Skip to main content


  • Gilbert C. Gee (a1) and Chandra L. Ford (a1)

Racial minorities bear a disproportionate burden of morbidity and mortality. These inequities might be explained by racism, given the fact that racism has restricted the lives of racial minorities and immigrants throughout history. Recent studies have documented that individuals who report experiencing racism have greater rates of illnesses. While this body of research has been invaluable in advancing knowledge on health inequities, it still locates the experiences of racism at the individual level. Yet, the health of social groups is likely most strongly affected by structural, rather than individual, phenomena. The structural forms of racism and their relationship to health inequities remain under-studied. This article reviews several ways of conceptualizing structural racism, with a focus on social segregation, immigration policy, and intergenerational effects. Studies of disparities should more seriously consider the multiple dimensions of structural racism as fundamental causes of health disparities.

Corresponding author
Gilbert C. Gee, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095. E-mail:
Hide All

The authors thank Kaori Fujishiro, the guest editors, and several anonymous reviewers for invaluable comments on an earlier draft of this manuscript. The authors acknowledge support from the California Center for Population Research at the University of California at Los Angeles.

Hide All
Acevedo-Garcia, D. (2000). Residential Segregation and the Epidemiology of Infectious Diseases. Social Science & Medicine, 51(8): 11431161.
Almond, D. V., Chay, K. Y., and Greenstone, M. (2006). Civil Rights, the War on Poverty, and Black-White Convergence in Infant Mortality in the Rural South and Mississippi. Working Paper No. 07-04, Department of Economics, Massachusetts Institute of Technology.
Angelon-Gaetz, K. A., Richardson, D. B., and Wing, S. (2010). Inequalities in the Nuclear Age: Impact of Race and Gender on Radiation Exposure at the Savannah River Site (1951–1999). New Solutions, 20(2): 195210.
Araujo, B. Y. and Borrell, L. N. (2006). Understanding the Link between Discrimination, Mental Health Outcomes, and Life Chances Among Latinos. Hispanic Journal of Behavioral Sciences, 28(2): 245266.
Barkan, E. R., Diner, H., and Kraut, A. M. (2008). From Arrival to Incorporation: Migrants to the US in a Global Era. New York: New York University Press.
Barker, D. J. P. (2002). Fetal Programming of Coronary Heart Disease. Trends in Endocrinology and Metabolism, 13(9): 364368.
Becker, M. H. (1986). The Tyranny of Health Promotion. Public Health Review, 14(1): 1523.
Bell, J. F., Zimmerman, F. J., Almgren, G. R., Mayer, J. D., and Huebner, C. E. (2006). Birth Outcomes among Urban African American Women: A Multilevel Analysis of the Role of Racial Residential Segregation. Social Science & Medicine, 63(12): 30303045.
Bobo, L. (2000). Racial Attitudes and Relations at the Close of the Twentieth Century. In Smelser, N., Wilson, W. J., and Mitchell, F. (Eds.), America Becoming: Racial Trends and Their Implications, pp. 262299. Washington, DC: National Academy Press.
Bonilla-Silva, E. (1997). Rethinking Racism: Toward a Structural Interpretation. American Sociological Review, 62(3): 465480.
Borrell, L. N. (2005). Racial Identity among Hispanics: Implications for Health and Well-Being. American Journal of Public Health, 95(3): 379381.
Boswell, R. A. (2003). Racism and U.S. Immigration Law: Prospects for Reform after “9/11”? Immigration and Nationality Law Review, 7: 315356.
Boyd, D. (2009). White Flight in Networked Public Places? How Race and Class Shaped American Teen Engagement with MySpace and Facebook. In Nakamura, L. and Chow-White, P. (Eds.), Digital Race Anthology. New York: Routledge Press.
Brave Heart, M. and DeBruyn, L. M. (1998). The American Indian Holocaust: Healing Historical Unresolved Grief. American Indian and Alaska Native Mental Health Research, 8(2): 6082.
Brondolo, E., Halen, N. Brady ver, Pencille, M., Beatty, D., and Contrada, R. (2009). Coping with Racism: A Selective Review of the Literature and a Theoretical and Methodological Critique. Journal of Behavioral Medicine, 32(1): 6488.
Bruch, E. and Mare, R. (2006). Neighborhood Choice and Neighborhood Change. American Journal of Sociology, 112: 667709.
