Structural Racism: Introduction
In 2020, the American Public Health Association issued a policy statement declaring structural
racism a public health crisis or emergency. Subsequently, local and state leaders in 30 states have issued
similar statements, according to data collected by the APHA. Five of these statements were issued by
governors or legislatures on behalf of the state at large, while other statements were issued by governing
boards at the county and local levels. Specifically, sixty-five local entities, including mayors, city
councils, town councils, and local health departments, have declared racism a public health crisis or
emergency. Eighty-seven statements have been issued by county-level agencies, including county
commissions and county boards of health.
Within North Carolina, boards of commissioners and/or public health departments in nine
counties (Buncombe, Cabarrus, Chatham, Durham, Mecklenburg, New Hanover, Orange, Pitt, and Wake)
have issued declarations.
As of March 7, 2021, the following states have issued at least one declaration at the state, county
or city level: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa,
Kentucky, Maine, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New
Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Vermont,
Virginia, Washington, West Virginia, and Wisconsin.
WHEREAS data demonstrate that Black and Brown communities exhibit poorer health outcomes,
including higher rates of maternal and infant morbidity and mortality; higher rates, earlier onset, more
rapid progression, and lower survival of chronic disease; and lower life expectancy;
WHEREAS Black and Brown communities are more likely to experience inequities in the social
determinants of health, including access to adequate housing and nutritious food, reliable transportation,
good quality education and jobs; exposure to gun violence; overrepresentation in the criminal legal
system; exposure to environmental toxins in air and water; and overall quality of life;
WHEREAS Black and Brown communities are shown to experience chronic stress associated with
personally mediated racism and implicit bias in their everyday lives, which undermines mental and
WHEREAS Black and Brown communities, experience less access to medical care, including lower
levels of insurance coverage; maldistribution of medical resources; restricted access to available services;
and provider bias, which undermines quality of care even though it can be unconscious and unintended;
WHEREAS the COVID-19 pandemic has disproportionately impacted Black and Brown communities,
in terms of adequate information, prevention, detection, access to vaccinations, treatment, disease
severity, and mortality as well as resulting higher rates of job loss, economic hardship, hunger, and
WHEREAS institutional policies and practices need not be explicitly or intentionally racist to have
stronger negative impacts on Black and Brown communities (Equal Rules + Unequal Situations =
WHEREAS the negative impact of racial disparities persists across all socioeconomic levels;
WHEREAS these disparities reflect the negative repercussions of historical racism and the racist
structures inherited from that history that continue to exert a differential impact on Black and Brown
Americans, including but not limited to lower wages for equivalent work; discriminatory lending;
restrictions on home purchase; educational systems emphasizing neighborhood schools with funding
linked to property taxes; and distrust of the medical system grounded in the lasting effects of historical
trauma (e.g., Tuskegee study; eugenics, sterilization practices);
Be it resolved that the Association of North Carolina Boards of Health (ANCBH) will
(1) Recognize that inequity associated with race and racism is a public health crisis and advocate for
policies that will demonstrably improve health conditions in Black and Brown communities.
(2) Advocate for efforts to expand understanding of how racism affects both individual and population
health and to provide tools for dismantling institutional and personally mediated racism, including
(3) Focus on enhancing organizational effectiveness by: (a) Assessing internal policy, procedures, and
goals to ensure that racial equity is a core element in all organizational practice; and (b) Working to create
an inclusive organization by identifying specific activities to increase diversity across the workforce and
in leadership positions.
(4) Build and solidify alliances and partnerships with organizations that have a legacy and track record of
confronting and fighting racism and encourage partners and stakeholders to recognize racism as a public
(5) Develop a consistent methodology for data collection, reporting, and analysis relevant to race to
ensure transparency in publishing of reports and to inform recommendations to decision-makers.
(6) Call on policymakers, businesses, schools, and other community leaders and institutions to begin
taking the necessary actions to address persistent discrimination in housing, education, employment,
health care, and criminal justice that ultimately leads to poorer health outcomes among Black and Brown
Bailey, Zinzi D., Justin M. Feldman, and Mary T. Basset. “How Structural Racism Works – Racist
Policies as a Root Cause of U.S. Racial Health Inequities. New England Journal of Medicine. 2021.
Evans, Michele K. et al., “Diagnosing and Treating Systematic Racism.” New England Journal of
Medicine 2020. 383:274-276.
Williams, David R., Joycelyn A. Lawrence and Brigette A. Davis. “Racism and Health: Evidence and
Needed Research. Annual Review of Public Health 2019. 40:105-25.
Love, Bayard and Deena Hayes-Greene. The Groundwater Approach: Building a Practical
Understanding of Structural Racism. The Racial Equity Institute, Greensboro, NC.
In North Carolina:
Black babies are 1.9 times more likely than White babies to have low birthweight.
Black infant mortality is 2.4 times higher.
Black adults are 2.2 times more likely to be diabetic.
Life expectancy at birth is 72.2 years for Black men, 76.6 for White men. It is 79.1 for Black women and 81.3 for White women.
Black men are 5.7 times more likely to die by homicide.
Black people are twice as likely to be unemployed and twice as likely to live in poverty.
Black people are less likely to have health insurance.
In the Piedmont metropolitan area, 41% of Black people own their homes, compared to 73% of White people.
Median salary of Black people is $35,000, compared to $55,00 for White people.