Date of Graduation

Summer 8-13-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Public Health (MPH)


School of Nursing and Health Professions

First Advisor

Erin Grinshteyn


The relationship between systemic and institutional racism in the U.S., and health outcomes in people of the African Diaspora have been well documented (Bailey et al., 2017). Distrust in the healthcare system is the result of generational trauma compounded by an ongoing issue that has yet to be fully addressed (Scharff et al., 2015). For decades people of African descent have expressed concern about negative experiences with the U.S. healthcare system. Often the encounters leave them feeling, mistreated, unheard and or criminalized. These feelings result in trepidation over using the healthcare system which often further compounds health issues (Washington, 2008). Within recent decades there have been both localized and national efforts to address the problem. The efforts have been wide ranging from simple community programs designed to build trust, to hospital staff trainings in cultural competency, and national policies designed to improve the equity of care (Maina et al., 2018). The failure of such projects to decrease systemic racism may be due in part to poor developmental frameworks. Many of which were designed to decrease the appearance of rather than end systemic racism (Danis, 2021). Despite efforts Black people continue to have worsening health outcomes. Some outcomes such as infant mortality are shown to be worse than during antebellum slavery (Owens et al., 2019). The project reviewed qualitative, quantitative, and cross-sectional studies exploring the historical patterns of inequity, and the complex layers of systemic and structural racism in healthcare. The resulting framework addresses the ways in which policy can drive industrywide change by creating cohesion between multiple systemic tiers using a multidisciplinary approach.

Keywords: Systemic Racism, Institutional Racism, African Diaspora, Black people, multitiered, multidisciplinary, equity, cultural competency