Carmichael, S. and Hamilton, C. V. (1967). Black Power: The Politics of Liberation in America. New York: Vintage Books.
Catanzarite, L. (2000). Brown-Collar Jobs: Occupational Segregation and Earnings of Recent-Immigrant Latinos. Sociological Perspectives, 43(1): 4575.
Chae Chang Ping v. United States (1889). 130 U.S. 581.
Chae, D. H. and Walters, K. L. (2009). Racial Discrimination and Racial Identity Attitudes in Relation to Self-Rated Health and Physical Pain and Impairment among Two-Spirit American Indians/Alaska Natives. American Journal of Public Health, 99(S1): S144S151.
Clarke, S. P., Davis, B. L., and Nailon, R. E. (2007). Racial Segregation and Differential Outcomes in Hospital Care. Western Journal of Nursing Research, 29(6): 739757.
Collins, W. J. and Margo, R. A. (2001). Race and Home Ownership: A Century-Long View. Explorations in Economic History, 38(1): 6892.
Daniels, J. (2010). Race, Civil Rights, and Hate Speech in the Digital Era. In Everett, A. (Ed.), Learning Race and Ethnicity: Youth and Digital Media, pp. 129154. Cambridge, MA: MIT Press.
Darity, W. A. Jr. (2003). Employment Discrimination, Segregation, and Health. American Journal of Public Health, 93(2): 226231.
Darity, W., Dietrich, J. and Guilkey, D. K. (2003). Persistent Advantage or disadvantage?: Evidence in Support of the Intergenerational Drag Hypothesis. American Journal of Economics and Sociology, 60(2): 435470.
de Castro, A. B., Fujishiro, K., Schweitzer, E., and Olivia, J. (2006). How Immigrant Workers Experience Workplace Problems: A Qualitative Study. Archives of Environmental and Occupational Health: An International Journal, 61(6): 249258.
Du Bois, W. E. B. (2003). The Health and Physique of the Negro American. American Journal of Public Health, 93: 272276.
Elliott, J. R. and Smith, R. A. (2001). Ethnic Matching of Supervisors to Subordinate Work Groups: Findings on “Bottom-Up” Ascription and Social Closure. Social Problems, 48: 258276.
Finch, B. K., Frank, R., and Vega, W. A. (2004). Acculturation and Acculturation Stress: A Social-Epidemiological Approach to Mexican Migrant Farmworkers' Health. International Migration Review, 38(1): 236262.
Ford, C. L. and Airhihenbuwa, C. O. (2010). The Public Health Critical Race Methodology: Praxis for Antiracism Research. Social Science & Medicine, 71(8): 13901398.
Ford, C. L. and Harawa, N. T. (2010). A New Conceptualization of Ethnicity for Social Epidemiologic and Health Equity Research. Social Science & Medicine, 71(2): 251258.
Freeman, L. C. (1978). Segregation in Social Networks. Sociological Methods and Research, 6(4): 411429.
Gaskin, D. J., Price, A., Brandon, D. T., and LaVeist, T. A. (2009). Segregation and Disparities in Health Services Use. Medical Care Research and Review, 66(5): 578589.
Gee, G. C. (2002). A Multilevel Analysis of the Relationship between Institutional and Individual Racial Discrimination and Health Status. American Journal of Public Health, 92(4): 615623.
Gee, G. C. and Payne-Sturges, D. C. (2004). Environmental Health Disparities: A Framework Integrating Psychosocial and Environmental Concepts. Environmental Health Perspectives, 112(17): 16451653.
Gee, G. C., Ro, A., Shariff-Marco, S., and Chae, D. H. (2009). Racial Discrimination and Health among Asian Americans: Evidence, Assessment, and Directions for Future Research. Epidemiologic Reviews, 31(1): 130151.
Goldman, D. P., Smith, J. P., and Sood, N. (2005). Legal Status and Health Insurance among Immigrants. Health Affairs, 24(6): 16401653.
Heckler, M. M. (1985). Report of the Secretary's Task Force on Black and Minority Health. Washington, DC: U.S. Department of Health and Human Services.
Heckman, J. J. and Payner, B. S. (1989). Determining the Impact of Federal Antidiscrimination Policy on the Economic Status of Blacks: A Study of South Carolina. The American Economic Review, 79(1): 138177.
Institute of Medicine (2009). Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement. Washington, DC: The National Academies Press.
James, S. A. (2008). Confronting the Moral Economy of US Racial/Ethnic Health Disparities. American Journal of Public Health, 98(Supplement 1): S16.
Jones, C. P. (2000). Levels of Racism: A Theoretic Framework and a Gardener's Tale. American Journal of Public Health, 90(8): 12121215.
Kaushal, N. and Kaestner, R. (2005). Welfare Reform and Health Insurance of Immigrants. Health Services Research, 40(3): 697722.
