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An In-Depth Look At The Scientific Evidence On Racism And Health, Part 1: Getting Real About Race In American Society


Over the past decade or so, researchers have increasingly focused on the roles of race and racism as determinants of the sustained patterns of racial inequalities in health. The relationships between race and health are complex. Just as the innumerable manifestations of racism exist at the individual-, social-, institutional-, and societal-levels, the mechanisms by which racism influences health are multilevel, multidimensional, bidirectional, and interrelated.

In the United States, as in other racialized countries in the world, racially stigmatized and disenfranchised populations suffer from poorer health than their more advantaged counterparts. Racial disparities in health are manifested in a variety of outcomes including higher rates of mortality, earlier onset of disease, greater severity and progression of disease, and higher levels of comorbidity and impairment. Racism also directly affects health, functioning as a chronic physiological stressor that increases allostatic load and, over time, has a negative influence on the health, quality of life, and lifespan of those who experience discrimination. Further, disadvantaged minority populations generally have lower levels of access to medical care and are more likely to receive care that is poorer in quality. These disparities persist over time and are evident at every level of income and education.

These issues are so complex that I can’t possibly cover them all in one article. So, I am starting a new series of articles that will explore the intricate relationships between racism and health, with a particular emphasis on racialized politics, institutional racism, and colorblind ideology (i.e., the “new” racism). In this first article, I will present an overview of racism in modern society, drawing from scholarly literature, sociological and political science theories, mainstream media, and cultural and political discourse. In order to really uncover the mechanisms behind racial disparities in health, I think it’s important to understand exactly what we are talking about when we talk about racism in America today.

Before I get started, I want to discuss my own motivation for writing this series on race, health, and politics. I have both professional and personal interest in all three of these issues, as well as the intersection of and interactions between them. I am a doctoral student in Social & Behavioral Health, which is a subfield of public health focused on the behavioral, social, and cultural factors related to individual and population health and health disparities over the life course. Research and practice in this field contributes to the development, administration, and evaluation of programs and policies in public health, health services, and various sectors of government to promote and sustain healthy environments, healthy lives, and equity in health outcomes. Health disparities, including racial disparities in health, are my primary research interest. My area of research encompasses a broad scope of issues including reproductive rights; racial and socioeconomic disparities in maternal health and birth outcomes; disparate access to and quality of health care among impoverished, minority, and other underserved populations; the influence of media and other social constructs (e.g., social norms, stigma, stereotypes, biases) on maintaining and intensifying or preventing and alleviating health problems; gender-based discrimination and violence; disparities in the application and outcomes of policy; bidirectional causal pathways between social and economic disadvantage and health, and more.

As hard as I work and as long as I have worked to get to this point in my education, I never tire of my research or doubt my decision to pursue a doctoral degree – mainly because the research I do for school and work is perfectly aligned with my personal interests. As my friends and family would attest to, the pursuit of social justice is not just a professional goal, but a deeply ingrained ambition that guides my actions in all domains of my life. My mother, a social epidemiologist who studied many of the same issues that I do, had a strong influence on my perspectives on politics, society, health, and justice. I was fortunate enough to grow up in a household where discussions about race were not frowned upon — my mother’s research, which largely focused on racial disparities in birth outcomes, was a common topic of conversation and, over the years, these discussions shaped my own worldview and caused me to question things that most other upper-middle class White girls weren’t even aware of. It didn’t seem right to me that the color of someone’s skin could determine how healthy their baby would be at the moment of birth. It didn’t seem right that a Black woman’s experience of discrimination could hurt her future child; that the racial prejudice of another person and the systemic inequalities in the American health care system could come back and inflict harm — not just on the target of discrimination, but on the next generation; that even before conception, the future of a Black child can be marred by racism.

These experiences, and others, guided me to the point where I am today. I still question many of the same things that I did as a child, but I also understand a lot more: I know that racial disparities – as well as other injustices – are fundamentally wrong; I know that they don’t just “happen,” but are maintained by societal forces; I know that we all have a role in changing the societal factors that perpetuate racial injustice; I know that racial injustice is the product of human action; and I know that we, as a society, are wholly responsible for changing that.

