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abstract The COVID-19 pandemic has illuminated and amplified the harsh reality of health inequities experienced by racial and ethnic minority groups in the United States. Members of these groups have disproportionately been infected and died from COVID-19, yet they still lack equitable access to treatment and vaccines. Lack of equitable access to high-quality health care is in large part a result of structural racism in US health care policy, which structures the health care system to advantage the White population and disadvantage racial and ethnic minority populations. This article provides historical context and a detailed account of modern structural racism in health care policy, highlighting its role in health care coverage, financing, and quality.
Members of racial and ethnic minority groups have long suffered from health inequities in the United States, and the COVID-19 pandemic has mercilessly worsened many of these inequities. As of November 2021, American Indian and Alaska Native, Black, and Latino people all had suffered from higher rates of hospitalizations and deaths related to COVID-19 compared with White people.1 These inequities result, in large part, from racial and ethnic minority populations' inequitable access to health care, which persists because of structural racism in health care policy.
Racism includes a complex array of social structures, interpersonal interactions, and beliefs by which the group in power categorizes people into socially constructed "races" and creates a racial hierarchy in which racial and ethnic minority groups are disempowered, devalued, and denied equal access to resources.2 Racism is often tied to the actions of an individual perpetrator, such as a health care professional denying equitable care to minority people. However, this narrow perspective ignores structural racism in health care, which shapes the many ways in which the US health care system is structured to advantage the White population-the racial group in power-and disadvantage racial and ethnic minority populations.3 A "characteristic of racism is that its structure and ideology can persist in governmental and institutional policies in the absence of individual actors who are explicitly racially prejudiced. ...[R]acism is [also] adaptive over time, maintaining its pervasive adverse effects through multiple mechanisms that arise to replace forms that have been diminished."2
Structural racism operates through laws and policies that allocate resources in ways that disempower and devalue members...