Beyond Systems of Oppression: the Syndemic of Injustice affecting Black Youth

The United States has been built on the unique contributions of Black, Brown, and Indigenous people via forced and unfair labor. Its history, as a result, is rooted in trauma and oppression. From chattel slavery to the forced relocation of First Nations people, the United States’ political economy has been one that disenfranchises those who are not white. Moreover, the legacy of settler colonialism and the transatlantic slave trade continues to shape socioeconomic stratification along ethno-racial lines in North America (Kelly & Bailey, 2018). The system of white supremacy has mechanisms which operate to maintain the social order including institutions in support of that aim. White society, as the dominant society, has disproportionate ownership of and political power over the capital needed for the sustainable livelihood of people of color. This situation dictates the allocation of goods (e.g., clean drinking water, food, equitable education, housing, etc.) and services (e.g., mental and physical health care, safety) necessary for one’s survival inequitably for people of color. The purposeful systematic deprivation of these resources from Black, Brown and Indigenous people is an act of violence (Garcia-Reid, 2008; Van Soest & Bryant, 1995).

Violence and anti-black racism

The World Health Organization defines violence as the intentional use of physical force or power, threatened or actual, against one’s self, another person, group or community that results in or has a high likelihood of resulting in injury, death, or psychological harm (Krug et al., 2002). A common interpretation of this definition is to think of physical acts of violence that occur between individuals or within a community. However, understanding the degree to which Black youth are chronically exposed to violence, requires a broader perspective that includes an understanding of structural and symbolic violence in addition to interpersonal violence.

Structural violence is operationalized through institutions (e.g., educational, economic, medical, legal, and child welfare) that are necessary for one’s livelihood and well-being (Farmer, 2004, 2009). The violence of injustice and inequity, that operates throughout these institutions shapes how individuals and groups interact within these systems (Rylkko-Bauer & Farmer, 2016) resulting in stigmatization and discrimination along the lines of race, ethnicity, gender, and/or sexual orientation. The systemic nature of this form of violence results in disproportionate increases in poverty, illness, injury and death for Black people. The result of this intentional privation of basic human needs throughout our societal structures is most notably apparent when we consider the disproportionate impact of multiple systems of oppression for Black people with outcomes such as homicide, mass incarceration, poverty, police brutality and surveillance. These overlapping systems intersect in ways that contribute to the learning and socialization of racism and Whiteness for Black youth; and, results in chronic experiences of trauma as well as dictates the responses to those traumatic experiences (McGuffey & Sharpe, 2015).

In her landmark work, Kimberlé Crenshaw coined the term intersectionality to describe how race, class, gender, and other characteristics intersect or overlap one another at the individual level (Crenshaw, 1991). To describe the overlapping multiple forms of oppression experienced by Black people at the collective or population level, the term best used to describe this is syndemic. A syndemic or synergistic epidemic is a term used in epidemiology to describe concurrent or sequential epidemics or disease clusters in a population which typically develop under health disparities. Factors contributing to a syndemic can be structural, socio-cultural, interpersonal and individual.

Critical to understanding how intersectionality manifests lies within the construct of symbolic violence. Symbolic violence refers to the sociocultural mechanisms and relations of unequal power and domination existing in interpersonal relationships and other aspects of one’s daily life. It manifests through language, symbolism, and actions which are perceived as normal and/or deserved (Bourdieu, 2000). Those who experience symbolic violence may internalize the messages given by those who inflict it upon them resulting in both psychological and emotional harm (Lazarus & Folkman, 1984). Black youth, both as a collective and as individuals, are suffering from the effects of multiple forms of systemic oppression, derived from structural and symbolic violence. Over the past decade, there has been an increase in videos depicting police brutality in the U.S. providing a glimpse into the systemic inequality and discrimination faced by Black communities (Richardson & Ragland, 2018). These videos while shining a light on these insidious acts also serve to perpetuate symbolic violence by reminding Black youth of what may happen when they do not comply with the dominant society.

