In the United States, systemic racism is embedded in policies and practices, thereby structuring American society to perpetuate inequality and all of the symptoms and results of that inequality. Racial, social, and class inequities and the public health crises in the United States are deeply intertwined, their roots and manifestations continually pressuring each other. This has been both illuminated and exacerbated since 2020, with the Movement for Black Lives (BLM) and the disproportionate effects of the COVID-19 pandemic on historically disadvantaged groups within the U.S. Dr. Dayna Bowen Matthew, Dean of the George Washington University Law School, explores and unpacks the public health crisis that is racism in her new book Just Health: Treating Structural Racism to Heal America (NYU Press, 2022). She describes how structural inequality undermines the interests of a thriving nation and the steps we can take to undo the pervasive nature of inequality to create more equitable and just systems.

Dr. Bowen Matthew describes her personal relationship with the concepts of structural inequality and racism in the public health system, opening with a heart-wrenching ode to her father’s experience with poverty and prejudice, which ultimately led to his premature death. Through her family’s story, she explains how structural inequality is perpetuated on a large-enough scale and with a powerful-enough scope so as to virtually guarantee social outcomes that reflect predetermined hierarchies based on race and/or class, hierarchies that remain consistent across generations. These disproportionate outcomes are often dismissed as due to comorbidities without the attention paid to social factors are the primary cause of comorbidities, because oppression in its many forms blocks equitable access to the social determinants of health. These social determinants include, but are not limited to, clean and safe housing, adequate education, nutritious food and fresh water, access to recreational spaces, and mental health services. Individuals who lack these, through no fault of their own, are then obligated to accept disproportionate care, illness, and disturbingly shorter life spans then are the norm for many Americans and are much closer to life spans in impoverished countries. Dr. Bowen Matthew presents evidence of discrimination in housing, education, employment, and the criminal justice system, detailing how law has played a central role in erecting disproportionate access to the social determinants of health, and therefore is a requisite tool for dismantling it. She provides a clear path to undoing structural racism and providing an equitable society to all, encouraging health providers, law makers, and citizens all to fight to dismantle the hurdles that many patients face because of the zip code in which they live.

Emma R. Handschke assisted in the production of this podcast.

Lilly J. Goren is a professor of political science at Carroll University in Waukesha, WI. She is co-editor of the award winning book, Women and the White House: Gender, Popular Culture, and Presidential Politics (University Press of Kentucky, 2012), as well as co-editor of Mad Men and Politics: Nostalgia and the Remaking of Modern America (Bloomsbury Academic, 2015). Email her comments at lgoren@carrollu.edu or tweet to @gorenlj.

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