Week One Introduction – The Global Black Lifespan Journey: From Cradle to Legacy
The Global Black Lifespan Journey: From Cradle to Legacy exposes why U.S. wealth does not equal protection. The first article examines cardiometabolic disease, maternal mortality, and kidney disease—revealing how systemic barriers, not biology, drive preventable Black health disparities.
It’s often said that your genetic code is the blueprint for your health. But what if your zip code was even more important? Mounting evidence suggests that the environment where you live, work, and play has a profound impact on your well-being. This document explores a powerful but often invisible force that shapes our neighborhoods and, in turn, our health: structural racism.
Our goal is to explain this complex idea in a clear, accessible way. We will break down what structural racism is, how it affects the places we live, and how researchers have drawn a direct, measurable line connecting it to cardiovascular (heart) health, using findings from a major U.S. study.
1. What is Structural Racism? Going Beyond Individual Prejudice
When we hear the word “racism,” we often think of individual acts of prejudice—one person treating another unfairly because of their race. This is interpersonal racism. Structural racism, however, is different. It isn’t about individual attitudes; it’s about the ways that systems, policies, and institutions—in areas like housing, education, and healthcare—produce and perpetuate racial inequality.
Think of it this way: interpersonal racism is like a person intentionally tripping someone on the sidewalk. Structural racism is a system of cracked, uneven sidewalks that makes everyone more likely to fall, but is far more common and hazardous in some communities than others, leading to predictable and unequal patterns of injury.
Even wealth and fame cannot always protect people from these systemic forces. The post-birth experience of tennis superstar Serena Williams is a powerful example of how a healthcare system can fail Black women.
After giving birth via C-section, Williams, who has a history of blood clots, felt the warning signs of a pulmonary embolism. She told a nurse she needed a CAT scan and a blood thinner immediately. However, medical staff initially dismissed her concerns, suggesting her pain medication was making her “crazy.” Only after she persistently pleaded was she taken seriously. A CT scan was finally done, which revealed that blood clots had been found in her lungs. As Williams later said, “I was like, listen to Dr. [me].” Her experience is a stark reminder that even a world-famous athlete’s concerns can be ignored within a system where such dismissals are common for Black women.
This case highlights how systemic issues can create dangerous inequities, regardless of an individual’s status. These same systemic forces also shape the physical and social environments of our neighbourhoods.
2. How Your Environment Affects Your Health
The conditions in your neighborhood—from the quality of the air to the availability of fresh food—can directly impact your cardiovascular health. A recent large-scale study investigated this connection using a tool called the Structural Racism Effect Index (SREI). This index combines measures across nine different domains to score how much a neighborhood is affected by structural racism.
Here are a few of those domains and how they connect to your heart health:
• Built Environment: This refers to the physical parts of where we live. Neighborhoods with safe parks and well-lit sidewalks encourage physical activity. Access to grocery stores with fresh produce supports a healthy diet, while a high concentration of fast-food chains and a lack of healthy options does the opposite. Exposure to pollution from nearby highways or industrial sites also puts a strain on the heart and lungs.
• Education: The quality of local schools has long-term effects on health. Better educational opportunities often lead to higher-paying jobs, greater health literacy, and more stable lives. In contrast, under-resourced schools can limit future prospects, contributing to a cycle of poverty and stress that is damaging to health.
• Income and Poverty: Living with constant financial stress takes a physical toll on the body. Worrying about paying rent, affording food, or covering unexpected medical bills can lead to chronic stress. This long-term stress can permanently damage vital organs, including the heart and blood vessels.
The cumulative effect of living with chronic stress and discrimination is so significant that scientists have a name for it: weathering.
Weathering is a concept introduced by Dr. Arline Geronimus, which explains how the constant stress of racism can cause “premature biological aging.” This chronic activation of the body’s stress response, also known as “allostatic load,” wears down the body’s systems over time, leading to worse health outcomes and making people more vulnerable to disease at an earlier age.
These environmental factors are not just theories; scientific research has found measurable connections between them and the health of entire communities.
3. The Evidence: Connecting Structural Racism to Heart Disease
To understand these connections, researchers conducted a massive cross-sectional study titled “Manifestations of Structural Racism and Inequities in Cardiovascular Health Across US Neighborhoods.” They analyzed data from over 71,000 U.S. census tracts to see if there was a quantifiable link between neighborhoods with high levels of structural racism (as measured by the SREI) and the heart health of the people living there.
The findings were stark. After adjusting for other factors, the study found that people living in neighborhoods most affected by structural racism had significantly higher rates of cardiovascular diseases and their risk factors. Crucially, the study also revealed that these neighborhoods were disproportionately Black; the percentage of Black residents was more than ten times higher in the areas most impacted by structural racism compared to those least impacted (23.0% vs. 2.2%).
Health Risks in Neighborhoods Most Affected by Structural Racism
| Health Condition | Increased Prevalence |
| Diabetes | 80% more common in neighborhoods with the most structural racism compared to those with the least. |
| Stroke | Nearly twice as common (99% more prevalent) in neighborhoods most affected by structural racism. |
| Coronary Heart Disease | 80% more common in the most affected neighborhoods compared to the least affected. |
| No Leisure-Time Physical Activity | 88% more common for residents in the most affected neighborhoods to report getting no exercise. |
| Current Cigarette Smoking | 84% more common in neighborhoods most impacted by structural racism. |
The Takeaway: The single most important conclusion from this data is that health disparities are not random. They are deeply connected to the measurable, systemic, and inequitable conditions in the places people live. These are not simply patterns of individual “bad choices,” but rather the result of environments that can either promote health or harm it.
These findings have profound implications for how we can create a healthier and more equitable society.
4. Conclusion: Why This Matters and What It Means for the Future
Health is not simply a matter of personal responsibility and genetics. As the evidence shows, it is profoundly shaped by systems, policies, and the environments they create. The link between structural racism and poor cardiovascular health demonstrates that where you live can have a powerful influence on how well, and how long, you live.
The researchers of the landmark study put their main conclusion this way:
“structural racism was associated with inequities in neighborhood cardiovascular health, highlighting opportunities for place-based prevention efforts.”
So, what are “place-based prevention efforts”? This is a hopeful, forward-looking idea that focuses on healing communities by fixing the root causes of poor health. Instead of focusing only on treating disease after it appears, this approach aims to build environments that prevent it from happening in the first place.
It means investing in communities to ensure everyone has access to the building blocks of a healthy life: high-quality schools, safe housing, nutritious food, and clean environments. By recognizing that our systems created these cracked sidewalks in the first place, we can begin the work of rebuilding them. This is how we create a country where your zip code doesn’t determine your life expectancy, and where every neighborhood is a foundation for good health for all.
Infographic maps policy, data, justice, and community care strategies to dismantle structural racism and advance equitable Black health outcomes nationwide.
