Remembering Past Lessons about Structural Racism — Recentering Black Theorists of Health and Society [nejm.org]

By Alexandre White, Rachel L.J. Thornton and Jeremy Greene, New England Journal of Medicine, August 26, 2021

Imagine your city is being ravaged by an infectious disease epidemic whose morbidity and mortality are disproportionately borne by Black Americans. A prominent scholar of health disparities reports that this “strikingly excessive rate,” often misattributed to putative biologic or genetic differences between Black and White bodies, must be understood as a spotlight illuminating the fundamental racial inequities in American society. This structural impact of race and racism as social determinants of health, rather than any biology of racial difference, confers on Black Americans a higher risk of getting sick and lower chances of having access to or adequate service from the health care system.

This argument sounds familiar in 2021. But this study, commissioned by the University of Pennsylvania, was a report on health and welfare entitled The Philadelphia Negro, published in 1899 by W.E.B. Du Bois and supported by a team of researchers. It provided an empirical foundation to demonstrate that racial disparities in mortality from tuberculosis, “the most fatal disease for Negroes,” were a product of social forces.¹ In meticulously mapped details accompanied by charts, survey data, and careful statistical analysis, it chronicled the processes by which the lives and lifestyles of middle-class, working-class, and unemployed Black Philadelphians alike were affected by racial segregation in regard to housing, economic opportunity, and access to healthy food and environments. These socially structured differences and enforced inequities, visible to anyone looking at a city map from across the room (Figure 1), worked their way into bodily differences in health and illness, life and death.

In Du Bois’ terms, to compare the health of White Philadelphia and Black Philadelphia was not only to view “side by side and in intimate relationship in a large city two groups of people, who as a mass differ considerably from each other in physical health,” but also to come to terms with powerful health disparities in urban and rural spaces throughout the United States. Charting the structural basis of health disparities, he concluded, “should then act as a spur for increased effort . . . and not as an excuse for passive indifference, or increased discrimination.”

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