Paula A. Braveman (
Elaine Arkin, independent consultant, Arlington, Virginia.
Health Aff (Millwood). 2022 Feb;41(2):171-178. doi: 10.1377/hlthaff.2021.01394.
Racism is not always conscious, explicit, or readily visible-often it is systemic and structural. Systemic and structural racism are forms of racism that are pervasively and deeply embedded in systems, laws, written or unwritten policies, and entrenched practices and beliefs that produce, condone, and perpetuate widespread unfair treatment and oppression of people of color, with adverse health consequences. Examples include residential segregation, unfair lending practices and other barriers to home ownership and accumulating wealth, schools' dependence on local property taxes, environmental injustice, biased policing and sentencing of men and boys of color, and voter suppression policies. This article defines and , using examples; explains how they damage health through many causal pathways; and suggests approaches to dismantling them. Because systemic and structural racism permeate all sectors and areas, addressing them will require mutually reinforcing actions in multiple sectors and places; acknowledging their existence is a crucial first step.
种族主义并不总是有意识的、明确的或显而易见的——它通常是系统性和结构性的。系统性和结构性种族主义是一种普遍而深刻地存在于制度、法律、成文或不成文政策以及根深蒂固的实践和信仰中的种族主义形式，这些形式会导致、纵容和延续对有色人种的广泛不公平待遇和压迫，从而对健康造成不利影响。例如，居住隔离、不公平的贷款做法以及其他阻碍拥有住房和积累财富的障碍、学校对地方财产税的依赖、环境不公正、对有色人种男性和男孩的有偏见的治安和判刑、以及选民压制政策。本文通过举例定义了它们；解释了它们如何通过多种因果途径损害健康；并提出了消除它们的方法。由于系统性和结构性种族主义渗透到所有部门和领域，因此解决这些问题需要在多个部门和地方采取相互加强的行动；承认它们的存在是至关重要的第一步。
