Structural inequalities: Definitions and historical context

This chapter will introduce theoretical perspectives developed within social and historical theory that are foundational to understanding structural inequality, as well as lay the groundwork for relating structural inequalities to health disparities and health equity. Contemporary structural inequalities are typically embedded in social norms, dominant belief systems, and laws and policies that are inextricably linked to events that occurred in the past. To underscore the pervasive nature of structural inequality, this chapter begins with a summary of present-day issues implicating the impact of structural inequalities within the fields of medicine, public health, and the biologic sciences that have become roadblocks to addressing the persistence of health disparities despite meaningful efforts to eliminate them. To advance our goal of identifying solutions toward more equitable systems for a healthy and just society, we must first understand how structural inequalities are produced over historical time and the social theories that help explain how structural inequality can manifest as structural racism. To that end this chapter will explore the epistemology of structural inequalities, race and gender norms, and historical events that provide context and framing, using the United States as the main source for analysis while providing some global examples for broader context.