My openness about race is not uncommon among my colleagues in social and behavioral health, as racial disparities are a pressing concern in many areas of public health. Reducing racial disparities in health mandates that we talk about race. Outside of public health and academia, my perspective on race is generally welcomed – but every once in a while, I find myself on the receiving end of a sardonic response that could only be produced in a mind characterized by parochialism. It doesn’t happen often, and to be perfectly honest, this type of contemptuous response always comes from another White person — and the reaction is pretty much the same every time. It comes in the form of incredulity and cynicism; of provincialism and benighted ignorance; of self-deception, indignant defensiveness, and resentful projection. As I talk about later in this article, these characteristics are, coincidentally, among the many defining features of colorblind ideology – also known as the “new racism.”

So, before I get any further, let me take a moment to preemptively address the burning questions of any cynics out there who may stumble across this article. Here we go: Yes, I am White. Yes, I am talking about racism and White privilege. And yes, I am calling out those White people who exploit White privilege and deny racism. And for God’s sake, no, I am not suffering from “white guilt” or any other mythical ailment invented by the insular members of society to pathologize the condition of being White and having moral conviction and genuine compassion for others regardless of whether or not they share my skin color. The real question is, why is it so difficult for some White people to accept that another White person’s commitment to equality of all kinds – racial, gender, sexual, marriage, religious, economic, social, health – is not motivated by a self-serving desire to assuage the discomfort of living with “white guilt?”

With that said, let’s get started!


Overview of Racism in American Society

BeFunky_RacismIs.jpgDr. Eduardo Bonilla-Silva, Professor of Sociology at Duke University, defines racism as an organized system premised on the categorization and ranking of social groups into races, resulting in a system that devalues, disempowers, and differentially allocates desirable societal opportunities and resources to racial groups regarded as inferior. Racism often leads to the development of negative attitudes (prejudice) and beliefs (stereotypes) toward stigmatized minority racial groups and differential treatment (discrimination) of these groups by both individuals and social institutions. However, these multiple dimensions of racism do not always co-occur. For example, it is quite possible for racism to exist in institutional structures and policies in the absence of racial prejudice and negative racial stereotypes at the individual level.

Despite reductions in explicit public support of racism, there is strong empirical evidence of the persistence of racism in American society. While Whites are more likely to express support for the idea of racial equality than they were in the 1950’s and 1960’s, support for policies and government programs to actualize and enact racial equality is unchanged – and in some cases lower – among Whites today than it was during the civil rights era. For example, just 28% of Whites currently support government efforts to ensure the fair treatment of Blacks in employment settings, a 10% reduction from 1964.

Racial Discrimination

At the time of President Obama’s inauguration in 2009, 85% of Blacks and 71% of Whites saw racism as a somewhat big or big problem in the United States, and a 2012 national survey found that 67% of Whites and 90% of Blacks agreed that Blacks and Hispanics currently experience discrimination in the United States. However, the same survey found that two-thirds (65%) of Whites believe that Blacks have achieved full racial equality, compared to just 16% of Blacks who believe the same. Other recent national data reveal that Whites now believe that they are more likely to be the victims of racial discrimination than Blacks, a belief that is not consistent with empirical evidence or temporal trends in culture and society. For example, there is decisive evidence that Blacks are disproportionately and negatively affected by racial discrimination and disparate outcomes in the criminal justice systememployment and hiring practices, housing and rental markets, credit and lending decisions, and consumer transactions. This past June, the Supreme Court struck down a major provision of the Voting Rights Act of 1965, saying in their ruling that “things have changed dramatically” in the nearly 50 years since the landmark legislation was signed into law. However, Republican lawmakers’ recent efforts to enact stringent, unwarranted voter ID laws have been shown to impose a much greater burden on minority and low-income voters, suggesting that things have not changed quite as dramatically as the Supreme Court claims. The author of one study concluded that voter ID laws are within a realm of policies that “collectively reduce electoral access among the socially marginalized” — which is exactly what the Voting Rights Act was designed to prevent.

