Structural Racism and Discrimination

NIMHD Director Statement in Support of NIH Efforts to Address Structural Racism

Read the full statement

Structural racism and discrimination (SRD) refers to macro-level conditions (e.g. residential segregation and institutional policies) that limit opportunities, resources, power, and well-being of individuals and populations based on race/ethnicity and other statuses, including but not limited to:

• Gender
• Sexual orientation
• Gender identity
• Disability status
• Social class or socioeconomic status
• Religion
• National origin
• Immigration status
• Limited English proficiency
• Physical characteristics or health conditions

Achieving health equity for all in the U.S. will require dismantling this country’s historical legacy of structural racism.

There is increasing recognition that SRD contributes to poorer health outcomes for racial and ethnic minorities and other populations who experience health disparities. Neighborhood segregation, a widely studied form of structural racism, has been shown to directly influence racial disparities in health outcomes. In addition to SRD’s direct effects on access to opportunities and resources, it affects psychological health. SRD in the forms of societal-level conditions, societal norms, and institutional policies that create and sustain disadvantage are risk factors for poor physical and mental health conditions.

Despite evidence pointing to the data on the detrimental health effects of racism and discrimination, measures of these constructs are not included routinely as social determinants of health (SDOH) in human research. Research that includes racism and discrimination is often limited to studies of one specific form of SRD, such as interpersonal interactions or residential segregation. An important facet of NIMHD's Research Framework is to expand our understanding about the interactions of interpersonal and structural racism and discrimination across multiple levels of influence (individual, interpersonal/organizational, community, societal) and the downstream impact on health and health disparities. 

NIMHD is studying and addressing issues related to SRD through a variety of initiatives:

NIMHD Seminars and Workshops on SRD

NIMHD hosts senior research investigators to present on SRD-related topics. Most recently:

• Dr. Ebony Boulware, Eleanor Easley Professor of Medicine, Director, Clinical and Translational Science Institute Associate Vice Chancellor for Translational Research at Duke University School of Medicine, spoke on the topic of democratizing health data to achieve community health equity.
• Dr. Sherman James, Susan B. King Distinguished Professor Emeritus, Sanford School of Public Policy at Duke University, presented for intramural researchers on John Henryism, an active coping style among African American men and its ill effects on health, especially among those of lower socioeconomic status.

Workshop on Structural Racism:
For this 2017 event, NIMHD organized national leaders to explore the issue and consider topics and challenges for future research.

NIMHD Content on SRD

Structural Racism and Discrimination: Impact on Minority Health and Health Disparities
NIMHD sponsored this special supplement in Ethnicity & Disease that features research articles and commentaries on the conceptualization, operationalization, and measurement of SRD, as well as strategies to reduce or eliminate structural racism and discrimination.

Discrimination and Hypertension Risk Among African Americans in the Jackson Heart Study
Dr. Allana Forde, Stadtman Investigator, NIMHD Division of Intramural Research, who studies racism and discrimination, published this article in Hypertension. This study demonstrated that among African American men in the Jackson Heart Study, higher stress from lifetime discrimination was associated with higher hypertension risk after adjustment for demographics, but the association was attenuated after adjustment for hypertension risk factors.

New Perspectives to Advance Minority Health and Health Disparities Research
In January 2019, NIMHD funded this special supplement to the American Journal of Public Health (AJPH). The issue presented perspectives on methodological approaches to understand and reduce health disparities for racial/ethnic minority and other disadvantaged populations, including articles on racism and interventions targeting structural factors.

NIMHD Science Visioning and Research Strategies
As part of the Scientific Vision Process, NIMHD developed a set of 30 strategies to transform minority health and health disparities research. Several focus on issues related to SRD, including:

• The need to improve our understanding of how racism and discrimination are conceptualized, measured, and contribute to health disparities.
• How to promote multi-sectoral interventions that address structural drivers of health disparities.

NIMHD Insights Blog
Examples of blog posts and articles focused on SRD-related issues and research:

• “In Search of Equity: Rethinking Race and Racism in Science and Medicine”
   by L. Ebony Boulware, M.D., M.P.H.
• “Racism and the Health of Every American” by NIMHD Director Eliseo J.
   Pérez-Stable, M.D.
• “Centering Structural Inequities in Conversations on Mental Health Among
   People of Color” by Margarita Alegría, Ph.D.
• “Spotlight on COVID-19 and Health Disparities: Opportunities to Achieve Better  Understanding and Equality for Vulnerable Populations” by NIMHD Director  Eliseo J. Pérez-Stable, M.D.
• “Addressing Social Needs and Structural Inequities to Reduce Health Disparities:  A Call to Action for Asian American and Pacific Islander Heritage Month” by  Marshall H. Chin, M.D., M.P.H.

NIMHD Funding Resources and Opportunities

Funding Opportunity Announcements

NIMHD supports many Funding Opportunity Announcements that include SRD-related topics as an area of particular interest:

• Understanding and Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities (R01 Clinical Trial Optional)
• Addressing the Etiology of Health Disparities and Health Advantages Among Immigrant Populations (R01 Clinical trial not allowed)
• Please see our list of Active NIMHD Funding Opportunities for more.

Funded Projects

Youth Violence Prevention Interventions that Incorporate Racism/Discrimination Prevention (R01-Clinical Trial Required)
This 2018 NIMHD Funding Opportunity Announcement funded five projects that incorporate topics such as:

• Racial/ethnic disproportionality in school disciplinary actions.
• Differential teacher treatment.
• Community-level youth and law enforcement violence prevention interventions.

NIMHD-supported research projects
See a list of active NIMHD-supported research projects studying structural racism.

Research Concepts

Understanding and Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities
In September 2020, NIMHD’s National Advisory Council approved this research concept for future funding opportunities. The NIH-wide initiative supports:

1. Observational research to understand the role of SRD in causing and sustaining health disparities.
2. Research testing interventions that address SRD in order to improve minority health or reduce health disparities.

NIMHD-Supported, NIH-Wide Initiatives

Community Engagement Alliance Against COVID-19 Disparities (CEAL)
NIMHD is co-leading the CEAL initiative with the National Heart, Lung, and Blood Institute. CEAL works with communities to address the disproportionate impact of the COVID-19 pandemic on underserved and racial and ethnic minority communities due to structural inequities.

Other NIH-Related Resources

The National Institute of General Medical Sciences is supporting an FOA Notice of Special Interest entitled "Understanding and Addressing the Impact of Structural Racism and Discrimination on Biomedical Career Progression and the Biomedical Research Enterprise."

Page updated June 14, 2021