Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
J Gen Intern Med. 2024 Feb;39(3):487-491. doi: 10.1007/s11606-023-08426-7. Epub 2023 Sep 22.
Significant national discourse has focused on the idea of structural inequalities and structural racism within a variety of societal sectors, including healthcare. This perspective provides an understanding of the historic and pervasive nature of structural inequalities and structural racism; uses well-known frameworks in health equity research for conceptualizing structural inequality and structural racism; offers a summary of the consequences of structural inequalities and structural racism on modern-day health outcomes; and concludes with strategies and suggestions for a way forward. Recommended strategies across different sectors of influence include (a) employment and economic empowerment sector: creating capacity for individuals to earn livable wages; (b) education sector: developing new funding structures to ensure equal opportunities are offered to all; (c) healthcare sector: prioritizing universal access to high-quality health care, including mental health treatment; (d) housing sector: improving access to affordable, safe housing through public-private partnerships; (e) criminal justice sector: focusing reform on restorative justice that is people-centric instead of punitive; and (f) environmental sector: creating sustainable systems that alleviate downstream consequences of climate change. The recommended strategies account for the mutually reinforcing and pervasive nature of structural inequalities/structural racism and target key sectors of influence to enhance overall health outcomes and achieve equity regardless of race, ethnicity, or socioeconomic status.
国家层面进行了大量讨论，关注包括医疗保健在内的各种社会领域中的结构性不平等和结构性种族主义问题。这一视角有助于理解结构性不平等和结构性种族主义的历史性和普遍性；利用健康公平研究中广为人知的框架来构思结构性不平等和结构性种族主义；概述结构性不平等和结构性种族主义对当今健康结果的影响；并提出前进的策略和建议。不同影响领域的建议策略包括：(a) 就业和经济赋权部门：为个人创造赚取可维持生计的工资的能力；(b) 教育部门：制定新的资金结构，确保向所有人提供平等机会；(c) 医疗保健部门：优先考虑普及高质量的医疗保健，包括精神健康治疗；(d) 住房部门：通过公私合作伙伴关系改善获得负担得起、安全住房的机会；(e) 刑事司法部门：关注以人为主而非惩罚为中心的恢复性司法改革；以及 (f) 环境部门：创建可持续系统，减轻气候变化的下游影响。建议的策略考虑到了结构性不平等/结构性种族主义的相互加强和普遍存在的性质，并针对关键影响领域，以提高整体健康结果并实现公平，无论种族、族裔或社会经济地位如何。
