Textbook Edited By Egede Focuses on How Structural Racism Impacts Health Care

“Structural Inequalities and Health Outcomes for Chronic Disease” (Elsevier, June 2025), edited by Leonard E. Egede, MD, Charles and Mary Bauer Endowed Chair and Professor of medicine in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, takes a broad, multidisciplinary approach to explore the structural factors underlying health disparities within the context of chronic disease.

“This textbook aims to serve as a reliable scientific resource,” Egede explains, “offering overviews of definitions and frameworks for understanding the problem, historical perspectives that provide context for the issue, summaries of the evidence across several chronic diseases and special populations, and recommendations for next steps to address structural inequalities and ultimately eliminate health disparities.”

In a foreword, Allison Brashear, MD, MBA, UB’s vice president for health sciences  and dean of the Jacobs School, notes that the book “not only elucidates how we arrived at our current state but also clearly identifies the opportunities for transformative change in research, clinical care and health policy. It is poised to revolutionize our understanding and approach to addressing structural inequalities.”

While many books have focused on health disparities and social determinants of health from an individual or community standpoint, Egede says evidence is mounting that structural factors underly these disparities.

Structural inequalities have been evident in societies throughout history and all over the world. At the most basic level, he notes, structural inequalities are due to differential access to, and distribution of, resources and power. Egede says that when this structural hierarchy is based on race or ethnicity, we refer to it as structural racism, but the basis of access to resources and power remains the same.

“Policies, laws and governmental structures that result in inequitable distribution of resources, such as high-quality education, employment with a livable wage, safe housing and neighborhood environments, and affordable and healthy food options will create economic, social and physical environments that result in worsening population health,” he says. “This is why there are no quick solutions to problems created over centuries of social, political and economic processes.”

Egede, who has worked on health equity issues for 25 years, is an advocate for the importance of leveraging multiple disciplines to address them. He solicited chapters from 65 scholars, physicians and other health professionals working in disciplines including internal medicine, pharmacy, nursing, family medicine, population health, environmental science, public health, economics, psychology, biomedical sciences and the social sciences.

Among the book’s key contributions is a chapter focusing on theoretical perspectives developed by social and historical study that are foundational to understanding structural inequalities.

Much of the book then examines the structural factors that contribute to disparities in specific diseases, from cardiovascular disease and chronic kidney disease to Type 2 diabetes, cancer and others. Specific populations and the disparities they experience are discussed, including racial and ethnic minorities; immigrant, refugee and asylee women; sexual and gender minorities; incarcerated individuals; veterans; and geriatric and rural populations.

Chapters at the end of the book focus on where health equity work needs to be headed, including two chapters that highlight the important role of implementation science in moving evidence-based strategies from the research world into routine practice and the role of artificial intelligence (AI) in health equity.

“We believe collaboration across disciplines is one aspect that sets this book apart. Years of disparities research shows that we need multiple disciplines working together to identify solutions,” Egede says. “This book can serve as a foundational text for undergraduates and graduate students in a variety of disciplines, as well as for health care professionals, public health specialists and policy makers aiming to understand how to work across disciplines to enact change.”

“The health care system does not exist in a vacuum and social determinants of health play an important role in the health of populations and differences in health across sub-groups within that population,” he concludes. “Change will require focus, persistence, private-public partnerships and community input into social and public policies. I hope this book is part of that change.”

In addition to his Jacobs School titles, Egede is also president and CEO of UBMD Internal Medicine, medical director of clinical research for Kaleida Health and Erie County Medical Center and medical director for population health for Great Lakes Integrated Network IPA.