Your health is decided by structural racism long before you see a doctor

Across countries and decades, evidence links discriminatory housing, education, and health systems to higher mortality, greater disease burden, and poorer birth outcomes among racialised communities. The pattern is remarkably consistent: inequities embedded in systems, not individual behaviour, drive the gap.

Our study lays it bare: structural racism remains one of the most powerful yet least visible forces driving health inequality around the world.

Structural racism operates across multiple domains

We synthesised findings from 1,416 studies and revealed how racism, woven into the fabric of institutions, laws, and everyday practices, continues to shape who lives longer, who suffers, and who dies too soon.

Many of these studies traced health inequities directly to policy-driven structures such as housing discrimination, criminal-justice practices, employment inequality, and environmental exposure. Collectively, they show that structural racism operates across multiple domains rather than within isolated institutions.

The system beneath the surface

When we talk about racism, we often imagine individual prejudice or acts of hate. But structural racism is not about individuals; it is about systems. It determines how neighbourhoods are designed, how hospitals are funded, how schools are segregated, and how policing and housing policies quietly decide who gets a fair shot at health.

One example is housing. Residents of certain neighbourhoods experience higher rates of asthma, stroke, and cancer mortality, showing how neighbourhood disinvestment shapes both environmental and biological risks.

This invisible architecture of inequality reaches deep into healthcare itself. Across countries, racially minoritised patients are more likely to receive less pain relief, face longer diagnostic delays, and experience subtle forms of disrespect and dismissal.

Over time, these daily injustices accumulate as chronic stress, mistrust, and poorer health outcomes. Racially minoritised patients remain less likely to receive life-saving organ transplants even when their clinical needs are identical, and women of colour continue to face delayed diagnoses and undertreatment for cancers. The erosion of trust in healthcare is itself a measurable health risk.

When inequality begins before birth

Perhaps nowhere is the human toll more visible than in maternal and infant health. Across continents, the data tell a consistent story.

Black and Indigenous women are far more likely to face life-threatening complications during pregnancy and childbirth, even when their income, education, and insurance are comparable to white women.

In the United States, Black mothers die from pregnancy-related causes at three times the rate of white mothers. In the United Kingdom, South Asian and Black women experience far higher rates of preterm birth. In Israel, Palestinian-Arab mothers have reported being physically separated from Jewish mothers in maternity wards, an institutionalised form of exclusion disguised as cultural sensitivity.

Mothers living in socio-economically disadvantaged neighbourhoods face dramatically higher odds of severe pregnancy complications. The message is unmistakable: the structures governing housing, economics, and policing are deeply entangled with maternal and infant survival.

A global pattern of neglect

While most studies came from the United States, the evidence shows that structural racism is a global public health issue.

In Brazil, Black, Biracial, and Indigenous populations experienced much higher Covid-19 mortality, driven by underfunded hospitals and geographic exclusion. In Canada, racialised patients described neglect, miscommunication, and systemic underfunding in care. Across Europe, ethnic minority populations continue to face barriers to diagnosis, treatment, and trust that mirror those found in North America.

Despite cultural differences, the same logic persists. Racial hierarchies embedded in social systems produce unequal health outcomes. Racism looks different in Oslo, São Paulo, or Toronto, but it operates through the same forces—unequal power, unequal opportunity, and unequal health.

Health cannot be separated from politics

The research is clear on this point: health inequity is political. To dismantle this system, we outline five urgent priorities:

• Test and scale interventions that target racism at the policy level. 
• Integrate health goals with housing, education, and criminal justice reform. 
• Expand research beyond high-income countries to include Africa, Asia, and Latin America. 
• Embed intersectionality by recognising how race interacts with gender, sexuality, and class. 
• Build accountability through public equity audits and transparent data reporting.

The cost of silence

The price of ignoring structural racism is paid in lives. It weakens economies, erodes public trust, and leaves deep psychological and physical scars that pass from one generation to the next.

Communities with greater systemic racism show wider gaps in infant survival, higher rates of maternal death, and more chronic illness. Our research shows that structural reform, not individual behaviour change, saves lives.

Health systems alone cannot eliminate racism. Achieving equity requires coordinated reform in housing, justice, environment, and education.

To dismantle it is not an act of charity. It is an act of justice. And justice, as this research shows, remains the most powerful form of public health we have.

Reference: 

• 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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