These structural ways of operating perpetuate systemic injustice and oppression and are seminal contributors to chronic exposure to violence and trauma for Black people. These societal ways of creating barriers for Black people manifest as symbolic violence as they appear commonplace in the dominant culture’s way of understanding the world, making these purposeful forms of injustice difficult to identify (Winter & Leighton, 2001). This results in the perpetration and perpetuation of anti-Black racism through institutional structures, disproportionately and chronically exposing Black people to trauma. “Trauma is the response to deeply distressing or disturbing events that overwhelm an individual’s ability to cope, causing feelings of helplessness, and diminish their sense of self and ability to feel the full range of emotions and experiences (para 1; Onderko 2019).” This definition helps to conceptualize the impact of the deliberate deprivation of resources through sociopolitical systems based upon one’s race as violent and traumatic.

The very nature of structural violence is insidious in that its main objective is to methodically work toward depriving and marginalizing people of color through political, criminal justice, and economic structures (Winter & Leighton, 2001). Structural violence is influenced by race, class, and gender both independently and in the ways in which they intersect within individuals and communities (Farmer, 2004). While developed at the systemic/macro level, this form of violence is operationalized in more explicitly violent ways at the micro level in the form of surveillance and state sanctioned police violence (Maynard, 2017). The perpetual experience of structural violence in its many forms places Black youth and their communities at great risk for exposure to chronic trauma.

Structural violence contributes to the social milieu of neighborhoods comprised primarily of people of color characterized by high levels of community violence derived from both symbolic and interpersonal violence. When Black youth are disproportionately exposed to community violence, they are not only placed at increased risk for physical harm but also emotional and behavioral symptoms that can detract from learning and undermine their academic achievement (Busby et al., 2013). Yet despite the knowledge that chronic exposure to violence contributes to traumatic mental health outcomes (e.g. hypervigilance, depression, and anger), Black youth are often stigmatized for their behavioral response to the trauma, labeled for exhibiting aggressive or problematic behaviors, and suspended from school more often (Gibson et al., 2014, 2019). As a result, aggressive behavior and interpersonal violence leads to educational inequities with the potential for negative consequences on their future educational attainment, employment and relationships (Finigan-Carr & Sharpe, 2017). Therefore the neighborhood serves as an ecological niche that hinders rather than promotes Black youth’s successful development as it influences both an individual’s propensity for aggression as well as provides opportunities for aggression and violent behavior to be learned over time (Finigan-Carr & Sharpe, 2017; Guerra & Williams, 2006).

Structural, symbolic and interpersonal forms of violence are not mutually exclusive, rather they are inextricably linked particularly as it pertains to Black youth. Structural violence is marked by deeply rooted inequitable access to resources necessary for one’s survival (e.g., affordable housing, quality health care, education, and employment opportunities). Symbolic violence serves as a vehicle in which inequities of oppression are delivered via language, cultural norms values and customs (Montesanti & Thurston, 2015). These sociocultural mechanisms create conditions where interpersonal violence occurs often for Black youth placing them at greater risk for experiencing traumatic injury.

The Syndemic of Injustice affecting Black Youth

Black youth are suffering from the effects of systemic oppression, derived from structural and symbolic violence. In other words, they are experiencing a syndemic of injustice. When utilized to describe the multiple epidemics due to oppression inflicted on Black people, a syndemic is the systematic confluence of multiple traumas on Black people based on structural and institutional discrimination and stigmatization. In this case, the concurrent epidemics are a direct result of anti-Black racism and include structural, symbolic and interpersonal violence, transmitted via intergenerational trauma experienced as a result of collective and chronic exposure to these epidemics.

What distinguishes this phenomenon as a syndemic as opposed to intersectionality or comorbidities is the mutually reinforcing interaction of the conditions which impact Black people as a collective. This is more than the simultaneous presence of the conditions but comprised of structural and socio-cultural factors interacting to contribute to the physiological, psychological, and behavioral outcomes that manifest at the population level. Reskin (2012) describes a race discrimination system comprised of feedback relationships between residential segregation, education, employment, community resources, socioeconomic status, and health care. The syndemic concept takes this further and examines these relationships as not only related to racial discrimination but also as it pertains to the presence of sustained intergenerational traumas, structural and symbolic violence at the population level rooted in anti-Black racism and white supremacy.

