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The Future of Population Health
Tiffany N. Ford
The Future of Population Health
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Profound racial inequities were entrenched in crucial domains of American life long before COVID-19. In the wake of the pandemic, these preexisting disparities deepened. Housing offers an arresting example. In 2019, just before the onset of the pandemic, 46% of renter households were paying more than 30% of their income toward rent, and nearly a quarter were spending more than half their income on housing.1 Black and Latinx renters were hit hardest: 54% of Black renters and 52% of Latinx renters were cost burdened (i.e.,spending disproportionate shares of their income on rent) compared with 42% of White renters.1 The pandemic exacerbated the financial struggles of renters. By September 2020, 9.7% of Black renter households and 8.7% of Latinx households (compared with 4.4% of White renter households) reported that they were “very likely” to be evicted in the next two months.2 By March 2021, one year after the COVID-19 pandemic was declared a national emergency in the United States, roughly 29% of Black renters and 21% of Latinx renters had fallen behind on rent compared with 11% of White renters.1
Similar dynamics unfolded across many domains. COVID-19 aggravated prepandemic racial chasms in arenas as varied as education, employment, nutrition, wealth, and health.3–8 Even as such gulfs were widening, the murder of George Floyd by Minneapolis police officers sparked historic nationwide (and global) uprisings against racial violence.9 This confluence of catastrophes brought racism to the forefront of American life. In response, health scholars and practitioners grappled more keenly with the health implications of racism. Many incisive essays and articles centered on the connections between racism and health.10–22 Even with this established and growing corpus of important research, the task of integrating theoretically nuanced and empirically grounded perspectives on racism into our understandings of health remains a work in progress. This essay contributes to the effort by elaborating three core principles. First, racism operates in conjunction with other forms of oppression. Second, racism extends across multiple policy domains, catalyzing cascades of disadvantage along the life course. Third, racism is a function of power relations. In the sections to follow, we explicate the logic and evidence undergirding these observations, and highlight their implications for research, practice, and policymaking.
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The Milbank Quarterly is an editorially independent multidisciplinary journal that offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.