Structural Racism as a Fundamental Cause of Health Inequities: Unveiling the Mechanisms and Implications
In recent years, the scientific and public health communities have increasingly recognized structural racism as a pivotal factor underpinning persistent health disparities across diverse populations worldwide. Structural racism refers to the systematic policies, institutional practices, cultural norms, and societal dynamics that perpetuate racial inequities across sectors, shaping the distribution of resources and opportunities. A groundbreaking scoping review by Kisa and Kisa, published in the International Journal for Equity in Health in 2025, meticulously delves into how structural racism operates as a root cause of health inequities, presenting a comprehensive synthesis of current research and offering a vital framework for future investigations and policy interventions.
At the core of this analysis lies the concept that health disparities cannot be fully understood by examining individual behaviors or isolated socioeconomic factors alone. Instead, structural racism must be acknowledged as a fundamental determinant—a “cause of the causes”—that systematically constrains the conditions in which racialized communities live, work, learn, and age. By leveraging a scoping review methodology, the authors collated and analyzed a broad spectrum of empirical studies and theoretical explorations, charting the multifaceted pathways through which structural racism manifests in health outcomes. This approach enables an integrative view that transcends disciplinary silos and highlights the complex interplay between systemic inequities and biological, psychological, and social determinants of health.
The review outlines several key domains where structural racism is enacted and consequential for health equity, including housing segregation, educational inequities, employment discrimination, criminal justice disparities, and unequal access to healthcare services. Each domain contributes cumulatively to the health disadvantage experienced by marginalized racial groups. For instance, residential segregation frequently leads to concentrated poverty, environmental hazards, limited access to nutritious food, and under-resourced medical facilities, all of which exacerbate chronic disease prevalence and mortality rates among affected populations. Furthermore, educational disparities rooted in systemic racism curtail health literacy and economic opportunities, perpetuating cycles of poverty and poor health outcomes.
Delving deeper into the healthcare system, structural racism influences not only access to care but also the quality and cultural competence of services rendered. Implicit biases among healthcare providers, institutional policies that fail to address the needs of racialized groups, and financial barriers combine to produce significant inequities in diagnosis, treatment, and preventive care. The review spotlights evidence showing that racial minorities often receive substandard care, experience delays in treatment, and have lower rates of insurance coverage, all contributing to adverse health trajectories.
On a mechanistic level, the authors emphasize the role of chronic stress induced by experiences of racism and discrimination as a biological pathway linking structural racism to health disparities. Prolonged exposure to psychosocial stressors activates neuroendocrine and immune responses that heighten susceptibility to cardiovascular disease, metabolic disorders, and mental health conditions. This mechanistic insight underscores the concept of “weathering,” wherein the physiological toll of racial oppression accumulates over time, leading to premature aging and increased morbidity in marginalized communities.
The scoping review also addresses intersections with other social determinants of health, illustrating how structural racism compounds vulnerabilities related to socioeconomic status, gender, geography, and immigration status. For example, Black women may experience intersecting oppressions that amplify disparities in maternal mortality rates, while Indigenous populations often face layered inequities rooted in colonial histories and ongoing systemic marginalization. Such intersectional analyses are critical for tailoring public health interventions that are both effective and equitable.
Moreover, the review critically examines the limitations within current research paradigms, noting that many studies rely on racial categorization without adequately unpacking the structural forces at play. This oversight risks perpetuating deficit-based narratives that assign blame to individual behaviors rather than addressing systemic inequities. The authors call for robust methodological frameworks that incorporate structural racism as a central analytic category, alongside community-engaged research approaches that amplify marginalized voices.
Kisa and Kisa highlight emergent research employing geographic information systems (GIS), structural equation modeling, and multilevel analyses to elucidate how neighborhood-level segregation and institutional policies drive health outcomes. Such advanced analytic techniques enable researchers to parse out the relative contributions of different structural factors, providing actionable data to inform policy reforms. Notably, their review also signals a growing global awareness of structural racism’s health impacts, extending beyond the United States to countries with diverse racial and ethnic stratifications.
Importantly, the authors advocate for integrated policy solutions that move beyond healthcare settings to dismantle structural barriers. They emphasize reforms in education, housing, labor markets, and criminal justice systems as essential for achieving health equity. They also stress the need for anti-racist public health frameworks that incorporate accountability measures, resource redistribution, and structural competency training for practitioners. This comprehensive approach aligns with calls from leading health organizations recognizing racism as a public health crisis.
The review also explores the potential role of technology and data science in advancing health equity research on structural racism. While big data and artificial intelligence offer new opportunities for identifying patterns and predicting health disparities, there are risks of perpetuating biases if datasets lack representativeness or if algorithms are not critically evaluated. Ethical governance and inclusive data practices are thus vital components for leveraging technology responsibly in this context.
Furthermore, the findings carry profound implications for medical education and workforce diversity. Cultivating a healthcare workforce that reflects the populations served and is trained in structural competency is pivotal for mitigating the effects of structural racism on patient care. The authors propose integrating curricula that address historical and contemporary manifestations of racism and equip future providers with skills to advocate for systemic change.
The review by Kisa and Kisa ultimately calls for a paradigm shift in public health research and practice, urging a transition from treating symptoms of inequity to confronting their root structural causes. This transformative perspective demands political will, sustained funding, and cross-sector collaboration to enact meaningful change. The authors argue that only by dismantling structural racism can societies achieve true health equity and social justice.
In conclusion, this comprehensive scoping review stands as a crucial scientific contribution that synthesizes existing knowledge about the foundational role of structural racism in health disparities. It offers a multidimensional framework linking systemic inequities to biological and social determinants of health and outlines concrete pathways for intervention. As global health inequities persist, recognizing and addressing structural racism is indispensable for fostering healthier, more equitable societies.
Subject of Research: Structural racism as a fundamental cause of health inequities
Article Title: Structural racism as a fundamental cause of health inequities: a scoping review
Article References:
Kisa, A., Kisa, S. Structural racism as a fundamental cause of health inequities: a scoping review. Int J Equity Health 24, 257 (2025). https://doi.org/10.1186/s12939-025-02644-7
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