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Population Health for Nurses

6.2 The Historical Context of Structural Racism in the United States

Population Health for Nurses6.2 The Historical Context of Structural Racism in the United States

Learning Outcomes

By the end of this section, you should be able to:

  • 6.2.1 Discuss patterns of structural racism in the history of the United States.
  • 6.2.2 Explain how policies of racial apartheid in the United States have reinforced structural racism and systemic inequities.

It is difficult to discuss structural racism without first discussing the long history of racism in the United States. Racism in the United States dates back to British Colonial America, prior to the country’s founding, with the ill treatment and forced removal of Native Americans from their lands and the terrible history of slavery. This longstanding history of racism is the foundation of contemporary structural racism.

The Killing and Forced Removal of Native Americans

Native American people have been targets of violence since the first European explorers arrived in North America in the 15th century. The expansion of European settlers and later U.S. government policies resulted in the killing and mistreatment of Native American people (Braveman et al., 2022; Fixico, 2021; Library of Congress [LOC], n.d-b). From the time of its establishment up to the late 19th century, the U.S. government authorized over 1,500 wars and attacks on Native Americans (Fixico, 2021). For decades, U.S. policies threatened Native American land and autonomy. In 1786, the United States established the first Native American reservation and designated each tribe as an independent nation. In the 1830s, under President Andrew Jackson, Congress passed The Indian Removal Act, requiring Native Americans to leave the East and settle in the Indian Territory west of the Mississippi River (Fixico, 2021). Imposing this act, federal soldiers and volunteers forcibly relocated the Cherokee tribe, requiring them to walk 1,000 miles to the Indian Territory with few provisions to sustain them. An estimated 4,000 Cherokee people died on this infamous “Trail of Tears” (Pauls, 2023). Though an estimated 5 to 15 million Native Americans were living in North America when Columbus first arrived in 1492, by the late 1890s, fewer than 238,000 Indigenous people remained in the country (Fixico, 2021). Legally, Native Americans were not citizens of the United States until President Calvin Coolidge signed The Indian Citizenship Act of 1924 (National Constitution Center, 2023b). This status as non-citizens meant the Indigenous population did not have the same legal rights as many other Americans, including the right to vote (LOC, n.d.c).

Slavery and Post–Civil War Reconstruction

In 1619, 20 enslaved Africans were brought to the British colonies in Virginia against their will, likely the first slaves to arrive in what would later become the United States (Shah & Adolphe, 2019). In 1776, when the Declaration of Independence was signed, the lines about all men being created equal did not apply to enslaved people as many of the nation’s founders were slaveholders. Slavery flourished on tobacco, cotton, indigo, and rice farms. According to the first U.S. census, 697,624 enslaved people were living in the United States by 1790 (Hacker, 2020, p. 840). By 1808, Congress had banned the slave trade, but slavery was still legal, and by 1860, four million enslaved Black people resided in the United States, representing 13 percent of the population (Shah & Adolphe, 2019). This tremendous growth in the number of enslaved people between 1790 and 1860 was the result of increasing numbers of new slaves being imported from Africa and the Caribbean and due to population growth among the American-born slaves (Hacker, 2020). In 1864, during the Civil War, President Lincoln issued the Emancipation Proclamation, declaring freedom for and protection of enslaved people who lived within the Confederate states that were rebelling against the Union, yet this presidential order did not officially end slavery.

It was not until the ratification of the 13th Amendment on December 6, 1865, 8 months after the end of the Civil War, that slavery was officially abolished in the United States. At this time, Congress implemented Reconstruction efforts to restructure the southern states and to outline the process for White and Black individuals to live together in a post-slavery society (LOC, n.d-a). Opposition to Reconstruction laid the foundation for segregated institutions separated by race (Shah & Adolphe, 2019). The 14th Amendment, passed in 1868, afforded equal protection of the law to all citizens, and the 15th Amendment, passed in 1870, guaranteed that the right of citizens to vote could not be denied on account of race. This trio of Civil War amendments greatly expanded the civil rights of most Americans, but by the late 1870s, Reconstruction efforts came to an end. With the end of Reconstruction, local governments in many of the former Confederate states began building legal systems that undermined the three amendments to codify White supremacy after Reconstruction.

