ESSAY: American Apartheid: From diagnosis to treatment and prevention

Editor’s note: The upcoming American Apartheid series will look at issues of racial inequities and injustice through several panel discussions. The series is collaborative initiative led by the newly established Center for Civil Rights and Racial Justice, and supported by the Office for Equity, Diversity, and Inclusion, the Office of Health Sciences Diversity, Equity, and InclusionUniversity Human Rights Working Group and PublicSource. Below is an essay about the goals of the series by Jackie Smithprofessor of sociology, and and Noble Maseru, professor of public health practice and director of social justice, racial equity and faculty engagement for the Schools of Health Sciences.


Early last year, Pitt Law School professor Jerry Dickinson argued that “Pittsburgh is America's apartheid city,” where Black residents face some of the biggest challenges to leading healthy and dignified lives. Dickinson states, “A confluence of private and state actions has led to a long history of segregation and discrimination in Pittsburgh” and that “the city’s policies and practices” have not been effective in narrowing racial inequality.  

This is not surprising. It has been nearly three decades since Nancy Denton and Douglas Massey published “American Apartheid,” revealing the U.S. racial divide’s origins in patterns of racial disparities that have continued to shape our cities since the early decades of the 20th century. 

As longtime scholars and practitioners working in areas of community health, human development and social conflict, we have spent our careers in public service and academia trying to understand and address the effects of white supremacy, patriarchal capitalist domination and institutionalized racism on community and population health.

Today we are working with colleagues at the University of Pittsburgh’s Office for Equity, Diversity and Inclusion; the Office of Health Sciences Diversity, Equity, and Inclusion; the Center for Civil Rights and Racial Justice; the University Human Rights Working Group; and PublicSource to host a series of presentations and panel discussions over the coming year entitled, “American Apartheid — A Series Addressing Racial Inequities and Injustices,” to expand upon Dickinson’s thesis.

Registration is now open for the inaugural program set for Feb. 21 at the University of Pittsburgh School of Law Teiplitz Memorial Courtroom. The event will serve as the official launch for the Center for Civil Rights and Racial Justice at Pitt Law. The center aims to facilitate community-engaged teaching, research and service

The inaugural lecture will be delivered by racial justice scholar and University of Albany law professor Anthony Farley and will be followed by responses from community members and institutional stake holders. We anticipate some lively and instructive exchanges about the notion of Pittsburgh as a “most livable city.” 

As part of the series, participants in the University Human Rights Working Group will host off-campus community dialogues paralleling each of the series panels. These will be led by community folk, leaders and activists involved in respective topic areas such as food justice, transportation, neighborhood underdevelopment, environmental justice, the carceral state, vaccine apartheid, community-oriented policing and the legacy of slavery’s role in African Americans inequality in human rights and development.

We’ll be considering how apartheid shows itself in people’s everyday experiences in areas like housing, education, environmental racism and in our workplaces, and what local groups are doing to try to change this. The community forums will provide opportunities for all participants to work together to transform Pittsburgh from America’s apartheid city to a leading human rights city.  

Our aim with this series is to move our conversation forward to not only confront the truths about our city’s and country’s long and sordid history of racial exclusion and structural violence, but also to bring our community together in a search for remedies with accountability. Dickinson’s essay disrupted mainstream liberal thinking that sees the United States and northern cities like Pittsburgh as exceptional in comparison to the racism seen in places like white minority South Africa or cities in the U.S. South. This sense of exceptionalism has resulted in complacency that perpetuates injustice, characterized as livelihood separation in quality of life. 

Our work in sociology and public health has convinced us that racism is a public health crisis. Social epidemiologists and public health policy scientists have long warned that people’s health and well-being is not separate from the context from which they live. It is influenced far less by individual lifestyle choices than by a mix of interrelated environmental, social, economic conditions referred to as the social determinants of health. We draw from our respective fields to highlight some lessons that we hope will shape a larger public dialogue that moves our diagnosis of our racial inequity, socio-economic apartheid problem toward concrete treatment plans that heal our communities and make Pittsburgh a place where everyone can thrive. 

We know from our research and practice in public health that access to safe and secure housing, clean water, nutritious food, and supportive social networks are all critical to both individual and population health. Just as in South Africa under apartheid, systemic racism is expressed as disinvestment in the social determinants of health, both nationally and locally in Pittsburgh and Allegheny County. Unequal and exploitative racial relations create mutually reinforcing systems of racialized exclusion in housing, health care, education, criminal justice, and voter rights. All of these manifest in racially disparate health outcomes.

