Abstracts Sociology

Dismantling The System: Unpacking Racism's Impact On Inequities In Behavioral Health, Healthcare Utilization, And Access To Care

by Nana Akosua Adjeiwaa-Manu

Identifying how the many elements of structural racism affect racial and ethnic health inequities remains an ongoing challenge. Although a growing body of work primarily focuses on structural racism's impact on population health outcomes, this dissertation examines structural racism's role in shaping inequities in behavioral health outcomes, behavioral healthcare use, and behavioral healthcare access. I argue that the complex features of structural racism work together to produce health inequities. First, I explore the relationship between self-reported racial and ethnic classification – which I conceptualize as placement in the racial hierarchy relative to whiteness – and inequities in behavioral health outcomes by analyzing a national survey of mental illness and substance misuse. Following the tenets of critical theories of race, I view each racially and ethnically classified group's place in the racial hierarchy as a measure of how vulnerable they are to racism. Next, I consider how placement in the racial hierarchy shapes inequities in behavioral healthcare use by examining a national survey of tobacco and health. Finally, I build on the findings from these two lines of inquiry by using political, healthcare, and economic data sources to investigate whether the level of racial and gender equity in U.S. counties is associated with access to mental healthcare. This dissertation demonstrates that structural racism's components, including inequities in healthcare treatment, the threat of harm from the criminal justice system, and histories of discrimination, can affect behavioral health outcomes. In addition, the dissertation shows that anti-Black racism, codified into health and drug policies, shapes inequities in behavioral healthcare use and geographical access to mental healthcare. Overall, this dissertation highlights that by unpacking the features of structural racism, research in this area can contribute to dismantling this system.