The Jim Crow Era and Systemic Racial Discrimination

The Jim Crow era refers to the period from the 1870s through most of the 1960s during which primarily southern U.S. states enacted many discriminatory laws in response to the civil rights and social gains of newly freed Black Americans during the Reconstruction period (Bailey et al., 2017; Shah & Adolphe, 2019). Although they are often thought of as the beginning of the Jim Crow era, the passage of the Black Codes in Mississippi and South Carolina in 1865 and the formation of the White supremacist group the Ku Klux Klan in Tennessee in 1866 were the era’s immediate precursors (National Constitution Center, 2023a; PBS, 2023). The Black Codes, often referred to as “slavery by another name,” were laws targeted at Black Americans that denied them rights to testify against White individuals, to serve on juries, and to vote and that limited their employment opportunities and the ability to leave a job once hired, often forcing them to work in the fields or as servants, stripping away their autonomy and ability to earn decent wages ( editors, 2023; National Geographic, n.d.; PBS, 2021). Founded by six former Confederate officers, the Ku Klux Klan terrorized Black families and pro-reform individuals, especially in rural areas. The Black Codes and Ku Klux Klan are emblematic of the efforts of former Confederate southern states in the post-Reconstruction era to keep Black Americans from gaining money, power, education, or land, all in service of maintaining White dominance (PBS, 2023).

The Black Codes: Reconstruction

Visit the PBS LearningMedia website to view the video “Black Codes: Reconstruction,” which describes the origins and effects of the Black Codes, a set of laws intended to restrict the freedom of Black individuals and compel them to work for White employers in a situation not unlike slavery.

Watch the video, and then respond to the following questions.

  1. What legacy do you feel the Black Codes have left behind?
  2. What parallels do you see between the institution of the Black Codes and the current treatment of individuals who are experiencing homelessness?

The Jim Crow laws of the 1870s–1880s were a formal system of laws codifying racial segregation and discrimination that dominated the American South, affecting every aspect of daily life. These laws mandated segregated, or separate parks, libraries, restrooms, buses, and trains (PBS, n.d.). This system of segregation prohibited Black Americans from eating at the same restaurants, drinking from the same water fountains, or attending the same schools as White Americans (Figure 6.2).

A Black man stands outside next to a parked bus. A sign above him says Colored Waiting Room.
Figure 6.2 The roots of structural discrimination are evident in this historical photo highlighting Jim Crow Laws. (credit: “At the bus station in Durham, North Carolina” by Jack Delano/Library of Congress, Prints & Photographs Division, FSA/OWI Collection, No known restrictions)

“Separate but Equal” and Civil Rights Laws in the United States

In 1896, the Supreme Court ruled in Plessy v. Ferguson that racially separate facilities did not violate the Constitution if they were equal, establishing the “separate but equal” rule (NMAH, n.d.). Though the Supreme Court insisted in Plessy v. Ferguson that separate facilities could be equal, the Black American experience of the era suggested otherwise. By the 1900s, Jim Crow laws had created a segregated society condemning Black Americans to unequal treatment and second-class citizenship (National Museum of American History [NMAH], n.d.; Shah & Adolphe, 2019). During the Jim Crow era, many places in the United States prevented Black Americans from exercising the right to vote using a variety of legal maneuvers including literacy tests, poll taxes, complex registration systems, and primaries in which only White people were allowed to vote. It was not until the Supreme Court’s ruling in Brown v. Board of Education in 1954 that racial segregation in public schools became illegal. This ruling overturned the “separate but equal” principle and made it unconstitutional for children to be separated in public schools on the basis of race (National Archives, 2021). Despite the Brown ruling, Jim Crow laws separating Black Americans from White Americans in housing, jobs, schools, and public gathering places persisted well into the 1960s in many areas of the United States (Shah & Adolphe, 2019).

The Civil Rights Act of 1964 prohibited discrimination based on race and outlawed segregation in businesses, public places, and public schools (National Archives, 2022). The Act made it illegal to discriminate on the basis of race. However, the enforcement of such laws was not and has not been adequate, allowing for the perpetuation of racial inequities and, by extension, socioeconomic inequities. These racial inequities persist due to the unjust systems that have sustained discriminatory practice in policies and laws (Bailey et al., 2017). BIPOC individuals are still significantly disadvantaged in contemporary society due to prior discriminatory laws mandating segregation by race (Braveman et al., 2022). These structures maintaining racial oppression are hidden, ensconced in the normal everyday operations of institutions, and invisible to most except those affected by them (Braveman et al., 2022).

