Study Points
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Study Points
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- Define structural racism and distinguish it from individual prejudice, discrimination, and implicit bias.
- Describe how historical and contemporary policies contribute to healthcare inequities.
- Recognize the effects of structural racism on health outcomes, healthcare delivery, and patient experiences.
- Identify ways structural racism may influence clinical decision-making, organizational practices, and healthcare access.
- Apply evidence-informed strategies to promote equitable care and reduce health disparities within their professional roles.
Which of the following statements best describes structural racism?
Click to ReviewStructural racism refers to the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, media, healthcare, and criminal justice [7]. It describes cumulative and compounding effects of an array of factors that systematically privilege White people and disadvantage people of color. Structural racism does not require individual racist actors. It functions through the policies, laws, and institutional practices that have become normalized over time (Table 1) [8].
Patient P, a 34-year-old South Asian woman, presents at 32 weeks' gestation with elevated blood pressure. She mentions that her concerns about headaches and swelling were dismissed at her last two prenatal visits. Which of the following best reflects how structural racism may be contributing to this situation?
Click to ReviewHEALTHCARE-SPECIFIC DISPARITIES: CONNECTING HISTORY TO TODAY
Domain Historical Policy Present-Day Impact Primary care access Hospital segregation, unequal facility distribution Black and Hispanic communities more likely to rely on emergency departments for primary care needs. Maternal health Historical dismissal of Black women's pain, exclusion from nurse-midwifery training Black women are two to three times more likely to die from pregnancy-related causes than White women. Behavioral health Criminalization of addiction and mental illness, disproportionately affecting communities of color Lower utilization of mental health services Higher rates of untreated depression and anxiety Preventive services Lack of community-based providers, insurance gaps Lower rates of cancer screening, vaccination, and chronic disease monitoring in minority communities Which of the following best describes the concept of "weathering" as it relates to health disparities?
Click to ReviewContributing structural factors include inadequate access to prenatal care, higher rates of uninsurance, lower rates of continuity of care, and the biological effects of chronic racial stress (known as weathering), which accelerates physiological aging in Black women [22].
In the case study, Patient J's nephrology referral has been pending for four months, partly because the nearest specialist is 18 miles away and he does not own a car. This is best described as a(n)
Click to ReviewStructural barriers, including lack of insurance, provider shortages in underserved areas, transportation challenges, and lack of time off work, all contribute to lower rates of preventive service utilization in minority communities. These are not preferences; they are consequences of systems that allocate resources inequitably.
Which of the following best explains why patient trust is an equity issue, not merely a communication issue?
Click to ReviewResearch consistently demonstrates that patients of color report lower levels of trust in the healthcare system, lower satisfaction with care, and less confidence that providers take their concerns seriously [26]. This is not irrational; it is a learned, evidence-based response to a documented history of mistreatment and neglect. Patient distrust is itself a downstream effect of structural racism, and addressing it requires more than communication skills training for individual providers. It requires system-level investment in building trustworthy institutions.
A hospital's eGFR algorithm historically assigned higher kidney function scores to Black patients than to White patients with the same creatinine level. What is the primary equity concern with this practice?
Click to ReviewVyas and colleagues examined several widely used algorithms, including [9]:
Estimated glomerular filtration rate (eGFR): The race-adjusted eGFR formula historically calculated a higher kidney function score for Black patients than for White patients with the same creatinine level, potentially delaying referral for nephrology evaluation and kidney transplant listing.
Vaginal birth after cesarean (VBAC) calculator: The algorithm assigned lower probability of successful vaginal delivery to Black and Hispanic women, influencing clinical recommendations without a sound biological basis.
Cardiac risk calculators: Race is embedded in several tools in ways that may alter risk stratification.
D, a community health worker at a federally qualified health center, is working with patients who frequently miss specialty appointments. Rather than attributing this to patient disengage-ment, he investigates and finds that the specialty clinic is only accessible by car, operates Monday through Friday from 8 a.m. to 4 p.m., and requires a co-pay that many patients cannot afford. Which approach best reflects D's response to structural barriers?
