Structural racism and health inequities in the USA: evidence and interventions

The ObGyn community has issued a call to action to prevent toxic environmental chemical exposures and their threats to healthy human reproduction. Recent committee opinions recognize that vulnerable and underserved women may be disproportionately impacted by environmental chemical exposures and recommend that reproductive health professionals champion policies that secure environmental justice. Beauty product use is an understudied source of environmental chemical exposures. Beauty products can include reproductive and developmental toxicants such as phthalates and heavy metals; however, disclosure requirements are limited and inconsistent. Compared to White women, women of color have higher levels of beauty product-related environmental chemicals in their bodies, independent of socioeconomic status. Even small exposures to toxic chemicals during critical periods of development, such as pregnancy, can trigger adverse health consequences such as impacts on fertility and pregnancy, neurodevelopment, and cancer. In this commentary, we seek to highlight the connections between environmental justice and beauty product-related chemical exposures. We describe racial/ethnic differences in beauty product use such as skin lighteners, hair straighteners, and feminine hygiene products as well as the potential chemical exposures and health risks associated with these products. We also discuss how targeted advertising can take advantage of mainstream beauty norms to influence use of these products. Reproductive health professionals can use this information to advance environmental justice by being prepared to counsel patients who have questions about toxic environmental exposures from beauty care products and other sources. Researchers and health care providers can also promote health-protective policies such as improved ingredient testing and disclosure for the beauty product industry. Future clinical and public health research should consider beauty product use as a factor that may shape health inequities in women’s reproductive health across the life course.

A clear link exists between social and economic inequality and poor mental health. There is a social gradient in mental health, and higher levels of income inequality are linked to higher prevalence of mental illness. Despite this, in the late 20th and early 21st century, psychiatric and psychological perspectives have dominated mental health research and policy, obscuring root socioeconomic contributors. Drawing on contemporary research on the social determinants of mental health, with particular reference to Europe and the U.S., this paper argues that a sharper focus on socioeconomic factors is required in research and policy to address inequalities in mental health. Current attempts to move this direction include: evaluation of the impact of economic policies on mental health, community-based partnerships, increased professional awareness and advocacy on socioeconomic factors. This necessitates greater understanding of the barriers to such actions. This paper argues that advancing 'upstream' approaches to population mental health requires an interdisciplinary research vision that supports greater understanding of the role of socioeconomic factors. It also demands collective cross-sectoral action through changes in social and economic policy, as well as economic frameworks that move beyond an exclusive focus on economic growth to embrace collective and societal wellbeing.

No abstract