Settler-defined healthcare is not healthy: Artair Rogers, Logics of Extraction, Exploitation, and Control in Healthcare: Applying a Racial Capitalist Settler Colonial Frame, PhD dissertation, Harvard University, 2026 | settler colonial studies blog

Settler-defined healthcare is not healthy: Artair Rogers, Logics of Extraction, Exploitation, and Control in Healthcare: Applying a Racial Capitalist Settler Colonial Frame, PhD dissertation, Harvard University, 2026

27Jul26

Abstract: This dissertation examines how U.S. nonprofit hospitals, grounded in a history of settler colonialism, racial capitalism, and chattel slavery, function as racialized organizations that perpetuate racial health disparities through the racialized allocation of resources. Throughout the chapters, I argue that health systems not only fail to break with legacies of extraction, exploitation, control, and conquest but often benefit from historically accumulated power and property, even while claiming commitments to community investment and health equity. Chapter 1 traces the historical development and role of medical institutions, especially hospitals, in promoting racial health inequalities. Then, I demonstrate how modern health systems are built to benefit from earlier regimes of extraction, exploitation, dispossession, control, and conquest, and how health sciences knowledge production often hides these structural causes of inequality. Chapter 2 explores the federal community benefit framework through the lens of structural racism, focusing on private, nonprofit hospitals. I examine nationwide trends in community benefit spending, the value of tax exemptions, and “fair share spending”—a measure developed by the Lown Institute that compares community investments to the estimated tax-exempt value. Using the Structural Racism Effect Index (SREI) and county-level racial demographics, I assess how hospitals exhibit racialized patterns in their investment or disinvestment in communities. I contend that community benefit policies, rather than addressing structural harms, function as tools to legitimize institutional power and secure tax advantages, with the costs ultimately passed on to taxpayers and communities most in need—demonstrating how nonprofit hospitals participate in racial capitalism. Chapter 3 uses a Settler-Colonial Racial Capitalism (SCRC) framework to analyze property tax exemptions, hospital siting, and wealth building through property assets. Based on historical and modern measures of neighborhood disadvantage, racial/ethnic makeup, and inequality, I assess the predicted property values of nonprofit hospitals that benefit from property tax exemptions over 10- and 20-year periods. I show how property tax exemptions, granted to nonprofit hospitals via community benefit regulations, have enabled hospitals to amass wealth and land in historically redlined and racially segregated neighborhoods. This reveals that community benefit can serve as a tool for extraction, displacement, gentrification, and institutional wealth growth, rather than genuine community investment. Chapter 4 links these organizational and policy dynamics to population health outcomes by combining Fundamental Cause Theory with Ray’s theory of racialized organizations. Viewing hospitals as meso-level institutions that mediate state power and resource distribution, I analyze the relationship between county-level fair-share spending (community investment minus tax-exempt value) and premature mortality rates, as well as differences across racial and ethnic groups. This analysis shows how nonprofit hospitals’ community investment efforts can either help reduce or reinforce resource-based health disparities. It demonstrates that although fair-share spending may offer a marginal protective benefit for some racial groups, fair-share spending itself is rooted in sociopolitical structures that uphold racial capitalism and settler colonialism, making its effects limited and emphasizing the need for solutions centered on collective action and reimagination. Thus, Chapter 5 shifts focus to application and praxis. Drawing on critical race and decolonial theories, I first explain the need for critical theories like SCRC to assess and interrogate healthcare institutions. Additionally, this chapter highlights the importance of connecting SCRC to theories of disease distribution. Finally, I present recommendations organized around four main pillars: reclaimed narrative and remembrance, resistance and reclaimed power, redress and repair, and radical reimagination. I emphasize how memorializing institutional harms, community-governed and community-accountable health models, Land Back and reparations initiatives, and institutional redress efforts can collectively shift hospitals away from racialized extraction and toward meaningful accountability, redistribution, and community self-determination in health.

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