Implicit Racial Bias and Aversive Racism

Documenting the persistence of racism is a challenge because the nature of racism in contemporary society has changed in ways that make it not readily recognizable to many people. Scientific evidence indicates that in addition to conscious, deliberate cognitive processes, humans also engage in implicit (unconscious), effortless, and automatic evaluative processes in which they respond to a stimulus based on images stored in their memory. This may partially explain the discrepancy between Whites’ support for the concept of racial equality and their opposition to policies aimed at actualizing equality.

Aversive racism is one of the terms used to characterize contemporary racism. According to Drs. Adam Pearson and John Dovidio, Professors of psychology at Yale University, “current racial attitudes of Whites toward Blacks in the United States are fundamentally ambivalent, characterized by a widespread contemporary form of racial prejudice, aversive racism, that is manifested in subtle and indirect ways, and illustrate its operation across a wide range of settings, from employment and legal decisions, to group problem-solving and everyday helping behavior.”

An aversive racist lacks explicit racial prejudice but has implicit biases that favor Whites over Blacks. BeFunky_70percentquote2.jpgThis type of racism is extremely common in modern society, with recent evidence showing that almost 70% of Americans have implicit biases that favor Whites over Blacks. These high levels of implicit bias strongly suggest that discrimination is likely to be quite common in American society, with much of it occurring through behaviors that the perpetrator does not experience as intentional.

Institutional Racism

In addition to implicit racial bias and disparate outcomes in domains such as employment and housing, racial discrimination also persists in institutional mechanisms and processes. Residential segregation is a prime example of this: while the Fair Housing Act of 1968 officially prohibited segregation, it persists today through an interlocking set of individual actions, institutional practices, and governmental policies. The 2010 Census indicates that decreased levels of residential segregation are largely driven by a few Blacks moving to formerly all-White census tracts, but overall this has had little impact on the very high percentage of Black census tracts, the residential isolation of most African Americans, and the concentration of urban poverty.

BeFunky_InstnlRacismDefinition.jpgImmigration policy in the United States, historically and currently, has been another form of institutional racism. These policies have ranked racial groups; excluded, segregated, and incarcerated some racial populations; and limited the rights and privileges of those deemed “dangerous” or otherwise “undesirable”.

The high level of incarceration of Blacks and other minorities is another example of institutional racism. Racial disparities in the criminalization and investigation of certain behaviors combined with discrimination in prosecution and sentencing have led to the inordinately high levels of incarceration of minorities in the United States. As I have written about previously, racial disparities in the criminal justice system are caused and maintained by a variety of factors including cultural stereotypes, myths and misrepresentations in the media, racial profiling, school arrests, biased legislation, and discriminatory enforcement practices.

“Stand Your Ground” (SYG) laws, which have received increasing criticism since the shooting death of unarmed teenager Trayvon Martin, are a perfect case study for institutional racism. While I have covered this extensively in previous articles (see this article for an overview of the statistics on SYG; see here and here and here and here for articles on the Trayvon Martin and Jordan Davis cases), I will briefly review the evidence on the staggering injustice of SYG laws. Nationwide, homicides involving a white perpetrator and a black victim are ten times more likely to be ruled justified (i.e., the perpetrator was not convicted on any homicide-related charges) than cases with a Black perpetrator and a White victim, and the gap is significantly larger in states with SYG laws. How much larger? According to researchers from the Justice Policy Center at the Urban Institute, cases in SYG states involving a White perpetrator and a Black victim are a staggering 281 percent more likely to be ruled justified than cases with a White perpetrator and White victim. Like many other forms of institutional racism — including those in the criminal justice system – racial disparities in SYG cases are exacerbated by other types of racial discrimination such as implicit racial bias, cultural myths and stereotypes, and individual racism.

Cultural Racism

The persistence of institutional and interpersonal discrimination is driven by the racism that remainsBeFunky_CulturalRacism.jpg deeply ingrained in American culture. Ideas of Black inferiority and White superiority have historically been embedded in multiple aspects of American culture, and many images and ideas in contemporary popular culture continue to devalue, marginalize, and subordinate non-White racial populations. For example, compared to White characters, Black characters in TV shows and movies are more likely to be portrayed negatively, a pattern that has been shown to increase viewers’ racial prejudice toward Blacks.

