This article identifies institutional racism as a form of oppression that contributes to the social and economic disadvantaged experienced by Blacks in residentially segregated communities. The authors highlight the existence of social, economic, environmental and political influences as contributors to disparate outcomes experienced in economically disadvantaged black communities. Through the lens of the social determinants of health, inequalities in health, housing, and the criminal justice system are examined as powerful indicators of disparate outcomes for Blacks isolated in segregated communities across the U.S. Specific policy implications are presented to address the context in which disparate outcomes occur.