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We must do better science: addressing racism to improve health and safety for all people
  1. Christen J Rexing1,
  2. Bernadette C Hohl2,
  3. Renee Johnson3,
  4. Marizen Ramirez4,
  5. Kathleen F Carlson5,6,
  6. Theresa H Cruz7
  1. 1 Department of Urban Public Health & Nutrition, School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA
  2. 2 Department of Biostatistics & Epidemiology, School of Public Health, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
  3. 3 Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4 Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
  5. 5 School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
  6. 6 Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon, USA
  7. 7 Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
  1. Correspondence to Dr Bernadette C Hohl, School of Public Health, Department of Biostatistics & Epidemiology, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA; bernadette.hohl{at}

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The brutal killings of George Floyd, Ahmaud Arbery, Breonna Taylor and others sparked widespread protests for racial and economic justice in the USA and around the globe. A fundamental principle espoused by the Black Lives Matter movement and other groups involved in direct action is that our most enduring social problems are rooted in structural factors and must therefore be addressed with structural solutions. (In this context, ‘structural’ refers to elements of social systems that provide a foundation for how societies operate, such as policies, norms, religion and other belief systems and economies.) This principle is as relevant to injury and violence as it is to other health and social problems; disparities in injury outcomes are closely connected to social inequities.1

At this critical point in history, we are called to confront the influence of structural factors on injury and violence directly. Giles and colleagues2 recently recommended that we incorporate equity as the fourth ‘e’ in injury prevention. Building on their recommendation, we argue that it is critical to highlight structural racism as a determinant of injury and violence. Structural racism is at hand …

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  • Contributors CJR, BCH, RJ, MR, KFC and THC each contributed to conceptualising and drafting and the manuscript. Each approved the final version for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.