News media also contributes to the dehumanization of Blacks. According to Dr. Jennifer Eberhardt, Professor of Psychology at Stanford University, news articles describing Black defendants are more likely to use animal language (such as “barbaric,” “animalistic,” “savage,” etc.) than articles about White defendants. In addition, news articles of Blacks who received a death sentence contain more animal language than the articles of those with life sentences – but this pattern is not seen in articles about Whites. “So not only are Blacks associated with apes, but this association is linked to justifications of violence and death,” Eberhardt concluded. “It’s almost as though the rules for what moral treatment is get shifted for Black suspects and defendants.”

In another study, researchers examined historical documents of executions. They found that Black defendants were more likely to have animal words used to describe them; further, the more animal words were used to describe the criminals in these trials, the more likely the person was to be executed.

Another study, released last month, found that the dehumanization of Blacks influences law enforcement officers’ perceptions of the criminality of Black versus White children. As a result, officers were more likely to inflict harsh punishment upon Black children (compared to White children), even for minor offenses.  “In other words,” the authors say, “our findings suggest that, although most children are allowed to be innocent until adulthood, Black children may be perceived as innocent only until deemed suspicious.”

Negative stereotypes about Blacks and other minorities are also pervasive among the general population. Even more alarming, these attitudes have not changed much over time – they’re just expressed differently. In the 1990 General Social Survey (GSS), 29% of Whites said they view Blacks as unintelligent, 45% saw them as lazy, 57% believed that Blacks prefer to live off welfare, and 51% believed that Blacks are prone to violence. Strikingly, just 21% of Whites saw Blacks as intelligent, and less than one in five Whites said they view Blacks as hardworking (17%), preferring to be self-supporting (13%), and not prone to violence (14%). In the 2010 GSS, the percentage of Whites endorsing the view that Blacks were hardworking dropped from 17% in 1990 to 16% in 2010.

Colorblind Racism

BeFunky_ColorblindIdeology.jpgWhile the prevalence of overt racism has fallen since the civil rights era, other forms of racial discrimination have taken the place of “classical racism.” In today’s society, colorblind racism is the dominant form of racial discrimination. First described by Dr. Eduardo Bonilla-Silva in the book Racism Without Racists: Colorblind Racism and the Persistence of Racial Inequality in the United States, colorblind racism is a sociological term referring to a more subtle form of racial discrimination characterized by minimizing or disregarding the role of race and denying the social reality of racism. As Dr. Bonilla-Silva explains, the essence of the new “colorblind” racism is that “racial inequality is explained in terms of nonracial dynamics.” In other words, flagrant forms of racism coexist with the denial of racism. Dr. Bonilla-Silva’s conceptualization of colorblind racism is based on recent empirical evidence obtained from interviews and surveys of Americans born between 1940-1980.

Race As A Social Reality

In contrast to the individual prejudices of classical racism, colorblindness is primarily manifested in systemic and institutionalized forms of racism. Dr. Bonilla-Silva says that, like other social categories such as class and gender, race is socially constructed via law, public policy, cultural standards, and social practices. However, he also points out that the social construction of race has a “social reality” – in other words, it produces real effects on those racialized as ‘Black’ or ‘White.’ In fact, the history of racial classification, of individual and systemic racial stratification, is the essence of the history of White supremacy

Bonilla-Silva explains this in more detail, saying: “When race emerged in human history, it formed a social structure (a racial social system) that awarded systemic privileges to Europeans (‘Whites’) over non-Europeans (‘non-Whites’). Racialized social systems, or White supremacy for short, became global and affected all societies where Europeans extended their reach. ..a society’s racial structure is the totality of the social relations and practices that reinforce white privilege…the task is to uncover the particular social, economic, political, social control and ideological mechanisms for the reproduction of racial privilege in a society.”

While race is a socially constructed category, this construction, in turn, produces racialized social structures that reinforce White privilege and are maintained and reproduced by Whites who materially benefit from the social order. The dominant race (Whites) thus needs racial ideologies to justify the racial status quo. According to Dr. Bonilla-Silva, colorblind racism represents the most dominant racial ideology. Importantly, the ideological framework of color blindness not only rationalizes racial inequality; it also serves to erase and delegitimize antiracist activities.

