“Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call “race”), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.”
What is Racism?
Racism impacts our nation by creating health inequity. Lack of equal access to health inhibits a person’s ability to attain their highest level of health. Racism affects our society on various levels and is a barrier in achieving true health equity. Dr. Camara Jones developed a theoretical framework to understand racism on 3 levels: institutionalized, personally mediated and internalized. This framework identifies a basis for race- associated differences in health outcomes and can inform effective solutions to eradicate those differences.
Levels of Racism: A Theoretic Framework
Institutionalized Racism is defined as differential access to the goods, services, and opportunities of society by race. Institutionalized racism is normative, sometimes legalized, and often manifests as inherited disadvantage. Institutionalized racism manifests itself both in material conditions and in access to power. With regard to material conditions, examples include differential access to quality education, sound housing, gainful employment, appropriate medical facilities, and a clean environment. With regard to access to power, examples include differential access to information (including one’s own history), resources (including wealth and organizational infra- structure), and voice (including voting rights, representation in government, and control of the media).
Personally Mediated Racism is defined as prejudice and discrimination, where prejudice means differential assumptions about the abilities, motives, and intentions of others according to their race, and discrimination means differential actions toward others according to their race. This is what most people think of when they hear the word “racism.” Personally mediated racism can be intentional as well as unintentional, and it includes acts of commission as well as acts of omission. It manifests as lack of respect (poor or no service, failure to communicate options), suspicion (shopkeepers’ vigilance; everyday avoidance, including street crossing, purse clutching, and standing when there are empty seats on public transportation), devaluation (surprise at competence, stifling of aspirations), scapegoating (the Rose- wood incident, the Charles Stuart case, the Susan Smith case), and dehumanization (police brutality, sterilization abuse, hate crimes).
Internalized Racism is defined as acceptance by members of the stigmatized races of negative messages about their own abilities and intrinsic worth. It is characterized by them not believing in others who look like them, and not believing in themselves. It involves accepting limitations to one’s own full humanity, including one’s spectrum of dreams, one’s right to self- determination, and one’s range of allowable self- expression. It manifests as an embracing of “whiteness” (use of hair straighteners and bleach- ing creams, stratification by skin tone within communities of color, and “the white man’s ice is colder” syndrome); self-devaluation (racial slurs as nicknames, rejection of ancestral culture, and fratricide); and resignation, helplessness, and hopelessness (dropping out of school, failing to vote, and engaging in risky health practices).
What is Antiracism?
Anti-racism refers to forms of thought and practice that seek to confront, eradicate, or mitigate
racism. (Bonnett A. Anti-Racism . Routledge; 2000)
“When we identify where our privilege intersects with somebody else's oppression, we'll find our opportunities to make real change.”
What is Social Justice?
Social justice is the view that everyone deserves equal rights and opportunities, which includes the right to good health. There are inequities in health that are avoidable, unnecessary, and unjust. These inequities are the result of policies and practices that create an unequal distribution of money, power, and resources among communities based on race, class, gender, place, and other factors. To assure that everyone has the opportunity to attain their highest level of health, we must address the social determinants of health and equity. (APHA, 2022)
A social justice approach to population health challenges us to deal with and recognize that racism, socioeconomic inequality, residential segregation, and hate, to name a few, have negative consequences for health. We simply cannot improve the health of populations without tackling these foundational causes.