Kelaher, M. and Jessop, D. J. (2002). Differences in Low-Birthweight among Documented and Undocumented Foreign-Born and US-born Latinas. Social Science and Medicine, 55: 21712175.
Kramer, M. R. and Hogue, C. R. (2009). Is Segregation Bad for Your Health? Epidemiologic Reviews, 31(1): 178194.
Krieger, N. (1999). Embodying Inequality: A Review of Concepts, Measures, and Methods for Studying Health Consequences of Discrimination. International Journal of Health Services, 29(2): 295352.
Krieger, N., Williams, D. R., and Moss, N. E. (1997). Measuring Social Class in US Public Health Research: Concepts, Methodologies, and Guidelines. Annual Review of Public Health, 18: 341378.
Lauderdale, D. S. (2006). Birth Outcomes for Arabic-Named Women in California Before and After September 11. Demography, 43(1): 185201.
Lauderdale, D. S., Wen, M., Jacobs, E. A., and Kandula, N. R. (2006). Immigrant Perceptions of Discrimination in Health Care: the California Health Interview Survey 2003. Medical Care, 44(10): 914920.
Laumann, E. O. and Youm, Y. (1999). Racial/Ethnic Group Differences in the Prevalence of Sexually Transmitted Diseases in the United States: A Network Explanation. Sexually Transmitted Diseases, 26: 250261.
LaVeist, T. A. (1994). Beyond Dummy Variables and Sample Selection: What Health Services Researchers Ought to Know about Race as a Variable. Health Services Research, 29(1): 116.
Lee, B. A., Reardon, S. F., Firebaugh, G., Farrell, C. R., Matthews, S. A., and O'Sullivan, D. (2008). Beyond the Census Tract: Patterns and Determinants of Racial Residential Segregation at Multiple Scales. American Sociological Review, 73: 766791.
Leonard, D. (2009). Young, Black (& Brown) and Don't Give a Fuck. Cultural Studies Gåö Critical Methodologies, 9(2): 248272.
Link, B. G. and Phelan, J. (1995). Social Conditions as Fundamental Causes of Disease. Journal of Health and Social Behavior, 35(extra issue): 8094.
Margo, R. A. (1990). Race and Schooling in the South: 1880–1950: An Economic History. Chicago, IL: University of Chicago Press.
Mays, V. M., Cochran, S. D., and Barnes, N. W. (2006). Race, Race-Based Discrimination, and Health Outcomes among African Americans. Annual Review of Psychology, 58: 201225.
Molina, N. (2006). Fit to Be Citizens. Berkeley, CA: University of California Press.
Morello-Frosch, R. and Jesdale, B. M. (2006). Separate and Unequal: Residential Segregation and Estimated Cancer Risks Associated with Ambient Air Toxics in U.S. Metropolitan Areas. Environmental Health Perspectives, 114(3): 386393.
Nacos, B. L. and Torres-Reyna, O. (2006). Fueling Our Fears: Stereotyping, Media Coverage, and Public Opinion of Muslim Americans. Lanham, MD: Rowman and Littlefield.
Nevins, J. (2002). Operation Gatekeeper: The Rise of the “Illegal Alien” and the Making of the US-Mexico boundary. New York: Routledge.
Office of Management and Budget (OMB) (1997). Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Federal Register, 62: 5878158790.
Ortega, A. N., Fang, H., Perez, V. H., Rizzo, J. A., and Carter-Pokras, O. (2007). Health Care Access, Use of Services, and Experiences among Undocumented Mexicans and Other Latinos. Archives of Internal Medicine, 167(21): 23542360.
Padela, A. I. and Heisler, M. (2010). The Association of Perceived Abuse and Discrimination after September 11, 2001, with Psychological Distress, Level of Happiness, and Health Status among Arab Americans. American Journal of Public Health, 100(2): 284291.
Park, J. S. W. (2004). Elusive Citizenship: Immigration, Asian Americans, and the Paradox of Civil Rights. New York: New York University Press.
Pembrey, M. E., Bygren, L. O., Kaati, G., Edvinsson, S., and Northstone, K. (2005). Sex-specific, Male-line Transgenerational Responses in Humans. European Journal of Human Genetics, 14(2): 159166.
Powell, J. A. (2008). Structural Racism: Building upon the Insights of John Calmore. North Carolina Law Review, 86: 791816.
Quadagno, J. (2000). Promoting Civil Rights through the Welfare State: How Medicare Integrated Southern Hospitals. Social Problems, 47(1): 6889.
Reardon, S. F., Farrell, C. R., Matthews, S. A., O'Sullivan, D., Bischoff, K., and Firebaugh, G. (2009). Race and Space in the 1990s: Changes in the Geographic Scale of Racial Residential Segregation, 1990–2000. Social Science Research, 38(1): 5570.
