Ecological Impacts of Structural Racism on Health Disparity Through Its Determinants and 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 (US) for visualizing ecological manifestation of this disparity attributed to structural racism. 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 via socio-economic and politico-legal determinants and associated mediating factors to health disparities, from which we synthesized a visualization model with the indicators of structural racism reported in the literature reviewed. To further visualize these 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 area-based ecological health outcome-LBW. Significant correlation and scatter plots provided evidence of LBW as a racially sensitive health indicator associated with impacts of structural racism. These findings were further notable through examination of socio-economic determinants (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 has opened a window for visualizing disparity across non-Hispanic Black, Hispanic, non-Hispanic White populations as demonstrated by the prevalence of LBW disparity through its determinants and mediating factors at the county level. Potentially important policy implications for reparative change are drawn through our study findings that are salutary and/or reductive for addressing impacts of structural racism. Further studies are needed to fully understand the comprehensive web of area-based ecological factors impacting various health outcomes through the impacts of structural racism.