Three Facets of Public Health and Paths to Improvements, Chapter 13 - Structural racism and social environmental risk: A case study of adverse pregnancy outcomes in Louisiana

Elsevier, Three Facets of Public Health and Paths to Improvements: Behavior, Culture, and Environment, 2020, Pages 353-380
Vanessa Lopez-Littletona and Carla Jackie Sampson

This chapter examines structural racism as a fundamental cause of health inequities by challenging conventional social determinants of health models. Evidence of structural racism exists in regions where high rates of pregnancy-related Black mortality persist at rates three times higher than rates of non-Hispanic White women in the US. Social environmental conditions experienced in racially segregated Black communities contribute to health disadvantages experienced by Black women. This case study explores the social environmental impact of structural racism and a combination of policy artifacts as the underlying cause of health inequities faced by Black women in Louisiana, by comparing maternal and infant mortality between Black and White women and between Louisiana parishes. We recommend the reconceptualization of public health approaches to health inequities through individual-level efforts made by public health professionals and policymakers to create, support, and engage in mechanisms that improve the social environmental deficits experienced by Black women.