The Central Frames of Colorblind Ideology

Colorblind racism is manifested in many different forms, but Dr. Bonilla-Silva identifies four common frames used to support and justify racist attitudes; these four frames were used by at least half of the participants in Bonilla-Silva’s research. These frames describe the ways in which the dominant racial group, White individuals in America— particularly White males— understand, articulate, promote, influence and reinforce our current social hierarchy — making race appear invisible, as if it were no longer an issue.

Abstract Liberalism

The first frame, termed abstract liberalism, describes a method of “dressing up” racism. “Abstract” is BeFunky_AbstractLiberalism.jpgthe key term here – while most Whites agree that all Americans, regardless of race, should have equal rights and opportunities, when asked about government policies that could bring about such equality (such as affirmative action), many Whites actually voice strong opposition. Often, this opposition is grounded in the belief that racial discrimination is no longer a major barrier for minorities, and thus policies designed to overcome racial disparities are no longer necessary. While it is hard to imagine that one could dismiss the social reality of race, this belief is widespread among White Americans.

In many ways, abstract liberalism is akin to the “bootstrap theory” of race, which posits that the gains made during the struggles of the Civil Rights Movement created a completely level playing field, making equality the new “reality.” Similarly, abstract liberalism represents the viewpoint that we are all individuals with equal opportunities and choices, and that we must be colorblind to allow equality to “happen” — and that discrimination is just a matter of individual prejudices, if it happens at all. Abstract liberalism obscures the institutional and structural policies put in place by a country founded upon slavery and racialized social, political, and economic inequality. It functions as if power and privilege are not still in the hands of those generations of the White, propertied, upper-class who aren’t so far removed from our very recent past of blatant racial violence (lynchings), economic disinvestment (exclusion of Blacks from land-ownership, public accommodations, equal access to jobs, housing, education), and political and legal discrimination (lack of legal recourse, lack of political representation, criminalization, racial profiling) – much of which persists to this very day.

Variations of abstract liberalism include: the notion of meritocracy perpetuating the myth that White privilege is earned and not granted by historical factors; laissez-faire politics seen in anti-affirmative action stances, based on the false notion that the “invisible hand of the market” will balance out social inequality — hence the government is seen as having no place in equalizing the playing field; claims of reverse discrimination in which individual incidents of prejudice and discrimination experienced by Whites or other non-minority individuals are viewed as equal to the larger, historically-based institutional and structural racism experienced by entire communities of color; individualism, by which the false notion of choice and opportunity is used to justify blaming individuals for structural problems — while the social world they reside in is not held accountable…..to name a few.

Hence, this underlying ideology of abstract liberalism works as the little voice inside our heads telling us that we all have the same opportunities, allowing Whites to blame poverty on communities of color and minorities rather than looking at the structures of whiteness and White privilege that provide inherent benefits based solely on skin color. It tells White people that these privileges are not, in fact, privileges, but are earned through hard work and “personal responsibility” – and it tells people of color that they are to blame for what they haven’t “earned.”  It tells us all that if we just work harder, we can attain the “American Dream.” As a result, abstract liberalism invests Whites in “whiteness,” for Whites don’t want to lose privilege — even if it’s unearned in the first place.

Minimization of Racism

BeFunky_PlayingtheRaceCard.jpgThe second frame, minimization of racism, is exactly what is sounds like: many Whites believe that, while discrimination still exists, it is not that bad and is no longer holding Blacks back. This frame is particularly insidious, as it allows Whites to ignore and even deny claims of racial inequality from individuals and communities of color who are experiencing it. Manifested in accusations of “playing the race card,” claims of “reverse discrimination,” and allegations that minorities are “too sensitive” or using race as an excuse, minimization of racism obscures real incidents of racism (not just prejudice) and racial discrimination. Minimization also allows Whites to be racist through the rhetoric of colorblind racism, i.e. by silencing the voice of the oppressed; telling those who are experiencing racism that they are being “hypersensitive” or only “using” race to justify personal shortcomings. Possibly the most twisted, unjust implication of minimization is that it gives power to the oppressor to analyze and mandate the terms of what “qualifies” as racism.

