Black Lives Matter Is About More Than Police Behavior

The Black Lives Matter (BLM) movement has brought attention to systemic racism in the justice system and highlighted police brutality. However, systemic racism in the justice system is only part of the brutality suffered by communities of Black, Indigenous, people of color (BIPOC) (Garcia 2020); the abuse also extends to institutional racism within social, environmental, and economic structures and directly affects systemic and oral health. Racism is based on an ideology of inferiority under which the dominant social group discriminates, disempowers, and marginalizes a minority group (Williams and Mohammed 2013). Based on this ideology, the North America colonist oppressed and enslaved BIPOC populations, promoting theories of White people’s superiority (Bailey et al. 2017). As a result, racism interacted with economic, educational, judiciary, and healthcare institutions, creating a structural system that solidified hierarchy and marginalization (Bailey et al. 2017; Williams et al. 2019a; Williams et al. 2019b). Different forms of racism modify determinants of health in underrepresented BIPOC communities in ways that affect social, environmental, behavioral, and genetic/epigenetic aspects of life (Brown 1995; Tajuddin et al. 2019). Segregation still remains as one of the most commonly used mechanisms to enforce institutional racism (Hurkele 2014). Historically implemented by federal policies, segregation has forced underrepresented minorities to reside in neighborhoods separate from White groups. Segregation brings about poor access to healthcare that leads to poor health outcomes because it correlates directly with low educational attainment, limited employment opportunities, and low socioeconomic status (Hurkele 2014; Williams et al. 2019a; Yang et al. 2020). Consequently, segregation has resulted in separated communities living in poverty, disadvantaged neighborhoods, lowquality housing, and hazardous physical environments with high levels of pollution (Brown 1995; Villarosa 2020). Added to that are the reported daily slights and slurs, provoking even greater stress and demoralization within communities of color (Williams et al. 2019a). These conditions lead to a higher prevalence of chronic diseases (diabetes, cardiovascular disease, asthma, obesity) and mortality rates within these populations (Beck et al. 2020). Centuries of oppression have resulted in health disparities that disproportionally affect Black communities with premature biological aging and disease vulnerability. Specifically, African American males have consistently lower life expectancy than White males (Kochanek et al. 2013), and Black infant mortality is 2.5 times higher than that of White infants (Beck et al. 2020). In an effort to understand the biologic mechanisms of the aging phenotype, published evidence reveals that the epigenetic aging of Black men is demonstrated by a high prevalence of changes in DNA methylation (Tajuddin et al. 2019); this genetic evidence highly correlates with epidemiologic data confirming chronic disease prevalence and premature mortality rates in Black communities (Yang and Matthews 2015; Bailey et al. 2017; Williams et al. 2019a; Kaur and Mitchell 2020). Consistent with the findings of poorer general health, there is considerable evidence that communities of color in the US have poorer oral health than do White communities. Compared with 22% of American White adults, 37% of Mexican American and 40% of African JCTXXX10.1177/2380084420952788JDR Clinical & Translational ResearchBlack Lives Matter Beyond Police Behavior research-article2020