may . . . distinctly foster toxic social environments that serve as a chronic exposure of psychosocial stress, directly impacting disease processes and health,” Cogburn writes. She reviews literature comparing cultural racism to environmental pollutants, like ever-present smog that impacts health through childhood and beyond. She notes, however, that little research has been conducted on the topic: “Further developing research that examines cultural racism as a source of psychosocial stress would also enhance our current understanding of pathways linking racism to health.”
- Measurement
Cogburn emphasizes that, to mitigate the negative health impacts of cultural racism, we need a way to measure those impacts, which may be challenging but must be done. “Effectively integrating cultural racism into empirical research examining racial inequities in health,” she declares, “will require both a reimagining of existing measures as well as measurement innovation.”