[Racism: the invisible social determinant of health in Spain]

The COVID-19 pandemic has catalyzed an increased focus on strategies to combat racism as a public health issue. However, this trend contrasts sharply with the stagnation in the response to these inequities in Europe, and in particular in Spain. This article offers a comprehensive diagnosis and proposes a roadmap to address racism as a social determinant of health in Spain. The paradigm in which the invisibilization of racism prevails manifests through the marginalization of racial stratification as a legitimate topic of discussion, the delegitimization of race as a valid analytical category, and the attribution of its effects to alternative variables such as social class or immigration status. In addition, it is noted that current initiatives tend to have significant limitations in both their approach and methodology. These initiatives often adopt an individual perspective to the detriment of a structural vision, and exhibit a culturalist bias that minimizes the importance of hierarchies of power. As a result, ethnicity is prioritized over race and interculturality over racial equity. The article concludes with a call to action, proposing a roadmap aimed at institutional actors to promote greater racial equity in the field of health in Spain. Key lines for the effective integration of racism as a critical component in public health analysis and the implementation of more equitable policies, are highlighted.