Japanese Internment Camps

The attitudes of racial discrimination common in the Jim Crow era extended to Japanese American individuals living in the United States, who, whether they were citizens and whether they were born in Japan or in the United States, were presumed to be loyal to Japan during World War II. Their loyalties to the United States were questioned solely on the basis of their ancestry. During the war, the United States forcibly detained Japanese Americans in concentration camps, also known as internment camps (Figure 6.3) (National Archives, n.d.). Around 120,000 Japanese-Americans were detained in these camps, imprisoned based on their race, with many losing their homes and businesses (National Archives, n.d.). Most of those interned were U.S. citizens, and half were children, incarcerated for up to 4 years without any recourse. At the time, the U.S. Supreme Court accepted the implementation of President Roosevelt’s Executive Order 9066, determining that civil rights could be denied to U.S. citizens based on the executive branch’s definition of membership in a specified ethnic group.

A group of Japanese American men and women stand in a line outside of a building. A row of soldiers in uniform stand off to the side watching them.
Figure 6.3 Japanese Americans arrive at Santa Anita Assembly Center in California in 1942 during the first phase of relocation and internment. (credit: Clem Albers/National Archives, Public Domain)

Boarding School Policy for Native American and Alaska Native Children

From 1869 through the 1970s, the U.S. government forcibly removed Native American and Alaska Native children as young as age 4 from their families, homes, and cultural traditions, placing them into boarding schools with the goal of replacing their tribal values, languages, and culture with dominant White Christian values, religion, culture, and language (Braveman et al., 2022; National Native American Boarding School Healing Coalition [NNABSHC], 2020). This practice began with the Civilization Fund Act of 1819, which financed Christian churches to provide education that fostered “civilization” for Native Americans (LoneTree, 2021; Wong, 2019). In 1824, the Bureau of Indian Affairs assumed oversight of the program, which ultimately became a program of cultural genocide (NNABSHC, 2020). Children in the program faced harsh punishment if they spoke their native language or engaged in Native American cultural practices. Survivors of the schools recount sexual, physical, and spiritual abuse; neglect; and witnessing murders of other children. By 1925, the Bureau of Indian Affairs had placed into boarding schools over 60,000 children—approaching an estimated 83 percent of all Native American children in 1926. Overall, the United States funded 367 Native American boarding schools operating in 29 states.

Over time, the poor conditions in these schools did not go unnoticed. For example, the 1928 Meriam Report: The Problem of Indian Administration documents starvation, poor and unsanitary living conditions, and the harmful effects of corporal punishment on children’s mental health at these boarding schools (NNABSHC, 2020). However, it was not until passage of the 1975 Indian Self-Determination and Education Assistance Act that Native Americans gained legal control of their own educational systems (Avalos, 2021), and the passage of the 1978 Indian Child Welfare Act protected Native children from forced adoption or placement in foster care with non-Native individuals (Braveman et al., 2022; NNABSHC, 2020). The effects of these forced removals have resulted in significant cultural losses for tribal nations.

Redlining and Residential Segregation by Race

During the 1930s, the U.S. government sanctioned residential racial segregation via the Home Owners’ Loan Corporation (HOLC) and the Federal Housing Administration (FHA). Residential racial segregation is the practice of keeping racial communities separate based on where people live. The HOLC was established in 1933 as part of the New Deal programs to relieve the effects of the Great Depression, to assist homeowners who defaulted on their mortgages and were in foreclosure, and to expand homeownership for the average middle-class American family.

Housing Segregation and Redlining in America: A Short History

This NPR podcast video explores the history of redlining with an emphasis on its legality. Despite the passage of the Fair Housing Act, maps and census data show that housing segregation persists.

Watch the video, and then respond to the following questions.

  1. Are you surprised by the history of legalized discrimination in housing and banking practices? Why or why not?
  2. How do residential segregation and racial profiling intersect?

