Structural Racism and Inequities Shaping Cardiovascular Health Disparities Across U.S. Neighborhoods – BIOENGINEER.ORG

Report on the Association of Structural Racism with Cardiovascular Health Disparities and Implications for Sustainable Development Goals

Introduction and Alignment with Global Goals

• A cross-sectional study published in the JAMA Health Forum establishes a significant link between structural racism and adverse neighborhood-level cardiovascular health outcomes.
• The findings provide critical insights into the social determinants of health, directly informing progress towards several United Nations Sustainable Development Goals (SDGs).
• This report highlights the study’s relevance to SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 11 (Sustainable Cities and Communities), among others.

Core Findings and Relation to SDG 3: Good Health and Well-being

The study’s conclusions present a direct challenge to the achievement of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

1. Increased Burden of Non-Communicable Diseases: The research demonstrates a robust correlation between higher indices of structural racism and poorer cardiovascular outcomes, including hypertension, obesity, diabetes, and stroke. This directly impedes progress on Target 3.4, which seeks to reduce premature mortality from non-communicable diseases.
2. Physiological Impact of Systemic Stress: Chronic exposure to stressors associated with structural racism is shown to exacerbate cardiovascular disease through pathophysiological mechanisms like increased inflammation and endothelial dysfunction. This undermines the foundational goal of ensuring healthy lives by revealing how social environments impose a tangible physiological burden.

Unpacking Systemic Barriers in the Context of SDG 10: Reduced Inequalities

The research frames structural racism as a system of policies, institutional practices, and norms that perpetuates racial inequity, aligning squarely with the objectives of SDG 10.

• Manifestations of Inequality: The study identifies how structural racism limits access to essential resources, creating disparities that are central to the mission of SDG 10. These include inequitable access to:
  • Quality healthcare
  • Nutritious foods, contributing to food insecurity (relevant to SDG 2: Zero Hunger)
  • Safe and adequate housing
  • Quality education (relevant to SDG 4: Quality Education)
• Call for Equal Opportunity: The findings underscore the necessity of fulfilling Target 10.3 (ensure equal opportunity and reduce inequalities of outcome) by dismantling the discriminatory systems that create and sustain health disparities.

Place-Based Interventions and SDG 11: Sustainable Cities and Communities

The study’s emphasis on neighborhood-level factors and place-based solutions strongly supports the vision of SDG 11 for inclusive, safe, resilient, and sustainable human settlements.

1. Environmental Determinants of Health: By linking neighborhood characteristics such as residential segregation and limited healthcare infrastructure to heightened cardiovascular risk, the research highlights the urgent need for inclusive urban planning as outlined in SDG 11.
2. Advocacy for Systemic Environmental Change: The report advocates for systemic interventions that transform neighborhood environments rather than focusing solely on individual behavior. This approach is critical for achieving Target 11.1 (access to adequate, safe, and affordable housing) and Target 11.7 (universal access to safe, inclusive, and accessible public spaces).

Policy Implications and Future Directions for Achieving the 2030 Agenda

• The study provides an evidence base for policymakers to integrate social justice and equity into public health initiatives, a crucial step for achieving the SDGs.
• Addressing cardiovascular disparities requires a multi-sectoral approach involving urban planning, economic investment, and legal reform to foster health equity. This holistic strategy contributes to SDG 16 (Peace, Justice and Strong Institutions) by promoting more inclusive and just societal structures.
• Future research, including longitudinal investigations and community-based participatory studies, is recommended to track how changes in structural determinants impact health trajectories, providing essential data for monitoring progress towards the SDGs.

Conclusion

• This research provides compelling evidence that structural racism is a critical social determinant of health that directly impedes the realization of a more equitable and healthy future for all communities.
• Achieving the Sustainable Development Goals—particularly those concerning health, inequality, and sustainable cities—is contingent upon confronting and dismantling these deeply embedded systemic inequities through targeted, place-based, and systems-level interventions.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   • The article’s primary focus is on “cardiovascular health disparities” and risk factors such as “hypertension, obesity, diabetes, and stroke.” It directly addresses health outcomes and the need for interventions to improve community well-being, which is the core of SDG 3.

2. SDG 10: Reduced Inequalities

   • The article identifies “structural racism” and “systemic racial inequalities” as the root causes of health disparities. It analyzes how policies and institutional practices “perpetuate racial group inequity,” directly connecting to SDG 10’s goal of reducing inequality within and among countries.

3. SDG 11: Sustainable Cities and Communities

   • The research is conducted at the “neighborhood level” and links health outcomes to factors like “safe housing,” “residential segregation,” “limited healthcare infrastructure,” and the need to reimagine “urban planning.” This aligns with SDG 11’s aim to make cities and human settlements inclusive, safe, resilient, and sustainable.

4. SDG 2: Zero Hunger

   • The article mentions “limited access to… nutritious foods” and the strategy of “addressing food deserts” as a place-based intervention. This connects to SDG 2, which aims to end hunger and ensure access to safe and nutritious food.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   • The article’s focus on cardiovascular diseases—including hypertension and stroke—directly relates to this target. The call for “place-based prevention strategies” to alter the “cardiovascular health landscape” is a clear effort to reduce mortality from these non-communicable diseases.

2. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

   • The article’s central argument is that structural racism leads to health inequities. By calling for the dismantling of these structures to “foster environments conducive to health equity across racial groups,” it directly advocates for the social inclusion and well-being of marginalized racial communities.

3. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.

   • The article defines structural racism as a framework of “policies, institutional practices, cultural representations, and other norms that perpetuate racial group inequity.” The recommendation to tackle disparities by “reimagining urban planning, economic investment, education equity, and legal frameworks” aligns perfectly with this target.

4. Target 11.1: By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums.

   • The article explicitly links cardiovascular health to “safe housing” and identifies “residential segregation” and poor housing as key problems in marginalized neighborhoods. The call for “reforming housing policies” is a direct connection to this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for Target 3.4

   • Rates of cardiovascular risk factors: The article explicitly mentions that neighborhoods with higher structural racism have “disproportionately high rates of these conditions,” referring to “hypertension, obesity, diabetes, and stroke.” These rates serve as direct indicators of cardiovascular health outcomes.

2. Indicators for Targets 10.2 and 10.3

   • Indices of structural racism: The study itself “correlated measures of structural racism with cardiovascular health metrics.” This implies that quantitative “indices of structural racism” are used as a key indicator to measure the level of systemic inequality.
   • Measures of residential segregation: The article identifies “residential segregation” as a characteristic of neighborhoods with poor health outcomes. The level of segregation can therefore be used as an indicator of racial inequality.

3. Indicators for Target 11.1

   • Access to quality healthcare infrastructure: The article notes that affected neighborhoods have “limited healthcare infrastructure.” The availability and accessibility of primary care facilities in a neighborhood is an implied indicator of basic services.
   • Prevalence of food deserts: The article suggests “addressing food deserts” as a key intervention. The number or percentage of neighborhoods classified as food deserts serves as an indicator of access to nutritious food, which is a basic service.

4. Summary Table of SDGs, Targets, and Indicators

Source: bioengineer.org