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Why the Conventional Social Determinants of Health Must Include Racism (Part 1: Education)

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Vanessa Lopez-Littleton and Carla Jackie Sampson
September 3, 2020

This article is the first in a three-part series that challenges prevailing social determinants of health models and argues for the explicit inclusion of racism as a critical determinant of health.

The social determinants of health (SDOH) were thrust into the national spotlight to explain why Black, Indigenous, and People of Color (BIPOC) were faring worse from COVID-19 than other racial and ethnic groups. Currently, Black and Latinx people remain as more likely to be hospitalized or die from COVID-19 related illnesses or reside in COVID-19 hotspot communities. According to the CDC, these inequities are driven by discrimination; toxic and chronic stress from exposure to long-term discrimination; poor access to quality healthcare services; occupational consequences; and income inequities in education, income, wealth, and housing. What is missing from this model, and many other social determinants of health models that attempt to explain disparate outcomes, is systemic racism. 

What are the social determinants of health?

The SDOH represent varied, multi-leveled interactions that together influence health outcomes. The SDOH typically include environmental factors (e.g., air and water quality), community features (e.g., housing, safety and transit) and individual health behaviors that affect health outcomes. An individual’s health outcomes emerge from interactions among these determinants, and change by location and throughout a person’s lifespan. The SDOH, then, are linked to wealth distribution, social networks, policies and politics, which then result in health inequities. The challenge for researchers has always been to parse the influence of any one health determinant on outcomes. However, the common denominator for each of the traditional health determinants is the unspoken effect of racism, either explicitly in the careful crafting of exclusionary policies or implicitly in policy administration. Thus, racism affects where BIPOC people live, work, play, worship, where their children attend school and even what they learn. 

Racism in Educatio

Education is one of the most influential institutions in American society. Schools have the duty to educate young Americans, and in so doing, determine the future of successive generations by bestowing predominant and prevailing ideals and values. Racism plays a critical role in shaping what the curriculum includes, but particularly what is left out of the curriculum. Historically, students in the United States have learned relatively little about those whose lives fall outside of mainstream thinking—a reinforcement of the white racial frame. For many students, these omissions mean they graduate with little to no understanding of historic racial divides, racialization, colonialism or resistance to oppressive systems.

The education system is critical to racial equity in the United States. Systematically failing to educate students on histories, adopting standardized tests that reproduce inequities and perpetuating school systems that increasingly segregate and isolate students does little to overcome the deeply entrenched divisions so prevalent in the United States today. Even the policies of school choice and school vouchers are rooted in racism, as they disregard the conditions of schools across the country that are marred by long-term divestment. The fact that schools are primarily funded by property taxes dooms those in divested communities to lower quality education. For predominantly BIPOC schools across the United States, the rates of suspensions, expulsions and detentions mark the gateway to the school-to-prison pipeline. All of these factors point to historical and ongoing patterns of racism and oppression. 

Real Effects of Racism 

COVID-19 has provided many lessons for the public sector, including insight into the prevalence of racialized outcomes in education. This fall, there will be stark differences in how students of color return to physical and virtual classrooms during the pandemic. For some students, their attendance will be affected by access to technologies or resources. Other students will not have access to teaching pods, college-educated parent(s) to assist with lessons, parents or guardians with stable or reliable incomes or regular nutritious meals. There will also be students whose parents have been deemed essential workers, leaving these students to navigate virtual learning environments by themselves while maybe caring for their younger siblings. These inequities have actual mental, physical and emotional consequences that are compounded by residing in communities marked by acute and chronic trauma and violence. 

An Antiracist Education Agenda

The public sector must begin to adopt an antiracist agenda in order to address systemic racism in education. A critical step is centering on the margins, a policy approach that broadens traditional policymaking approaches by intentionally integrating inclusive practices. In much the same way, public sector personnel must reject those policies that produce racial inequities and actively work to establish policies that lead to racial equity. These are intentional and specific acts that actively work to dismantle racism. 

One strategy for dismantling systemic racism in higher education is the passage of California’s AB 1460, an ethnic studies requirement for all California State University (CSU) students. This bill will ensure that all CSU students are educated on the histories of BIPOC groups in the United States. These graduates can then apply this competency in future advocacy, coordination, service or decisionmaking roles. This push towards equity in education by centering on historically oppressed groups is a foundational step towards dismantling structural racism, but there is still so much more work to be done.


Vanessa Lopez-Littleton, Ph.D., RN, is an Associate Professor at California State University, Monterey Bay and Chair of the of Health, Human Services, and Public Policy Department. Her research interests include social determinants of health, racial equity, and organizational behavior. She may be reached at [email protected], DrVLoLil.Com or @DrVLoLil

Carla Jackie Sampson, Ph.D., MBA, FACHE, is a Clinical Associate Professor and Director of the Health Policy and Management Program and online Master of Health Administration Program at NYU’s Robert F. Wagner Graduate School of Public Service. Her research interests include healthcare workforce policy, social determinants of health, and anchor mission strategy development. She may be reached at [email protected] or @ProfessorSamps1

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