As a part of its City Survey Program, the HOLC employed examiners who consulted with local bank officers, city officials, appraisers, and realtors across the country to appraise neighborhoods according to perceived lending risk. Using this information, the HOLC created Residential Security maps of cities that graded neighborhoods based on condition and age of housing, transportation, proximity to parks and polluting industries, and the economic class and ethnic and racial composition of the residents (Mitchell & Franco, 2018). Examiners assigned each neighborhood a letter grade and then outlined them on the map in different colors. Green neighborhoods received the letter A, indicating the best neighborhoods; blue neighborhoods received the letter B, indicating desirable neighborhoods; yellow neighborhoods received the letter C, indicating neighborhoods in decline; and red neighborhoods received the letter D, indicating “hazardous” or high-risk (Mitchell & Franco, 2018). Loan officers, appraisers, and real estate professionals used these maps to calculate or estimate mortgage lending risk in the 1940s and 1950s (Mitchell & Franco, 2018).

Red lines were often drawn around communities that had predominantly Black populations, effectively labeling them as risky investment areas (Figure 6.4) (Bailey et al., 2021). Redlining these communities of color made mortgages on homes in these areas less available, placing Black homebuyers at risk for predatory lending terms and reducing their access to home ownership. The term redlining came to mean a system of denying borrowers access to mortgage loans based on the location of properties in disadvantaged neighborhoods that were often made up of minority populations (Mitchell & Franco, 2018). Borrowers who obtained loans in HOLC red zones paid higher interest rates. Some White homeowners signed restrictive racial covenants that prevented them from selling their homes to non-White individuals. These covenants were justified as protecting the value of the home and other neighborhood properties, and they allowed brokers to follow segregation standards in the resale of properties acquired by foreclosure (Mitchell & Franco, 2018). Restrictive racial covenants became popular in the immediate post–World War II era and were often required by the FHA for builders or homeowners to receive homeowners’ insurance. This further undervalued real estate in BIPOC neighborhoods and incited violence against BIPOC individuals who moved into White neighborhoods (Bailey et al., 2021).

A map of Chicago shows different sections highlighted in red, yellow, green, or blue.
Figure 6.4 In this HOLC-era redlined map of Chicago, red areas outline so-called “hazardous” urban, industrial neighborhoods that house a majority-BIPOC population, whereas the green areas outline neighborhoods in suburbia, away from the inner city and associated industrial pollution. (credit: “holc-chicago” by Kara Zelasko/Flickr, Public Domain)

Multiple sectors, including banking, real estate, private developers, and homeowners, were involved in redlining and restrictive racial covenants, all with the cooperation and backing of the U.S. government. Lending was discouraged in red zones, while green neighborhoods were preferred (Mitchell & Franco, 2017). The FHA refused to insure mortgages in or near redlined communities while subsidizing builders who produced subdivisions in suburbia for White Americans (Gross, 2017). As a condition for these subsidies, the FHA required restrictive racial covenants to prevent BIPOC individuals from purchasing homes in these subdivisions, justifying their policy to ensure their loans would not be at risk (Gross, 2017). That the FHA included these covenants in its Underwriting Manual amounts to a U.S. government agency essentially stating in an official document that different racial groups should not live in the same communities (Gross, 2017). These practices perpetuated stereotypes that Black individuals would be poor neighbors, would drive down home values, and would increase crime (Bailey et al., 2021).

As a result of these policies, White Americans in the 1950s began leaving urban areas for the suburbs, a phenomenon often referred to as white flight, largely blocking BIPOC individuals from new suburban housing communities and isolating them in urban housing projects (Filippino, 2017; Gross, 2017).

Another government action that segregated BIPOC communities during the late 1950s through the early 1970s was the 1956 Federal-Aid Highway Act. This law authorized the largest public works program in history at that time, promising to construct 41,000 miles of an interstate highway system crossing the nation and connecting 42 state capitals. A consequence of this highway expansion was the displacement of more than one million people, largely in urban BIPOC communities (Evans, 2021). Highways cut through neighborhoods, disrupted green spaces, worsened air quality, and sank property values (Figure 6.5). Communities already struggling due to disinvestment and white flight ended up losing churches, community spaces, homes, and small businesses (Evans, 2021). Policymakers viewed highway construction as an easy way to destroy undesirable neighborhoods and used concrete walls, ramps, and overpasses as further physical tools of segregation to isolate BIPOC communities (Evans, 2021). These highways were built during the civil rights movement, and as the prospect of integrated neighborhoods became more real, highway construction offered a means to reinforce racially segregated neighborhood boundaries (Evans, 2021).

