JAMA Psychiatry
Systemic racism as a determinant of health inequities for people with substance use disorder
Systemic Racism as a Structural Determinant of Health Inequity
Often used interchangeably, health inequality and inequity represent different constructs; the recognition of this difference is nuanced but clinically meaningful and helps our understanding of racism as a structural determinant. Health inequality refers to specific differences resulting in poor outcomes among socially disadvantaged people, while health inequities represent disparities resulting from structural, avoidable, and unjust policies and practices. Access-related factors and poor socioeconomic conditions are significant predictors of the quality of health care; however, even when these factors are controlled, according to a study by Nelson, historically excluded populations still have worse health outcomes.
Systemic racism is at the core of health inequities associated with health outcomes via complex, interrelated social, psychological, and biological pathways, including stress systems and trauma. The concept of allostatic load provides a framework to understand how the cumulative stress of systemic racism over the lifespan leads to perturbations in neuroendocrine adaptations, potentially leading to chronic diseases, including SUD. A critical mass of scientific literature is now emerging, examining the spate of inequities in every area of medicine, including addiction.