Where we live, work, and play greatly shapes our health and well-being. While it's common to think first about individual behavior, genes, and health care access as most important for good health, in actuality, factors such as housing, education, environmental exposure, public safety, employment and income are also strong predictors of health and well-being. When examining how these factors contribute to health inequities, it is important to understand how experiences within the individual and community context differ by race. In the United States, racism plays a significant role in creating and perpetuating health inequities. Social inequities, such as poverty, segregation, and lack of educational and employment opportunities have origins in discriminatory laws, policies, and practices that have historically denied people of color the right to earn income, own property, and accumulate wealth. Health promoting resources are distributed unevenly across the city of Boston and follow patterns of racial segregation and poverty concentration. As a result, on average, Boston residents who are White enjoy better health than many residents of color. These significant differences in health outcomes between residents of color and White residents are systemic, avoidable, unfair, and unjust. Other forms of oppression also contribute to different health outcomes. We must understand and address the many factors shaping our individual and collective health and provide all residents with fair access to the conditions that promote the best possible health.
Figure 1. Health Equity Framework
Figure 1. The Boston Public Health Commission's framework for understanding health inequities illustrates how racism has an independent influence on all the social determinants of health and that racism in and of itself has a harmful impact on health.