Denton and Massey’s “American Apartheid” and countless other studies have documented racial deprivations in areas of housing, education, employment and access to health care, food and clean water. In Pittsburgh, we can trace racism’s long history and its lasting impacts. Maps of the city that identify areas of concentrated poverty and neighborhood accessibility of basic needs such as housing, public transportation, high-performing public schools and full-service grocery stores all reflect much older, redlining maps, which legitimized and reinforced discriminatory lending policies and laid the foundation for America’s segregated cities. 

Our 2020 Live Longer Project compiled life expectancy data for 63 Pittsburgh area neighborhoods, showing neighborhood disparities between Black- and white-majority neighborhoods ranging between 62 and 84 years. Racism is costing Black Pittsburghers literally decades of life.

The Gender Equity Commission’s 2019 report, Pittsburgh’s Inequality Across Gender and Race ranked Pittsburgh among the least livable and unequal cities for African-American residents. That report and the Black Femmes response aim to force an uncomfortable conversation about systemic racism and structural inequalities in Pittsburgh and Allegheny County. The creation of the Black Equity Coalition is an important response to this institutional racial, cultural and professional racial exclusion. 

Gabriel Winant’s 2021 book, “The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America” shows how such racial disparities are baked into our city’s history. The marginalization of Black workers in the steel industry shaped Pittsburgh’s geography and laid tracks for successive waves of intensified exploitation of increasingly marginalized essential health care workers.

Today these essential workers include both the UPMC workers demanding their right to join a union and the newly unionized adjunct faculty teaching at the University of Pittsburgh and other area campuses. By failing to demand a right to living, equitable wages for all workers — including women and all people forced to the margins of the labor market where essential work happens — white Americans have contributed to this country’s growing inequality, social exclusion and related health and social vulnerabilities. 

While systemic racism produces and perpetuates inequities that disproportionately harm Black and brown communities, inequality’s detrimental health impacts are not limited to marginalized racial groups. Physician Jonathan Metzl’s 2019 book shows how white Americans are “Dying of Whiteness,” as they support conservative politicians and the politics of racial resentment that include public spending cuts and gun laws that make all people more sick even as they must work harder and longer to stay afloat.

Also, in their 2018 book, “The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity, and Improve Everyone's Well-Being,” Richard Wilkinson and Kate Pickett discuss extensive research on links between economic inequality and a variety of physical and mental health outcomes. Drawing from a wealth of cross-national evidence, they show that not only is inequality bad for those in poverty, but it also worsens the health impacts for high-income groups.

In short, the overall health of our communities requires that we come to grips with the realities of our country’s racial exclusion, white supremacist and patriarchal past and its implications for our present. If we don’t, the collective health, national stability, and the cohesion of our communities will suffer. We paraphrase Dr. Martin Luther King Jr. to point out what this COVID-19 pandemic has made so blatantly clear: “Health injustice anywhere is a threat to health and justice everywhere.”

Our prescription then is for a transformation of our thinking and institutions to make all people’s well-being both the end and means of policies and practice. Racial and other inequalities have been justified by the assumption that marginalized others can eventually “catch up,” and our society will become more equal. But at the current rate it would take white women 34 years and African-American women 112 years to achieve income parity with white men. Clearly more concerted efforts are needed to address persistent social inequities and ensure just health and well-being for all. 

The American Apartheid series is part of our effort to understand inequality, inequity — 21st century apartheid — and social justice. It is especially timely as Ed Gainey becomes the city’s first African-American mayor, with a vision for the city that says: “Come together as one community. Everyone has an opportunity to live and thrive.”

In this series we are committed to addressing and sorting out forces of white supremacy driving racial and economic apartheid in Pittsburgh. The series will compel us to think about racial inequity and what is required to establish sustainable, equitable communities. We will engage questions about policies that perpetuate apartheid and consider how we should be talking about race in a society that continues to treat Black bodies and non-essential workers as disposable. 

In the spirit of Steve Biko we are dedicated to eradicating systems of control that perpetuate racial injustice and dehumanize African-Americans, producing “man only in form.” Our quest through this series is to identify paths that will lead us to eliminating social and economic apartheid and racial inequities in Pittsburgh. When no longer will a people’s whole life be shaped in the context of separate development. We welcome your participation and look forward to seeing you on Feb. 21.

The first event of the American Apartheid series will be at 5 p.m. Feb. 21. Register here.