Click to ReviewAPPROACHES TO ADDRESS THE IMPACT OF STRUCTURAL RACISM IN HEALTH CARE
Action Description Individual-Level Actions: What Clinicians Can Do Screen for social needs Use validated tools (e.g., PRAPARE, AHC-HRSN) to identify food insecurity, transportation barriers, housing instability, and other social needs at the point of care Use person-centered communication Elicit patient preferences, concerns, and social context before making recommendations Avoid assumptions based on demographic characteristic Recognize and interrupt implicit bias Reflect on differential patterns in your own practice Seek feedback Use structured decision-making tools where appropriate Address race-based clinical algorithms Know which tools in your practice embed race-based corrections Advocate for evidence-based alternatives Document social needs Record identified social needs in the patient record to support care coordination and continuity Advocate for patients Navigate system barriers on behalf of patients (e.g., expediting referrals, connecting with social work, escalating unmet needs) Engage in ongoing learning Commit to continuing education on structural racism, health equity, and culturally responsive care Organizational-Level Actions: What Health Systems Can Do Review policies for disparate impact Regularly audit policies related to scheduling, discharge planning, referral processes, and resource allocation for unintended inequitable effects Stratify quality metrics by race and ethnicity Move beyond aggregate outcome reporting to identify disparities within the patient population Invest in language access Ensure robust interpreter services, translated materials, and multilingual staffing Create accountability structures Tie equity metrics to leadership performance goals and organizational dashboards Diversify the workforce Implement evidence-based strategies to recruit, retain, and advance providers and staff from under-represented groups Partner with communities Develop formal community advisory structures that give historically marginalized communities genuine influence over healthcare decisions Assess the built environment Evaluate service lines, facility locations, and hours of operation through an equity lens Which of the following is an evidence-based organizational strategy for reducing health disparities?
Click to ReviewAPPROACHES TO ADDRESS THE IMPACT OF STRUCTURAL RACISM IN HEALTH CARE
Action Description Individual-Level Actions: What Clinicians Can Do Screen for social needs Use validated tools (e.g., PRAPARE, AHC-HRSN) to identify food insecurity, transportation barriers, housing instability, and other social needs at the point of care Use person-centered communication Elicit patient preferences, concerns, and social context before making recommendations Avoid assumptions based on demographic characteristic Recognize and interrupt implicit bias Reflect on differential patterns in your own practice Seek feedback Use structured decision-making tools where appropriate Address race-based clinical algorithms Know which tools in your practice embed race-based corrections Advocate for evidence-based alternatives Document social needs Record identified social needs in the patient record to support care coordination and continuity Advocate for patients Navigate system barriers on behalf of patients (e.g., expediting referrals, connecting with social work, escalating unmet needs) Engage in ongoing learning Commit to continuing education on structural racism, health equity, and culturally responsive care Organizational-Level Actions: What Health Systems Can Do Review policies for disparate impact Regularly audit policies related to scheduling, discharge planning, referral processes, and resource allocation for unintended inequitable effects Stratify quality metrics by race and ethnicity Move beyond aggregate outcome reporting to identify disparities within the patient population Invest in language access Ensure robust interpreter services, translated materials, and multilingual staffing Create accountability structures Tie equity metrics to leadership performance goals and organizational dashboards Diversify the workforce Implement evidence-based strategies to recruit, retain, and advance providers and staff from under-represented groups Partner with communities Develop formal community advisory structures that give historically marginalized communities genuine influence over healthcare decisions Assess the built environment Evaluate service lines, facility locations, and hours of operation through an equity lens A hospital quality team reviews readmission data and finds that its 30-day readmission rate for heart failure is 12% overall. What additional step is most important for an equity-focused quality improvement approach?
Click to ReviewStandard quality improvement approaches measure outcomes at the population level but may not stratify data by race, ethnicity, language, or other equity-relevant characteristics. Equity-focused quality improvement (EFQI) builds on established quality improvement methods by explicitly examining whether improvements are distributed equitably [31]. The Institute for Healthcare Improvement's framework for achieving health equity recommends that organizations [31]:
Make a commitment to health equity as a strategic priority
Build infrastructure to support equity work
Address the multiple determinants of health
Eliminate racism and other forms of oppression
Partner with community
A provider who genuinely holds no conscious racial prejudice works in a health system where Black patients are consistently discharged to lower-quality post-acute facilities than White patients with identical diagnoses. This scenario most clearly illustrates that
Click to ReviewStructural racism is a system, not a sentiment. It operates through policies, laws, institutional practices, and resource allocation decisions, not only through individual attitudes or prejudice. It produces racially inequitable outcomes whether or not individual actors intend to cause harm [1,7].
- Back to Course Home
- Participation Instructions
- Review the course material online or in print.
- Complete the course evaluation.
- Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.