Defining racism as a social determinant of health

By Kenzie Ferguson, Vice President of Foundation and Corporate Social Responsibility for Delta Dental of California and the Delta Dental Community Care Foundation

Race is often one of the most reliable predictors of life expectancy.

Black Americans face poorer health outcomes across the board. They are more economically disadvantaged with disproportionately high rates of asthma, diabetes, hypertension, cancer, and obesity. According to research done by sociologist W.E.B. Du Bois, in 1899 infant mortality was almost twice as high among Blacks as whites; it is now 2.34 times higher.

Today, minority populations are being hit disproportionally hard by the pandemic. One in 1,450 Black Americans has died of COVID-19, even though geographic factors should make them less likely to be at risk. For example, in Washington, D.C. Blacks are less than 46.9% of the population but account for 76% of COVID-related deaths. These disparities are a signal of the impact of racism on public and individual health.

Unfortunately, these disparities exist within oral health as well. Black children have higher levels of dental caries than their peers, and these gaps widen during adolescence. The consequences of poor oral care can compound, creating oral health problems that are more costly and difficult to treat later in life. Compared to peers, Black people experience higher rates of tooth decay and missing teeth. Poor oral health can lead to a lower quality of life, resulting in a lack of self-esteem, trouble eating, and missed days of school and work.

On the provider side, Black patients are more likely to feel more comfortable with Black dentists. However, as of 2015, only 3.8% of dentists identified as Black despite making up 12.4% of the population at the time.

Black Americans face gaps in health coverage, uneven access to services, and poorer health outcomes compared to white counterparts. These inequities are the result of institutionalized discrimination and decades-old policies that must be intentionally named and dismantled.

Social determinants of health are the conditions in the places where people live, learn, work and play (e.g., housing, education, income, community), which affect a wide range of health risks and outcomes and have a bigger influence than the individual risk factors (such as behavioral risk factors or genetics). Imbalance in social determinants of health is caused by the unequal distribution of power, income, goods, and services, globally and nationally. According to the World Health Organization, "The unequal distribution of health-damaging experiences is not in any sense a 'natural' phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics."

The medical community understands this and is also speaking out. The American Academy of Pediatrics (A.A.P.), American Medical Association (A.M.A.), and the American College of Physicians (A.C.P.) each named racism a public health issue. The A.M.A., in describing a recent study about the effects of law enforcement-involved deaths of unarmed Black individuals on the Black community stated, "The trauma of violence in a person's life course is associated with chronic stress, higher rates of comorbidities and lower life expectancy, all of which bear extensive care and economic burden on our healthcare system while sapping the strength of affected families and communities." 

We must start by recognizing racism as a social determinant of health. It's evident that the longstanding inequities built into our institutions, including our health care systems, have resulted in poorer oral and overall health outcomes for Black Americans. To rebuild a health care system with equity at its core, it's essential that the medical and dental care community engages with and learns from Black communities. The process of building equity into our health care system won't be done tomorrow, in a year, or in a decade from now. Still, we pledge to continue working to ensure all Americans can achieve their optimal health. 


About Delta Dental of California

Since 1955, Delta Dental of California has offered comprehensive, high quality oral health care coverage to millions of enrollees and built the strongest network of dental providers in the country.

The Delta Dental of California network includes its affiliates, Delta Dental Insurance Company, Delta Dental of Pennsylvania, Delta Dental of New York, Inc., and provides dental benefits to more than 36 million people across 15 states and the District of Columbia. All are members of the Delta Dental Plans Association, based in Oak Brook, Illinois, the not-for-profit national association that collectively covers millions of people nationwide.

For more information about Delta Dental of California, please visit


About the Delta Dental Community Care Foundation

The Delta Dental Community Care Foundation partners with local communities to increase access to care, support dental education and fund research that advances the oral health field. Since 2011, the Foundation has awarded more than $60 million across 15 states and the District of Columbia. The Foundation is the philanthropic arm of Delta Dental of California and its affiliated companies, including Delta Dental Insurance Company, Delta Dental of Pennsylvania and Delta Dental of New York, Inc.