Figure 1 depicts how interpersonal, structural and symbolic violence undergirded by anti-Black racism intersect to produce the Syndemic of Injustice phenomenon. For Black youth, exposure to this syndemic of injustice, results in them being more likely to have experienced three or more adverse childhood experiences (ACEs) compared to their white and Latino peers (Child Trends, 2019). The effects of these experiences can have negative, long term impact on the health and well-being of countless populations of Black youth.

Fig. 1
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Syndemic of Injustice

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A pandemic assessment often requires an episodic stance that assesses individual symptoms and behaviors in response to one event or wide spread disease. However this assessment does not adequately depict pandemic experiences for Black people. The syndemic concept is an important framework to consider as it captures the lived reality of surviving multiple events (e.g., anti-Black racism, COVID-19, community violence) that occur simultaneously at the population level and are often chronic for Black youth. The syndemic framework allows for the assessment of issues impacting Black youth at both the interpersonal and broader systemic levels. The COVID-19 pandemic, in particular, while global in impact has highlighted the syndemic as it manifests for Black people in the U.S. by exacerbating existing disparities and social injustice due to police brutality and violent structural inequity (Fishbein, 2020). Although these disparities will still exist due to mutual reinforcing systems of oppression even after the viral pandemic has ended, many Black youth have harnessed their social capital across social media platforms in response to syndemic injustice (Galea & Abdalla, 2020). During this global COVID-19 pandemic, despite physical distancing protocols youth have increasingly utilized social media as a tool for activism and a new social movement toward Black liberation (Saxton et al., 2015).

Black Youth’s Identity Development and intergenerational racial trauma

As adolescence is a significant period in identity formation, ethnic identity may take on heightened importance at this developmental stage. We acknowledge that there is a long-standing controversy regarding the use of race and ethnicity in the extant literature. The majority of the literature related to identity development utilizes the terms: ethnic identity and/or ethnic racial identity. We use the term ethnic identity to be consistent with this literature (See Rivas-Drake et al., (2014) for context). Integrating a sense of ethnic identity into an overall understanding of one’s personal identity is a particularly important task for Black youth as it has impacts on aspirations, ideology, and interpersonal identity (Phinney & Rosenthal, 1992; Rivas-Drake et al., 2014). Black youth are not only navigating these developmental changes but doing so while navigating issues related to anti-Black racism, numerous forms of violence and systemic oppression.

Historical race-based trauma is a result of deliberate, systematically inflicted, ongoing and extensive forms of structural violence that create a collective experience of trauma for Black people. Race based trauma evokes symptoms similar to post-traumatic stress disorder. However, the systemic and frequent nature in which race based trauma is experienced, would suggest that there is in fact no “post” in the experience of traumatic stress disorder for Black people. Moreover, the effects of race based trauma differ depending on an individual’s experiences with racism and messages they have been taught on how to best respond to these experiences. This is particularly relevant when considering the process in which Black youth experience and are taught how to cope with racism (Andersonet al., 2021). Traumas experienced by the parents are transmitted to their children as a part of these intergenerational discussions.

Adolescent cognitive development, especially at the stage of pre-formal reasoning, has been found to be impacted by perceptions and experiences of racism (Seaton, 2010). Diaquoi (2017) offers invaluable insight relevant to how the impact of experiencing systemic forms of racism has resulted in an intergenerational impact and appraisal of traumas, dictating the messages adolescents receive about how to cope with them. The discourse which Black parents have with their children about race starts young with conversations that describe how others see them based on their race and how to navigate a world replete with anti-Black racism that criminalizes them from childhood (Anderson et al., 2021; Brunson & Miller, 2006; DiAquoi, 2017; Malone Gonzalez, 2020). Messages on how to cope with race based trauma also derive from adolescent peer groups and social media (Patton et al., 2016). These coping mechanisms include the creation of informal and formal same-race peer networks to buffer their own experiences with racism and affirm their racial identity both in real life (Carter, 2007) and online (Lee, 2017).

