Structural Racism: its Operationalization and Intergenerational Health Impacts


Reem Kadri, Western University

Racial-ethnic minorities suffer from worse health outcomes, including higher morbidity and mortality rates, as compared to their white counterparts. Structural racism is a fundamental cause of health inequality and the root cause of the social determinants of health (SDOH). As a fundamental cause, it has lasting connections with health as it is consistently (re)producing the conditions necessary for the perpetuation of inequality. It is an oppressive system and ideology, ingrained at the macro-level in institutions and policy, intended to systematically subjugate racialized groups through exclusion from social, political, educational, health and occupational institutions. It differentially allocates and withholds symbolic resources from minoritized groups within social institutions and society, while also differentially exposing them to health risks across the life course. Families are the meso-level context through which structural (dis)advantage is experienced and transmitted across generations. Accumulation theories suggest that mechanisms of inequality begin in early-life and lead to growing health disparities between advantaged and disadvantaged groups over time. Research on the intergenerational transmission of health and health inequalities examines how adulthood health is related to earlier life conditions, specifically childhood disadvantage which has an enduring influence. Yet, most research focuses on only one generation with little understanding of the intergenerational health impacts of structural racism, especially regarding minoritized families across multiple generations. Although research highlights the significance of the effects of macro-level social circumstances on health, most literature focuses on the health effects of interpersonal racism. My research addresses this limitation while adding to the burgeoning research on the intergenerational transmission of health by examining the health effects of structural racism on three generations. Structural racism is a complex concept to observe and conceptualize and its role in driving health inequality has yet to be operationalized in-depth empirically. The comprehensive examination, operationalization and conceptualization of structural racism is a main objective and contribution of my research to fill this gap in the health inequality literature.  I employ the Panel Study of Income Dynamics (PSID), the longest-operating longitudinal household survey, and its Child Development Supplement (CDS) and Transition into Adulthood Supplement (TAS) to address three research questions. First, I examine the mental and physical health effects of growing up and residing in environments with high structural racism in childhood. Second, research into the “long arm of childhood” indicates early-life circumstances, beginning during the critical periods of gestation and childhood, have enduring effects on one’s health in later life. Thus, I examine the long-term impacts of structural racism experienced in childhood on physical and mental health in adulthood. Lastly, following the life course principle of linked lives, a mother’s health and wellbeing has persisting impacts on her developing fetus, with prenatal conditions preparing the fetuses’ biological stress response systems from its mother’s social circumstances. Consequently, my third research question examines the health effects of structural racism across generations, from mothers to their children, beginning at birth and through age 18.  The ability to link the CDS to the TAS and PSID’s Main Interview files is highly advantageous because of the availability of long-term data on family socioeconomic context and individual-level family structure variables that allow for detailed data analysis over a prolonged period, beginning in childhood through young adulthood into adulthood. Because no comparable Canadian data exists, this panel study provides the best opportunity to study the intergenerational impacts of structural racism. Moreover, the ability to link geospatial data to the PSID provides longitudinal contextual data on the poverty level, unemployment rate, and educational attainment of racialized groups in a geographic area, as well as vital data on neighbourhood quality, residential segregation, political participation and criminal justice. Although these variables by themselves do not capture the complex process of structural racism, they can be incorporated as indicators of a latent construct. Finally, the PSID includes multiple physical and mental health measures, such as health level, depression, emotional and psychiatric problems, cancer, and chronic illnesses allowing for the operationalization of health status.  Findings from this research respond to the growing calls from policymakers for studies that quantify structural racism’s impact on health disparities. Research into structural racism as a public health issue is critical for informing policy that aids Healthy People’s 2030 mission of eliminating health inequality by addressing the SDOH. 

This paper will be presented at the following session: