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Member Research & Reports

Member Research & Reports

Columbia Shows Structural Racism Predicts Worse Cardiovascular Health for Blacks

Blacks in states where they experience more systematic disadvantage than Whites have worse cardiovascular health than those in states where they have greater opportunity, according to a study by researchers at Columbia’s Mailman School of Public Health. Findings are published in Social Science & Medicine.


While past research has looked at the effects of self-reported experiences of discrimination on health at an individual level, this study is one of the first to examine how unfair treatment at an institutional level contributes to health, according to the authors, Dr. Katherine Keyes, assistant professor of epidemiology, Dr. Mark Hatzenbuehler, assistant professor of sociomedical sciences, and Dr. Alicia Lukachko, a postdoctoral alumna of the psychiatric epidemiology training program, all from the Mailman School of Public Health.

To determine what the researchers call “structural racism,” which they define as “the systematic exclusion of Blacks from resources and mobility in society,” they looked at the percentage of Blacks compared to the percentage of non-Hispanic Whites in each of the 50 U.S. states on several measures: holding a college degree, employment, incarceration, and participation in the state’s political system.

They found that Blacks were more likely to report having had a heart attack in the past year in states where there were a low percentage of Blacks and a high percentage of Whites employed, well educated, and politically represented–representing greater inequality of opportunity. In states where Blacks were more over-represented in the prison system relative to the percentage of the state that is Black, they were at greater odds for a heart attack in the past year. Across the U.S., blacks are jailed or put in prison from two to 14 times as much as Whites.

The results indicate that structural racism plays a larger role than socioeconomic status in determining health outcomes: in states where on average Blacks occupy lower socioeconomic status, the health disparities were not as pronounced as they were in states where the gap in opportunity between Blacks and Whites was greater.

“While inequality does track with socioeconomics of U.S. states, there is considerable variation; for example, states like Maine and New York have higher rates of inequality than would be expected given their economic profiles,” says Dr. Keyes. As for Whites, they reported better cardiovascular health in states where there was more structural racism.