Cultural Racism

This brings us to the third frame, cultural racism, which describes the tendency to blame Black BeFunky_CultureofPovertyMyth.jpgculture for racial inequality in modern society. Due to a lack of consideration (or awareness) of the institutional effects of discrimination in the labor, housing, and educational markets, and the well-documented impact of racial discrimination on middle-and upper-class Blacks, Whites often construe racial disparities as the product of a cultural problem, drawing from the “culture of poverty” arguments of the 1960’s. Since biological deficits based on race have been disproven, dominant society looked to develop alternative explanations for “racial differences”; hence, instead of biology, Black “culture” is used as an explanation for social, political, and economic inequality. In contrast to Jim Crow racists, who often cited biological defects among Blacks, colorblind racists point to cultural flaws such as “broken families,” “bad values,” “poor work ethic,” “lack of personal responsibility,” or “dependency on government” to explain systemic racial disparities in education, income, employment, criminal justice proceedings, and more. Blaming the victim absolves Whites – and society as a whole — of responsibility for racism and racial inequality. If, after all, racial inequality is a “cultural phenomenon,” Whites don’t have to examine their own complicity in maintaining the dominant status quo – i.e., White privilege. Because of their insistence that race itself has nothing do with racial inequalities, colorblind racists sometimes claim that Blacks “exploit” experiences of racism and “expect” handouts based on their race.

Naturalization of Racism

The fourth and final frame of colorblind ideology is the naturalization of racism, which allows Whites to justify racial inequality as if it were inevitable and natural. For example, claims that people of color “segregate themselves” overlook and minimize the history of economic disinvestment, discriminatory and exclusionary housing and financial market practices such as redlining, and other race-based policies designed to obstruct home ownership and integration. Naturalization is also used to justify school segregation. Rather than acknowledging the clear racial context of disparities in the public education system, naturalization is used to justify and de-racialize the disproportionately low levels of funding for schools in communities of color and the inequality created by the Bush Administration’s No Child Left Behind Act. Hence, the historical causality of racism (i.e., the connections between past and present) – which, in this example, determines where Blacks live, and in turn, where they can go to school — and the racialized policies that structure these “choices” are obscured.

Race Talk

BeFunky_RaceTalk.jpgDr. Bonilla-Silva describes the four styles of colorblind racism as ways “to talk nasty about minorities without sounding racist.” The “race talk” of colorblind racism, according to Dr. Bonilla-Silva, is the way in which this racial ideology allows users to justify themselves individually, and to legitimize the system of White supremacy/privilege/complicity as a whole. The stylistic elements of “race talk” include: the avoidance of actual race talk altogether; “semantic moves” to save face; the use of projection, or “blaming the victim” instead of taking responsibility and being accountable for, or at least acknowledging, the place of Whites in the social hierarchy; the role of diminutives to “candy-coat” racial ideology; and finally, rhetorical incoherence when asked to clarify racial beliefs.

In a political context, this type of race talk referred to as “dog-whistle politics,” which describes a deceptive style of political messaging characterized by the use of coded language that may appear benign on the surface, but is designed to take on different and more specific resonance for a targeted subgroup. Dog-whistle politics are most frequently discussed in relation to race. One of the results (and also the primary purpose) of dog-whistle politics is that, although the overt discussion of race is omitted from political messaging, the meaning of race remains imbedded in political discourse. Consequently, transparent dialogue about race is labeled as problematic, while veiled race talk is permitted and used to espouse prejudiced attitudes and discriminatory policies.

Ian Hany López, author of Dog Whistle Politics: How Coded Racial Appeals Have Reinvented Racism and Wrecked the Middle Class, describes how dog-whistle politics have changed the dialogue about race in American politics: “[C]onservatives have made racism mean only an open reference to race itself. What that means is that whenever liberals or racial progressives say, ‘Hey, you know racism remains a big problem in our society,’ something as innocuous as that, they immediately get slammed for playing the race card and conservatives run around saying, ‘Hey, we’re a post-racial society, but you just introduced race into the conversation.’”

This style of race talk is extremely common in modern politics – I discuss this in more detail later in the article.

