Racial Disparities in Health Status and Access to Healthcare: The Continuation of Inequality in the United States Due to Structural Racism

• DOI: http://doi.org/10.1111/ajes.12230
• Published date: 01 May 2018
• Date: 01 May 2018
• Author: Ruqaiijah Yearby

Racial Disparities in Health Status and

Access to Healthcare: The Continuation of

Inequality in the United States Due to

Structural Racism

By RUQAIIJAH YEARBY*

ABSTRACT. During the Jim Crow era of 1877 to 1954, the federal

government sponsored and supported the racially separate and

unequal distribution of resources, including, but not limited to,

education, housing, employment, and healthcare. On May 14, 1954, the

Supreme Court ruled in Brown v. Board of Education that separate and

unequal education violated the Constitution because separate is

inherently unequal. Many believed that this ruling, the Civil Rights Acts

of 1957, 1960, 1964, 1968, and the Voting Rights Act of 1965 would put

an end to the unequal treatment of African Americans in the United

States. However, inequalities still exist today because the ruling and the

laws did not change the structures of the United States. Specifically,

structural racism prevents African Americans from obtaining equal

access to resources such as wealth, employment, income, and

healthcare, resulting in racial disparities in health. Because racial

disparities between African Americans and Caucasians are the most

studied in the United States, this article will focus exclusively on how

structural racism continues and causes racial inequalities between

African Americans and Caucasians in wealth, employment, income, and

healthcare, which lead to racial disparities in access to healthcare and

health status.

*David L. Brennan Professor of Law and Associate Dean of Institutional Diversity

and Inclusiveness, Case Western Reserve University, School of Law, B.A. (Honors

Biology), University of Michigan, 1996; J.D., Georgetown University Law Center, 2000;

M.P.H., Johns Hopkins School of Public Health, 2000.

American Journal of Economics and Sociology, Vol. 77, No . 3–4 (May-September, 2018).

DOI: 10.1111/ajes.12230

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C2018 American Journal of Economics and Sociology, Inc.

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Introduction

Structural racism operates at the societal level in theUnited States and is

the power used by the dominant group to provide members of the

group with advantages, while disadvantaging the non-dominant group

(Mullings and Schulz 2005: 3, 12). The dominant group uses structural

racism not only to obtain resources, such as wealth, employment,

income, and healthcare, but also to limit the non-dominant group’s

access to these resources. During the Jim Crow era, structural racism

sponsored by the federal and state governments explicitly created

advantages for Caucasians and disadvantages for African Americans.

Structural racismstill exists after the Jim Crow era.

This article will focus on the federal government’s failure to enforce

the civil rights laws, which has given advantages to Caucasians in the

obtainment of wealth, employment, income, and healthcare, while cre-

ating disadvantages for African Americans. In the past, I have written

about the failure of the government to enforce civil rights laws in

healthcare and its impact on health status and outcomes (Yearby 2007:

462–470; 2012: 1281, 1288; 2014: 287, 289). Recently, Hahn, Truman,

and Williams (2018) have shown that the enforcement or lack thereof

of civil rights laws concerning healthcare, education, employment, and

housing can impact racial health disparities. This article builds on prior

work by arguing that the lack of enforcement of civil rights laws is an

example of structural racism, which causes racial disparities in health

status and access to healthcare.

I. Structural Racism: Wealth

There are racial inequalities in net worth and wealth. Net worth is the

difference between what a household owns and what it owes. Based

on a recent Pew Research Center Report, the net worth of Caucasian

households was $144,200 in 2013, approximately 13 times the net

worth of African American households, which was $11,200 (Pew

Research Center 2016). The net worth of Caucasian households was

$98,700 in 1983, comparedto $12,200 for African American households.

Thus, in 30 years, the net worth of African American households

decreased by $1,000 in comparison to the $45,500 increase of

Caucasian households.

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Wealth is money in the bank that allows families to buy a home,

obtain a college degree, and/or retire. Research suggests that racial

wealth inequalities have grown over the last 30 years because of racism

(Asante-Muhammad et al. 2016). The averagewealth of Caucasian fami-

lies has grown by 84 percent—three times the rate of growth for the

African American population. In 1983 the average wealth for African

American households was $67,000 compared to $355,000 for Caucasian

households. By 2013, the average wealth for African American house-

holds was $85,000 compared to $656,000 for Caucasian households. If

the average wealth of African American families continues to grow at

the same pace that it has for the last 30 years, it will take African Ameri-

can families 228 years to amass the same amount of wealth Caucasian

families have today, which is 17 years shorter than the 245-year span of

slavery in the United States.

The Institute on Assets and Social Policy at Brandeis University con-

ducted a study that followed the same households for over 25 years

(1984–2009) and found that the total wealth gap between Caucasian

and African American families nearly tripled, increasing from $85,000 in

1984 to $236,500 in 2009, a difference of $152,000 (Shapiro et al. 2013).

The study also showed that in 2009 the median wealth of Caucasian

families was $113,149 compared with $5,677 for African American fami-

lies, a difference of almost $108,000. Researchers found that approxi-

mately 66 percent of the wealth gap between African Americans and

Caucasians was a result of racism, which caused racial inequalities in

homeownership,income, employment, education, and inheritance.

During the Jim Crow era, structural racism provided Caucasians, the

dominant group, with support and money to obtain net worth and

wealth through home ownership, while preventing African Americans,

the non-dominant group, from obtaining net worth and wealth through

homeownership. This is significant because home ownership is the

central way that Americans build net worth and wealth, which is often

passed from generation to generation.

A. Homeownership: Jim Crow and Beyond

With the enactment of the National Housing Act of 1934, which created

the Federal Housing Administration (FHA), housing builders were

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