A map of an area near Syracuse University shows how Highway 81 was planned to cut through the 15th Ward near downtown.
Figure 6.5 This map is an example of how the 1956 Federal-Aid Highway Act created highway systems that cut through Black communities. Interstate 81 was designed to break up the 15th Ward, where 90 percent of Syracuse's Black population lived. Homes, businesses, and churches were destroyed, severely disrupting the community and increasing poverty among its residents. (See Sullivan, 2021; attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Redlining and residential segregation practices have broad implications today. Residential segregation resulted in a range of social disinvestment, or lack of investment of money in businesses, schools, homes, and infrastructure, in BIPOC communities. Social disinvestment largely dictated the built environment, resulting in poor neighborhood infrastructure, services such as schools and transportation, and employment opportunities (Bailey et al., 2021). Residential segregation is an influential predictor of Black disadvantage (Bailey et al., 2021). Redlining is associated with poor health outcomes, including higher rates of preterm birth, cancer, tuberculosis, maternal depression, and other mental health issues in residents who live in neighborhoods that were once redlined (Bailey et al., 2021). Many factors are related to these differences in health outcomes, such as environmental toxins and the physical impact of persistent psychosocial stressors (Bailey et al., 2021). In contrast, neighborhoods that received high HOLC grades have more tree coverage and lower levels of airborne carcinogens and air pollution; such areas tend to be predominantly White neighborhoods (Bailey et al., 2021).

Why Are U.S. Cities Still So Segregated?

This TED-Ed video recounts the history of the American suburbs, discussing racial covenants, white flight, and the massive freeway projects in redlined areas that further devalued properties and created environmental health injustices.

Watch the video, and then respond to the following questions.

  1. What factors do you think drove white flight?
  2. How are racial covenants and redlining similar to other racially discriminatory practices in the United States in the past and today?
  3. How does residential segregation intersect with poverty and environmental injustice?

Mass Incarceration and Police Violence

Mass incarceration is another manifestation of structural racism in the United States. The United States has one of the highest incarceration rates globally (ACLU, 2023; Bailey et al., 2021; Nellis, 2021; Sawyer & Wagner, 2023). Though the United States makes up less than 5 percent of the world’s population, incarcerated individuals in the U.S. make up 25 percent of the world’s inmate population (ACLU Washington, 2022). These rates of incarceration, and in particular the large numbers of young Black men who are incarcerated in the U.S. prison system, are often referred to as mass incarceration (Cullen, 2018; Hinton & Cook, 2021). Research has consistently demonstrated racial bias across the U.S. criminal legal system in policing, bail setting, sentence length, prison disciplinary measures, and capital punishment (Bailey et al., 2021; Hinton & Cook, 2021; Nellis, 2021).

After slavery was outlawed and following initial Reconstruction-era civil rights progress, police and prisons in some locations became institutions where White dominance was reasserted (Bailey et al., 2021; Hinton & Cook, 2021). For example, some individuals in law enforcement sanctioned the lynching of Black Americans or used it to police them (Bailey et al., 2021; Hinton & Cook, 2021). Law enforcement also enforced vagrancy laws, jailing individuals for vagrancy and then leasing them to perform agricultural work, essentially compelling formerly enslaved people back into slavery (Bailey et al., 2021; Hinton & Cook, 2021). With the passage of the Civil Rights Act of 1964, lynching and the convict-leasing system became less common.

In the decades following the passage of the Civil Rights Act of 1964, federal legislation has persisted in undercutting the gains it represented. In 1965, President Johnson declared a “War on Crime,” giving the federal government new responsibility for fighting crime within communities. Not solely focused on criminal behavior, this “war” targeted the sociological and economic factors the government believed led to criminality, tasking police and law enforcement officials with monitoring poverty, family breakdown, and youth and young adult restlessness within their communities. Law enforcement presence increased in poor urban neighborhoods mostly comprised of Black Americans, leading to a racial criminalization of young Black individuals on the street. This resulted in racial profiling, suspecting an individual of criminal misdeeds based on racial stereotypes rather than on an individual’s behavior (Lassiter, 2021a; Lassiter, 2021b; Laurencin & Walker, 2020).