Ethnic socialization for Black youth starts much younger and is utilized to speed up the process of ethnic identity formation (Boykin & Toms, 1985). Typically, this socialization occurs as Black parents attempt to teach their children about their ethnicity and experiences they may have within the broader society, including discrimination, anti-Black racism (Seaton et al., 2012), and the effects of structural violence especially from the police (Brunson & Miller, 2006; Malone Gonzalez, 2020). As such, ethnic socialization is a process of learning how to operate within systems of oppression and can be seen as an antecedent to identity development. Ethnic socialization includes not only how one responds to bias and discrimination but also socialization related to cultural customs and traditions (Hughes et al., 2006). Parents’ racial socialization messages are aimed at counteracting negative anti-Black racism experiences, influencing academic motivation and may increase academic performance by emphasizing pride in Black history and culture while highlighting the inequalities existing between Blacks and other racial ethnic groups (Neblett et al., 2009). These messages typically are provided via “The Talk” which is a specific racial socialization message that many Black parents have with their children about how to conduct themselves in a way which buffers their experiences with those in positions of power while providing them with tools to navigate the structural and symbolic trials of oppression, inequity and injustice stemming from anti-Black racism (Anderson et al., 2021).

There are four posited identity statuses – Diffuse, Foreclosed, Moratorium and Achieved. Achieved is considered to be the optimal identity resolution but all four identity statuses may be found in different age groups. Black youth are developmentally expected to engage in an ethnic identity search which leads to an Achieved ethnic identity status (Phinney & Rosenthal, 1992) to be integrated into their personal identity. Ethnic identity has several components. These include identifying as part of a racial/ethnic group, engaging in particular characteristics of that group (i.e. holidays or dress), feelings about group membership, and the importance placed on being in that racial/ethnic group (Phinney & Rotheram-Borus, 1987). Black youth don’t have the luxury of choosing some of these components. The color of their skin, in most cases, indicates their membership. The dominant society assumes their membership for them ascribing characteristics derived from negative stereotypes and designed to maintain the status quo. In a 3-year longitudinal study, Seaton and colleagues (2012) found that by the time they reach adolescence the majority of Black youth appear to have already integrated their ethnic identity into their personal identity.

Identity development is affected by one’s social context. In this case, a context embedded within systems of oppression and comprised by racially traumatic experiences via the syndemic of injustice. Therefore, Black youth’s ethnic identity development cannot be understood without an examination of these environmental and social contexts. Racial and ethnic minorities are encouraged to assimilate into the dominant, i.e. white, culture; yet, in the presence of prejudice, discrimination, anti-Black racism, and systemic oppression, Black youth prefer to separate themselves from the dominant culture (Duncan, 2005). Biculturalism, operating effectively within both one’s ethnicity and that of the dominant culture, allows a person to negotiate both cultures and know which is better to embrace in particular contexts (McGee, 2013). Biculturalism has been posited as a successful approach to integrating one’s ethnic identity into one’s personal identity. The question to be asked is: successful by whose standards? Academically high-achieving Black youth who are successful in predominately White environments do so at the expense of their racial, cultural, and personal identities (Harris & Marsh, 2010; McGee, 2013). Outwardly successful, their mental health is at risk resulting in stress, isolation, and/or social anxiety as a result of the constant pressure to choose which culture to represent (Iwabuchi, 2018; Vivero & Jenkins, 1999).

Hypothetical example

Consider a young, gifted, Black boy growing up in an urban neighborhood characterized by high levels of community violence and low levels of societal investment. Neighborhoods like his tend to be racially segregated and disenfranchised due to systems of oppression (Brown, 2021); and, have been linked to increased risks for emotional and behavioral symptoms that compromise learning outcomes (Busby et al., 2013). Researchers have found that Black youth in general (Woods-Jaeger et al., 2020) and Black male high school students, in particular, demonstrate resilience and competence despite the extreme conditions of urban environments (Spencer et al., 2012). Being born into that environment is the initial example of unjust syndemic conditions.

The boy’s parents provide for his needs and attend church regularly. He does well in school and is rewarded by being bused to a predominately white magnet high school. However, his presence in the high school is always subject to scrutiny as Black males are disproportionately suspended and expelled from school, often due to deficit thinking by educators stemming from anti-Black racism (McCray et al., 2015). The risk of suspension or expulsion would not be decreased if it was a Black girl in this scenario. Black girls are disproportionately punished for subjective disciplinary infractions, such as insubordination (Morris, 2016).

