Estrada Leah V, Levasseur Jessica L, Maxim Alexandra, Benavidez Gabriel A, Pollack Porter Keshia M
Center for Health Policy, Columbia University School of Nursing, New York, New York, USA.
Nicholas School of the Environment, Duke University, Durham, North Carolina, USA.
Health Equity. 2022 May 12;6(1):356-366. doi: 10.1089/heq.2021.0190. eCollection 2022.
Place is a social determinant of health, as recently evidenced by COVID-19. Previous literature surrounding health disparities in the United States often fails to acknowledge the role of structural racism on place-based health disparities for historically marginalized communities (i.e., Black and African American communities, Hispanic/Latinx communities, Indigenous communities [i.e., First Nations, Native American, Alaskan Native, and Native Hawaiian], and Pacific Islanders). This narrative review summarizes the intersection between structural racism and place as contributors to COVID-19 health disparities.
This narrative review accounts for the unique place-based health care experiences influenced by structural racism, including health systems and services and physical environment. We searched online databases for peer-reviewed and governmental sources, published in English between 2000 and 2021, related to place-based U.S. health inequities in historically marginalized communities. We then narrate the link between the historical trajectory of structural racism and current COVID-19 health outcomes for historically marginalized communities.
Structural racism has infrequently been named as a contributor to place as a social determinant of health. This narrative review details how place is intricately intertwined with the results of structural racism, focusing on one's access to health systems and services and physical environment, including the outdoor air and drinking water. The role of place, health disparities, and structural racism has been starkly displayed during the COVID-19 pandemic, where historically marginalized communities have been subject to greater rates of COVID-19 incidence and mortality.
As COVID-19 becomes endemic, it is crucial to understand how place-based inequities and structural racism contributed to the COVID-19 racial disparities in incidence and mortality. Addressing structurally racist place-based health inequities through anti-racist policy strategies is one way to move the United States toward achieving health equity.
场所是健康的社会决定因素，最近的新冠疫情就证明了这一点。以往关于美国健康差异的文献往往没有认识到结构性种族主义对历史上被边缘化社区（即黑人及非裔美国人社区、西班牙裔/拉丁裔社区、原住民社区[即第一民族、美国原住民、阿拉斯加原住民和夏威夷原住民]以及太平洋岛民）基于场所的健康差异所起的作用。本叙述性综述总结了结构性种族主义与场所之间的交叉点，它们是导致新冠疫情健康差异的因素。
本叙述性综述考虑了受结构性种族主义影响的独特的基于场所的医疗保健经历，包括卫生系统和服务以及物理环境。我们在在线数据库中搜索了2000年至2021年期间以英文发表的、与美国历史上被边缘化社区基于场所的健康不平等相关的同行评议和政府来源资料。然后，我们阐述了结构性种族主义的历史轨迹与历史上被边缘化社区当前的新冠疫情健康结果之间的联系。
结构性种族主义很少被认为是场所作为健康社会决定因素的一个促成因素。本叙述性综述详细说明了场所如何与结构性种族主义的结果错综复杂地交织在一起，重点关注人们获得卫生系统和服务以及物理环境（包括室外空气和饮用水）的情况。在新冠疫情期间，场所、健康差异和结构性种族主义的作用得到了鲜明体现，历史上被边缘化社区的新冠发病率和死亡率更高。
随着新冠疫情成为地方病，了解基于场所的不平等和结构性种族主义如何导致新冠疫情在发病率和死亡率方面的种族差异至关重要。通过反种族主义政策战略解决基于场所的结构性种族主义健康不平等问题，是推动美国实现健康公平的一种方式。