In 1971, President Nixon’s “War on Drugs” increased law enforcement and penalties for drug possession and imposed mandatory incarceration for drug offenders. Critics have argued that Nixon’s War on Drugs was both racially motivated and an effort to criminalize those individuals who were protesting the Vietnam War, often described as hippies. Through a media campaign, the government sought to suggest to the American public that they should associate anti-war hippies with marijuana and Black individuals with heroin and that they should consider both populations as prone to criminal behavior (Taifa, 2021). Both the War on Crime and the War on Drugs arguably spread fears about supposed Black criminality (Bailey et al., 2021; Hinton & Cook, 2021; Lassiter, 2021a; Taifa, 2021). Following these two presidential declarations, the incarcerated population increased sevenfold, with Black individuals incarcerated at five times the rate of White individuals. In 1981, President Reagan expanded the War on Drugs, allocating more funding to law enforcement, emphasizing incarceration over treatment, and instituting mandatory minimum sentences for drug possession (Hinton & Cook, 2021). The large gap between the amounts of crack and of cocaine powder that resulted in the same minimum sentence reinforces claims that the War on Drugs was racially motivated; 5 grams of crack and 500 grams of cocaine powder resulted in the same minimum five-year prison sentence. Because most crack users were Black, these mandatory minimums resulted in inequitable increases in incarceration rates for nonviolent Black drug offenders (Taifa, 2021).

It is unknown if poverty is a reason why an individual is more likely to perpetrate a crime, but records confirm that poverty renders an individual not only more vulnerable to being arrested but also more likely to be accused of a more severe crime and receive a longer punishment (Hayes & Barnhorst, 2020). Adults experiencing poverty are three times more likely to be arrested than those who are not living in poverty (Hayes & Barnhorst, 2020). The Brookings Institution found the probability that a boy from a family with an income in the bottom 10 percent of income distribution has a 20 times greater risk of being incarcerated in his thirties than a boy from a family with an income in the top 10 percent (Hayes & Barnhorst, 2020).

In 1972, 34 percent of the U.S. Black population lived below the poverty level, and 42 percent of incarcerated Americans were Black (Hinton & Cook, 2021). In contrast, only 10 percent of the White population in 1972 lived below the poverty level. This socioeconomic disparity worsened as the Nixon administration defunded many social welfare programs, resulting in a decrease in access to education and employment opportunities. The 1970s were characterized by increased police presence in low-income neighborhoods, police brutality, and increased incarceration. Discriminatory behaviors among national policymakers and law enforcement continued throughout the next three decades, resulting in a quadrupling in the size of the prison system between 1980 and 2000. This mass incarceration, which still exists in the United States today, disproportionately affects BIPOC populations (Bailey et al., 2021; Hinton & Cook, 2021).

The policies of the 1960s and 1970s that resulted in increased police surveillance in poor, often predominantly BIPOC, urban communities involved the policing of social issues such as alcohol use and an increase in police violence against and killing of Black individuals (Bailey et al., 2021; Green & Peneff, 2022; Lassiter, 2021a). Some of the outcomes of the War on Crime and the War on Drugs include:

  • By the mid-1970s, Black and Latino/Latina people were overrepresented in state and federal prisons despite being minority populations within the United States (Hinton & Cook, 2021).
  • In Philadelphia, from 1970 to 1974, Black people incarcerated in county jails increased from 50 percent to 95 percent, accounting for more than 62 percent of prisoners state-wide even though Black Americans made up less than 10 percent of the entire state’s total population (Hinton & Cook, 2021).
  • The 1984 Comprehensive Crime Control Act eliminated parole in the federal prison system (Taifa, 2021).
  • The 1986 Anti-Drug Abuse Act established mandatory minimum sentences, including the 100:1 ratio between crack and cocaine powder sentences (Taifa, 2021).
  • In 1991, the Supreme Court asserted that mandatory life imprisonment for a first-time drug offense was acceptable (Taifa, 2021).
  • The 1994, the Violent Crime Control and Law Enforcement Act resulted in the largest expansion to date of the federal death penalty. The Act treated teenagers as adults, increased the police force, eliminated Pell educational grants for incarcerated people, implemented the “Three Strikes” law, and resulted in the creation of many new prisons (Taifa, 2021).

