Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism: Looking Upstream from Disease Inequities among People Who Use Drugs

Friedman, Samuel R.; Williams, Leslie D.; Jordan, Ashly E.; Walters, Suzan M.; Perlman, David C.; Mateu‐Gelabert, Pedro; Nikolopoulos, Georgios K.; Khan, Maria R.; Peprah, Emmanuel; Ezell, Jerel M.

doi:10.3390/ijerph19127453

Cited by 7 publications

(5 citation statements)

References 142 publications

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“…This can gradually result in social segregation between ethnic minorities and the majority social groups. Social segregation is noted as a form of structural racism that could subsequently affect the health outcomes of ethnic minorities ( 30 ). Being noted as a social determinant, racism is noted as closely associated with poorer physical and mental health among ethnic minorities ( 31 , 32 ), and their poorer mental health is particularly associated with the negative stereotypes attached to their ethnicities ( 31 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

Stigma and health inequality experienced by ethnic minorities during the COVID-19 pandemic in a Chinese community: an implication to health policymakers

Siu

Cao

Shum

2023

Front. Public Health

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IntroductionEthnic minorities are considered one of the most vulnerable groups during the COVID-19 pandemic. However, the explanatory pathway of how their disadvantaged experiences during epidemics are related to the embedded and longstanding stigmas against them and how these embedded stigmas can affect their resilience in disease outbreaks are not well understood. This study investigated the experiences of ethnic minorities in the COVID-19 pandemic, and how their experiences were related to the embedded stigma toward them.MethodsThis study adopted a qualitative approach, interviewed 25 individuals (13 women and 12 men) from ethnic minority groups residing in Hong Kong from August 2021 to February 2022 in a semi-structured format. Thematic analysis was conducted to analyze the data.ResultsThe participants were isolated and stereotyped as infectious during the COVID-19 pandemic at community and institutional levels. Their experiences did not occur suddenly during the pandemic but were embedded in the longstanding segregation and negative stereotypes toward ethnic minorities in different aspects of life before the pandemic. These negative stereotypes affected their resilience in living and coping with the pandemic.ConclusionThe participants’ experiences during the COVID-19 pandemic were mostly disadvantageous and predominantly initiated by the mainstream stigmatization toward them by the local Chinese residents and government. Their disadvantaged experiences in the pandemic should be traced to the embedded social systems, imposing structural disparities for ethnic minorities when accessing social and medical resources during a pandemic. Because of the preexisting stigmatization and social seclusion of ethnic minorities in Hong Kong, the participants experienced health inequality, which stemmed from social inequality and the power differential between them and the Chinese locals. The disadvantaged situation of the participants negatively affected their resilience to the pandemic. To enable ethnic minorities better cope with future epidemics, merely providing assistance to them during an epidemic is barely adequate, but a more supportive and inclusive social system should be established for them in the long run.

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Section: Discussionmentioning

confidence: 99%

Stigma and health inequality experienced by ethnic minorities during the COVID-19 pandemic in a Chinese community: an implication to health policymakers

Siu

Cao

Shum

2023

Front. Public Health

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“…This study did not find race or ethnicity to be significant; however, we controlled for individual race and ethnicity, not beliefs about people of different races and ethnicities. Structural racism is a main driver of health inequities for persons who use drugs [78,79]. Previous studies measured racial beliefs and racism [75], and it is possible that racist beliefs influence stigma beliefs and policy supports, therefore future research should explore this.…”

Section: Discussionmentioning

confidence: 99%

A National Portrait of Public Attitudes toward Opioid Use in the US: A Latent Class Analysis

Walters

Liu

Lamuda

et al. 2023

IJERPH

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Background: Opioid overdose rates have steadily been increasing in the United States (US) creating what is considered an overdose death crisis. The US has a mixture of public health and punitive policies aimed to address opioid use and the overdose crisis, yet little is known about public opinion relating to opioid use and policy support. Understanding the intersection of public opinion about opioid use disorder (OUD) and policy can be useful for developing interventions to address policy responses to overdose deaths. Methods: A national sample of cross-sectional data from the AmeriSpeak survey conducted from 27 February 2020 through 2 March 2020 was analyzed. Measures included attitudes toward OUD and policy beliefs. Latent class analysis, a person-centered approach, was used to identify groups of individuals endorsing similar stigma and policy beliefs. We then examined the relationship between the identified groups (i.e., classes) and key behavioral and demographic factors. Results: We identified three distinct groups: (1) “High Stigma/High Punitive Policy”, (2) “High Stigma/Mixed Public Health and Punitive Policy”, and (3) “Low Stigma/High Public Health Policy”. People with higher levels of education had reduced odds of being in the “High Stigma/High Punitive Policy” group. Conclusion: Public health policies are most effective in addressing OUD. We suggest targeting interventions toward the “High Stigma/Mixed Public Health and Punitive Policy” group since this group already displays some support for public health policies. Broader interventions, such as eliminating stigmatizing messaging in the media and redacting punitive policies, could reduce OUD stigma among all groups.

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“…“Keeping people down” refers to systems of exploitation and domination, and racism is an example of “keeping people down.” The U.S. economy thrives because of unpaid, or low-paid, labor of Black and Hispanic people (Robinson, 2020), and such racial capitalism leads to health inequities (Laster Pirtle, 2020). Stigma reinforces economically driven societal hierarchies, creates an “us” versus “them” mentality (Link & Phelan, 2001), and facilitates divide-and-rule politics (Friedman, Williams, et al, 2021; Friedman et al, 2022). In many cases, this allows for those in power to increase their profit margins (Keefe, 2021).…”

Section: Stigmamentioning

confidence: 99%

Intersectional stigma as a fundamental cause of health disparities: A case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time.

Walters¹,

Kerr²,

Cano³

et al. 2023

Stigma and Health

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Recent evidence points to racial and ethnic disparities in drug-related deaths and health conditions. Informed by stigma, intersectionality, intersectional stigma, and fundamental cause theories, we aimed to explore whether intersectional stigma was a fundamental cause of health. We document key events and policies over time and find that when progress is made new mechanisms emerge that negatively affect health outcomes for Black and Hispanic persons. We then focus on intersectional stigma targeting Black and Hispanic persons who use drugs. We document that when a person, or group of people, occupy multiple stigmatized identities, the processes of stigmatization and scapegoating are particularly persistent and pernicious since people and groups can be stigmatized and scapegoated on varying intersections. We propose that an intersectional stigma framework allows for a better understanding of observed patterns over time, thereby providing a better guide for policies and interventions designed to reduce disparities. As a framework, intersectional stigma aims to recognize that when different sources of stigma collide, a new set of circumstances is created for those who reside in the intersection. We conclude that intersectional stigma is a fundamental cause of health inequities and provide policy recommendations aimed at dismantling intersectional stigma processes and mitigating the effects of intersectional stigmas to ultimately promote better health outcomes for Black and Hispanic persons who use drugs.

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Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism: Looking Upstream from Disease Inequities among People Who Use Drugs

Cited by 7 publications

References 142 publications

Stigma and health inequality experienced by ethnic minorities during the COVID-19 pandemic in a Chinese community: an implication to health policymakers

Stigma and health inequality experienced by ethnic minorities during the COVID-19 pandemic in a Chinese community: an implication to health policymakers

A National Portrait of Public Attitudes toward Opioid Use in the US: A Latent Class Analysis

Intersectional stigma as a fundamental cause of health disparities: A case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time.

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