In 2020, awareness of the disproportionate impact of Covid-19 on racially minoritized populations in the United States and the death of George Floyd, a Black man murdered by a white police officer in Minneapolis, Minnesota, fueled a rush to address inequities in health care delivery and throughout society.

In 2025, disparities in care continue, despite programs created at many health care organizations to address health equity. Some leaders have acknowledged the underlying impact of structural racism in society, defined as “the normalized and legitimized range of policies, practices, and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color.”¹

In March 2025, members of the NEJM Catalyst Insights Council — made up of clinicians, clinical leaders, and executives across the globe at organizations that are involved in care delivery — were surveyed on structural racism and its effects on care delivery. Of the 647 Insights Council members who completed the survey, 455 are located in the United States and 232 in countries outside of the U.S.

Over half of respondents globally (54%) say patient care at their organization is affected by structural racism (Figure 1). A higher share of U.S. respondents, 61%, say this, against 39% of non-U.S. respondents. Just over half of respondents globally (52%) say their organizations have publicly committed to addressing structural racism. Among U.S. respondents, 58% say this, well above 41% of non-U.S. respondents.

The survey results are not surprising overall, says Chandra Ford, PhD, MPH, MLIS, Professor of Behavioral, Social, and Health Education Sciences (Rollins School of Public Health) and African American Studies at Emory University. The findings confirm much of what she and others are aware of through their research. “But for some of these places,” she adds, “we need more information to know what’s going on beneath the surface.”

For instance, it’s important to note that racism is context-specific, she says. “The language of structural racism reflects the nature of racism in the United States, but structural racism operates differently in other places. For instance, it may not be named structural racism and operate based on phenotype instead. It might instead be based on racialized colonialism and occur based on ethnicity or religion. The latter nevertheless operates just like structural racism and produces similar results.”

The top three ways in which respondents say they observe structural racism affecting care delivery in their organizations are unequal access to care, such as geographic, financial, or systemic barriers (indicated by 49% of respondents); environmental and social determinants, such as housing, food insecurity, or pollution (38%); and inequities in health outcomes, such as higher morbidity and mortality rates for marginalized groups (37%). Some of these causative factors may “seem to fall outside of the organization’s responsibility,” Ford says. For example, she points out that asking about a patient’s “language and communication barriers” (which 22% of respondents say is a way in which structural racism affects health care) may erroneously place the responsibility solely on patients’ communication abilities, when “the more actionable question for the organization is whether providers have the language skills needed to communicate effectively with their patients.”

Asked how their organizations address structural racism, the most common answer was to establish partnerships with local community residents and organizations — a tactic noted repeatedly in prior Insights Council surveys on addressing challenges in care delivery organizations. The second most common tactic was collecting data on patient demographics, including race, although Ford expresses a caveat. “Collecting data on demographics is important — but with an asterisk and a caution,” she says, “because organizations in our society assume racial differences. We need not think of race as a piece of information that’s useful in itself. It’s more a proxy indicating the types of racism-related exposures and experiences for which a person is at risk.”