a. Structural drivers help determine how society operates. For example, at the time of this writing—just 6 months after the 2020 election cycle—lawmakers in 47 states have introduced nearly 400 bills aiming to restrict voting rights

(primarily in the areas of absentee voting, ID requirements, voter registration, the power of local election officials, and early voting). Where these bills are enacted into law, they will likely disproportionately burden People of Color and people with disabilities—groups of voters who historically have been suppressed from having their voices heard on important health and other matters.

b. Structural drivers are generally outside the direct control of individuals. For example, few individuals can control public policies concerning how robustly to subsidize health insurance premiums or education services, or officials’

decisions about where to store and release toxic substances, or rules about working conditions at private companies.

c. The effects of structural drivers conceived during a time when race discrimination was legally sanctioned can still be felt today. For example, long-standing structural racism in the U.S. housing system has contributed to racial wealth (and thus health) disparities, especially between Black and White households. One form of structural racism in housing was

“redlining,” a commonplace practice from the 1930s through the 1960s in which federal agencies would draw red lines around portions of a map to indicate areas or neighborhoods considered to be poor financial risks. In turn, mortgage lenders and insurers would simply refuse to provide a loan or insurance product to anyone living within the red boundary.

The practice effectively blocked African Americans from obtaining homes, home loans, and home repairs, and it remains a major factor today in the wealth gap between Black and White families given how important homeownership is to building and passing down wealth across generations.