Upon their release, formerly incarcerated individuals often experience the long-term effects of an infectious disease contracted in prison and have a higher risk of death (American Academy of Family Physicians, 2021; Binswanger et al., 2016). Mass incarceration means that these effects disproportionately impact BIPOC individuals.

Jason’s Sentence

This video from the American Civil Liberties Union highlights the story of Jason Hernandez, a 21-year-old who was sentenced to life in prison without parole for a low-level drug crime. Although the judge wanted to give Jason a second chance, he was obligated to enforce mandatory minimum sentencing laws.

Watch the video, and then respond to the following questions.

  1. Based on the video, how do socioeconomic factors play a role in mass incarceration?
  2. How do mandatory minimum sentencing laws affect families and communities?
  3. What role does structural discrimination play in these laws?

A surge in police killing of Black men in the late 1960s led to efforts to curtail police use of force, but it was not until 1985 that the Supreme Court decision in Tennessee v. Garner placed restrictions on police use of force. In that case, the Court found that deadly use of force on a fleeing suspect is unconstitutional unless there is cause to believe the suspect poses a significant threat to the officers or the public (Bailey et al., 2021; Green & Peneff, 2022). Even with these restrictions in place, fatal police violence is an ongoing public health threat, disproportionately impacting BIPOC communities and highlighting the persistence of systemic racism (GBD 2019 Police Violence U.S. Subnational Collaborators, 2021 [GBD]; Peeples, 2020). Police killings are a leading cause of death for young Black men in the United States. Recent studies suggest that 1 in every 1,000 Black men are killed by the police, 2.5 times more than White men (GBD, 2021). In 2021, an investigation found that at least 135 unarmed Black men and women had been killed by police in the United States since 2015, and for more than a dozen of the officers involved, the fatal shootings were not their first. In more than half of these cases, the officers were not charged (Thompson, 2021). Aggressive policing in BIPOC communities and the lack of accountability for police officers involved in the deaths of Black people perpetuate disparities and erode trust in law enforcement, discouraging individuals in these communities from reporting crime (Schindler & Kittredge, 2020). Police violence has many indirect effects; racial profiling and surveillance with threats of violence negatively impact the mental health of a community (Bailey et al., 2021).

Case Reflection

Structural Racism

Read the scenario, and then respond to the questions that follow.

Thirty-three-year-old James Cole lives in Chicago and works full-time at a downtown marketing firm. He just graduated with a master’s degree in business administration and feels lucky as he reflects on the struggles of his parents and childhood friends. His parents grew up in Chicago in the late 1930s and 1940s, living in apartment complexes within a densely populated area consisting mostly of BIPOC families. When his parents were starting a family, they were unable to secure a mortgage to purchase a house because they were Black. In 1970, the Coles moved into a public housing project on the North Side of Chicago, where James grew up. By the 1980s, the War on Drugs and mass incarceration created an atmosphere of police distrust due to racial profiling. Crime and concentrated poverty increased, and the media portrayed the area as full of drugs and gangs. Many of the Coles’ neighbors were incarcerated for drug-related crimes. The community where the Coles resided became undesirable to new businesses and social programing, resulting in overall disinvestment. The school district for the Coles’ neighborhood was poorly funded and was considered one of the worst in the state, and many of James’s friends did not graduate from high school.

  1. How do you think structural racism impacted James and his family?
  2. How do you think the Coles’ social situation impacted their health?

Know Their Names

This interactive slide show “Know Their Names” offers a brief history of some of the Black people killed by the police in the United States between 2014 and 2021.

Read through the slide show, and then respond to the following questions.

  1. What do the victims featured in this slide show have in common?
  2. Why do you think these individuals were the victims of police violence?
  3. How does racial profiling relate to structural racism?
  4. Compare the actions taken in response to these killings. Do the responses seem appropriate? Why? What do you think accounts for the differences in the responses?

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