Ecological Impacts of Structural Racism on Health Disparity and its Mediating Factors: A Case-Study on Low Birthweight in Three Race/Ethnicity Groups in the United States

Health disparities among populations across geographic regions, demographic and socio-economic groups are well documented; however, ecological studies which visually demonstrate health disparities associated with structural racism among racialized populations are limited. The purpose of this study was to examine low birthweight (LBW) as a measurable indicator of disproportionate health impacts across three race/ethnicity groups- non-Hispanic Black, Hispanic and non-Hispanic White in the United States. We begin by providing the contextual background of structural racism through a literature review, and then more specifically, we examine LBW as a selected health indicator characterized with a socio-biological pathway of structural racism leading to health disparities. To visualize this pathway of impacts, publicly available US County Health Ranking data for LBW, at the county level in two US States, Tennessee and Ohio, were analyzed to uncover ecological (area-based) outcomes. Significant correlation and scatter plots provided evidence of LBW as a racially sensitive health indicator associated with impacts of structural racism. These were further notable through examination of mediating socio-economic (e.g. race/ethnicity, income, education, and employment) and environmental factors such as housing issues as well as other underlying health conditions. Our case study provided a window for more fully visualizing disparity across Non-Hispanic Black, Hispanic, Non-Hispanic White populations as demonstrated by the prevalence of LBW and its mediating factors at the county level. Potentially important policy implications are identified through our study findings that are salutary and/or reductive for addressing impacts of structural racism.