This young, gifted Black male youth is seen as having a bicultural ethnic identity and succeeds academically. Yet when he goes to the store after school in his high school’s neighborhood, he is followed and treated as if he may steal something; and, a white woman shopping in the store calls him a racial slur. So despite having numerous factors that improve his educational outcomes, father in the household, high parental expectations, feeling safe at school, being a part of the African American church community (Toldson, 2008; Young, 2007), he is consistently subjected to structural and symbolic violence, racism and discrimination. He is dealing with stress, isolation, and pressure to conform to the dominant culture at school in order to succeed while being treated negatively due to his existence as a Black person. The toll that this has on his mental health has implications not just for his development during adolescence but also as he transitions into adulthood (Williams et al., 2019). This case study illustrates how the syndemic of injustice manifests itself in the lives of Black youth in the U.S. Moreover, the syndemic framework provides invaluable considerations for social work practice with Black youth.

Implications for Social Work Practice

The field of social work is rooted in ethical principles of social justice designed to engage in the pursuit of social change for vulnerable and oppressed groups (National Association of Social Workers, 2021). The syndemic of injustice is a framework that can be utilized to root social work efforts to address injustice in a larger systemic framework, helping service providers to move beyond focusing on narrow definitions of trauma that often focuses on the outcomes of traumatic experiences to also understanding the root causes. This macro trauma-informed framework allows for Black youths’ trauma reactions to anti-Black racism to be viewed not as pathological but as adaptations to chronic, traumatic structurally violent experiences. Using a syndemic of injustice framework while working with Black youth, starts with acknowledging the physical and cognitive consequences of anti-Black racism as trauma. The field of social work can begin this acknowledgment process through the recognition of the ways in which the profession has been both complacent and complicit in the systematic long-term trauma of Black people.

The Grand Challenges of Social Work have called for the implementation of not just cultural competency and anti-racist social work but specifically a racial equity framework. This framework would provide competencies and best practices for eventually eliminating racial inequity (American Academy of Social Work and Social Welfare, 2021). However addressing anti-Black racism requires social workers to both dismantle systems of inequity and create systems of equity that ultimately inform social justice practice. Social workers need to be at the forefront of addressing the issues brought on by the syndemic of injustice. The Grand Challenges are challenging because they do not call out the racism inherent in social work as a profession nor address how to deal with it in a way that centers Black people. For example, anti-racist pedagogies in social work education such as being an anti-racist social worker are constructs built around the idea of self-reflexivity and the examination of white privilege. This examination is designed to help confront enormous obstacles in a profession that was created to support and provide benevolent treatment to society’s marginalized and unfortunate individuals and groups. However, these pedagogies are designed to fit within the structures or parameters of the field itself and the field has utilized a white, heteronormative lens to identify who is deserving or undeserving and that very lens is marginalizing for anyone who does not fit the mold. In other words, the day to day practices of social work, those that sustain the profession, are built to reproduce whiteness and equate whiteness with goodness.

As long as social work practice is synonymous with benign notions of diversity management and the development of competencies, it will not be possible to reconcile being a “good” social worker with anti-racist practice. Reading books on how to be anti-racist and deal with privilege may make one feel bad or good. It may lead to self-reflection about potential harms caused. But the profession still has provided a sense of right and wrong based on notions derived from structural forms of anti-Black racism. Moreover, these issues cannot be located in discussions outside of practice because otherwise we ignore how the practice of social work itself is raced. Social work practice has paid insufficient attention to the intricacies of the many complex questions that arise when considering race and neglect the practice behaviors as a potential form of racism.

Conclusions

The syndemic of injustice framework allows us to understand and acknowledge how political and social factors rooted in systemic racism drive, perpetuate, or worsen the emergence and clustering of diseases and disparities. Research into the identity development of Black youth needs to move away from examining individual behaviors to examining the overall context in which identity is formulated. This examination requires more than including the social context as a factor in models but must consider the structural and sociocultural factors at the collective level which contribute to the syndemic of injustice that shapes the social context. These factors are widespread, interdependent and inextricably linked to anti-Black racism (Reskin, 2012); thereby creating the systems of oppression that Black youth experience. Understanding the multiple factors that contribute to the syndemic of injustice for Black youth suggests that policy responses to the chronic violence and victimization they experience should move beyond individual-level approaches to violence, and consider how structural and interpersonal level violence and power relations shape the lived experiences of Black youth.