Ross, S. L. and Turner, M. A. (2005). Housing Discrimination in Metropolitan America: Explaining Changes between 1989 and 2000. Social Problems, 52(2): 152180.
Sacerdote, B. (2005). Slavery and the Intergenerational Transmission of Human Capital. Review of Economics and Statistics, 87(2): 217234.
Seckl, J. R. and Holmes, M. C. (2007). Mechanisms of Disease: Glucocorticoids, their Placental Metabolism and Fetal ‘Programming’ of Adult Pathophysiology. Nature Clinical Practice Endocrinology & Metabolism, 3(6): 479488.
Smith, Aaron (2010). Technology Trends Among People of Color. Pew Internet & American Life Project, September 17. ⟨⟩ (accessed December 17, 2010).
Smith, D. B. (2005). Racial and Ethnic Health Disparities and the Unfinished Civil Rights Agenda. Health Affairs, 24(2): 317324.
Smith, D. B., Feng, Z., Fennell, M. L., Zinn, J. S., and Mor, V. (2007). Separate and Unequal: Racial Segregation and Disparities in Quality across U.S. Nursing Homes. Health Affairs, 26(5): 14481458.
Sommers, B. D. (2010). Targeting in Medicaid: The Costs and Enrollment Effects of Medicaid's Citizenship Documentation Experiment. Journal of Public Economics, 94(1-2): 174182.
Sondik, E. J., Huang, D. T., Klein, R. J., and Satcher, D. (2010). Progress toward the Healthy People: 2010 Goals and Objectives. Annual Review of Public Health, 31(1): 271281.
Subramanian, S. V., Acevedo-Garcia, D., and Osypuk, T. L. (2005). Racial Residential Segregation and Geographic Heterogeneity in Black/White Disparity in Poor Self-Rated Health in the US: A Multilevel Statistical Analysis. Social Science & Medicine, 60(8): 16671679.
Turner, M. A., Freiberg, F., Godfrey, E., Herbig, C., Levy, D. K., and Smith, R. R. (2002). All Other Things Being Equal: A Paired Testing Study of Mortgage Lending Institutions. Washington, DC: U.S. Department of Housing and Urban Development.
Vanderbilt, D. and Augustyn, M. (2010). The Effects of Bullying. Paediatrics and Child Health, 20(7): 315320.
Viruell-Fuentes, E. A. (2007). Beyond Acculturation: Immigration, Discrimination, and Health Research among Mexicans in the United States. Social Science & Medicine, 65(7): 15241535.
Wakefield, S. and Uggen, C. (2010). Incarceration and Stratification. Annual Review of Sociology, 36: 387406.
Walsemann, K. M. and Bell, B. A. (2010). Integrated Schools, Segregated Curriculum: Effects of Within-School Segregation on Adolescent Health Behaviors and Educational Aspirations. American Journal of Public Health, 100(9): 16871695.
Wang, J., Iannotti, R. J., and Nansel, T. R. (2009). School Bullying among Adolescents in the United States: Physical, Verbal, Relational, and Cyber. Journal of Adolescent Health, 45(4): 368375.
White, T. K. (2007). Initial Conditions at Emancipation: The Long-Run Effect on Black-White Wealth and Earnings Inequality. Journal of Economic Dynamics and Control, 31: 33703395.
Williams, D. R. and Collins, C. A. (2001). Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health. Public Health Reports, 116: 404416.
Williams, D. R., Costa, M. V., Odunlami, A. O., and Mohammed, S. A. (2008). Moving Upstream: How Interventions That Address the Social Determinants of Health Can Improve Health and Reduce Disparities. Journal of Public Health Management and Practice, 14(6): S8S17.
Williams, D. R. and Mohammed, S. A. (2009). Discrimination and Racial Disparities in Health: Evidence and Needed Research. Journal of Behavioral Medicine, 32: 2047.
Wright, R. O. (2008). Chronology of Immigration in the United States. Jefferson, NC: McFarland & Company, Inc.
Yoo, H. C., Gee, G. C., and Takeuchi, D. (2009). Discrimination and Health among Asian American Immigrants: Disentangling Racial from Language Discrimination. Social Science & Medicine, 68(4): 726732.
Yu, S. M., Huang, Z. J., Schwalberg, R. H., and Nyman, R. M. (2006). Parental English Proficiency and Children's Health Services Access. American Journal of Public Health, 96(8): 14491455.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Du Bois Review: Social Science Research on Race
  • ISSN: 1742-058X
  • EISSN: 1742-0598
  • URL: /core/journals/du-bois-review-social-science-research-on-race
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 155
Total number of PDF views: 845 *
Loading metrics...

Abstract views

Total abstract views: 3192 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th June 2018. This data will be updated every 24 hours.