It happens when associations, foundations or governments segregate, either purposely or in a roundabout way, against specific gatherings of individuals to restrict their rights. Institutional and systemic racism establishes separate and independent barriers to access and quality of health care. Institutional racism does not have to result from human agency or intention. Thus, racial discrimination can occur in institutions even when the institution does not intend to make distinctions based on race. In fact, institutional discrimination can occur without any awareness that it is happening. Although data on institutional racism is scarce, it does