Structural and Historical Trauma

Structural-Historical Trauma

  o  Emotional damage from inequity enforced through public policies, institutional practices, cultural images, and behaviors which are built into the structure of the culture, and which reinforce social inequity.
  o  May have occurred in the past and/or continue into the present.
  o  Through intergenerational experience and secondary trauma, descendents of a family or community who have experienced historical trauma (slavery, war, etc) may show similar adverse emotional and behavioral reactions even though they did not directly experience the trauma themselves.

While discrimination of all types operates "on multiple levels, it is perpetuated and reinforced at a structural level."  (Ref:  Renee Boynton-Jarrett, MD ScD)

Structural Trauma is supported by the history, culture and ideologies within a culture - and supported by policies, laws, institutions, and cultural practices. (Ref:  Camara P Jones, MD MPH PhD)


1.   Boynton-Jarrett (2021). Structural integrity:  Recognizing, measuring and addressing systemic racism and its health impacts.  EClinical Medicine.   Structural integrity, applying a systemic racism lens and intersectionality deliberately and methodically in research and practice to understand how inequity is constructed, operationalized, and perpetuated, can advance anti-racist practices and racial equity.

2.  Mullings (2005) Interrogating Racism.  Annual Reviews.  Analyses of racism have sought to interrogate its history and contemporary manifestations, how it is maintained and reproduced, and to predict its future.  

3.  Nogrady (2019). Trauma of Australia's Indigenous 'Stolen Generations' is still affecting children today.  Nature.  One in three Aboriginal and Torres Strait Islander children were taken from their families and communities between 1910 and the 1970s.  Children living in families that experienced forced separations are more likely to have poor health and negative school experiences.

4.  Bailey (2017) Structural racism and health inequities in the USA: evidence and interventions.  Lancet.   A contemporary and historical perspective to discuss research and interventions that grapple with the implications of what is known as structural racism on population health and health inequities.

5.  Peek (2020).   Practical Lessons for Teaching about Race and Racism:  Successfully Leading Free, Frank, and Fearless Discussions.    Academic Medicine.  12 lessons learned within 4 main themes: ground rules; language and communication; concepts of social constructs, intersectionality, and bidirectional biases; and structural racism, solutions, and advocacy.

6.  Farmer (2005).  Structural Violence and Clinical Medicine.   PLOS Medicine.   With few exceptions, clinicians are not trained to understand social forces, nor are we trained to alter them. Yet it has long been clear that many medical and public health interventions will fail if we are unable to understand the social determinants of disease.  The good news is that such biosocial understandings are far more “actionable” than is widely recognized.