In Du Bois’ terms, to compare the health of White Philadelphia and Black Philadelphia was not only to view “side by side and in intimate relationship in a large city two groups of people, who as a mass differ considerably from each other in physical health,” but also to come to terms with powerful health disparities in urban and rural spaces throughout the United States. Charting the structural basis of health disparities, he concluded, “should then act as a spur for increased effort . . . and not as an excuse for passive indifference, or increased discrimination.”1
Since the first data on racial disparities in Covid-19 mortality were published in April 2020, and in the wake of widespread mobilization and attention to bodily effects of structural racism after the police killing of George Floyd last May, more health care experts have acknowledged the centrality of structural racism as a driver of racial and ethnic disparities in clinical medicine and public health. The American Academy of Pediatrics published a policy statement on “The Impact of Racism on Child and Adolescent Health” that explicitly identifies racism as a threat to children’s health and describes the scientific evidence supporting this position.2 This report and others like it are the result of decades of theoretical and empirical scholarship by public health scholars and health equity researchers.3-7 Their work contradicts a prevailing myth that physicians are always impartial and that medical and public health institutions are somehow unaffected by the inequities and biases that saturate all aspects of American life.
We have reached an inflection point where understanding structural racism may become a central focus and core requirement of medical education, with social theory incorporated into health policy and medical practice.8,9Though the mounting resolve to address structural racism as a fundamental problem in American medicine and public health is welcome and overdue, the existence and effects of that racism are not revelatory.
The theory and empirical grounding for this work were laid out more than a century ago by Du Bois and his colleagues in the Atlanta school of sociology. Their internationally celebrated examinations of the intersections of racism, health, and society yielded the first detailed study of the relationship between racism and health in this country. But their message was forgotten, actively suppressed by the very forces of structural racism they described. What would the health professions look like if every medical, nursing, or public health student studied Du Bois in their first year?