According to Dr. Bonilla-Silva, storytelling also has a fundamental role in the multigenerational transmission of status, biases, and beliefs about the social order. Racial narratives and testimonies are often used to legitimize, maintain, and perpetuate the dominant group’s racial ideology.

“Stories are also important because they help us reinforce our arguments,” he says. “[T]hey assist us in our attempt of persuading listeners that we are ‘right.’” As social representations, racial narratives are a very powerful tool used to explain away racism; testimonies provide more authenticity and emotionality to what is already a very subjective interpretation of events. According to Bonilla-Silva, racial stories among the dominant racial group (Whites) often overlook the reality that “pro-White policies in jobs, housing, elections, and access to social space have had a positive multiplier effect for all those deemed ‘White.’” In other words, racial privilege is obscured just as it is normalized. Whites are deemed race-less, but not class-less; therefore, class — not race — is situated as the determining factor in society. Another way that Whites assert racial superiority is by claiming they have no culture — because to be cultureless implies that one is either “normal” or “simply human” (and therefore the standard by which others are judged, and to which others should strive) or “rational” and “post-cultural” (therefore, developmentally advanced). Culturelessness can serve as an intentional, or unintentional, measure of White racial superiority. These portrayals allow Whites to alleviate themselves of social responsibility for the world around them, overlooking the effect of our actions on non-dominant racial groups — as if the “multiplier effect” or the “wages of whiteness” of a history in our favor has had no effect upon disproportionate wealth and ownership accumulation, political power, access to jobs, schools, health care, education, and other resources necessary for social advancement and equality. As Whites, we are given permission to overlook this unearned privilege; therefore, White privilege isn’t only disproportionate wealth, access, and resources, but it is the privilege of not having to acknowledge where this came from, or the cost to those who were denied so that we could have what we have. White privilege is unearned; it is historically rooted; it is the ability to “choose” ignorance as bliss – and to not be held responsible for it.

The Politics of Race

History of Colorblind Racism in American Politics

The widespread culture of colorblind racism helps to explain how racial inequality persists despite the fact that few White Americans would claim to be (or wish to see themselves as) racists. Colorblind ideology emerged as the modern face of racism during the Reagan-era and is now the dominant form of racism in modern society. As a member of the Reagan administration in 1981, Lee Atwater (also an advisor for President George H.W. Bush) gave a now infamous interview to political scientist Alexander P. Lamis. The interview was anonymous and for years no one knew that Atwater was the subject, but when Lamis reprinted his book Southern Politics in the 1990’she included the interview transcript and revealed Atwater’s name. The interview focused on the “Southern Strategy,” a new style of political campaigning first used by Nixon and later perfected (i.e., exploited) by Ronald Reagan. The “Southern Strategy,” which was designed to gain support among groups essential to the new Republican majority, relied on leveraging race and religion to mobilize southern conservatives. Using racialized language – but carefully avoiding overt racism – Reagan exploited the post-civil rights era racial tensions of the south, intensifying existing racism and igniting new, racially motivated fears and animosity among White Americans. The final step, then, was to capitalize on this new culture of racism, while masterfully eschewing the conspicuous racism of past decades.

During his interview with Lamis, Republican strategist Lee Atwater succinctly summed up the strategy: “You start out in 1954 by saying, ‘N*gg*r, n*gg*r, n*gg*r.’ By 1968 you can’t say ‘n*gg*r’—that hurts you, backfires. So you say stuff like, uh, forced busing, states’ rights, and all that stuff, and you’re getting so abstract. Now, you’re talking about cutting taxes, and all these things you’re talking about are totally economic things and a byproduct of them is, blacks get hurt worse than whites… ‘We want to cut this,’ is much more abstract than even the busing thing, uh, and a hell of a lot more abstract than ‘N*gg*r, n*gg*r.’” If that sounds familiar, it’s because this is the same strategy exploited by conservative politicians to this very day.

Reagan put this plan into action, beginning his campaign in Philadelphia, Mississippi, a town notorious for the murder of three civil rights workers in the 1960s. Standing beside a known segregationist, Reagan stressed his belief in “states’ rights,” code for the obstruction of Black advances. Using wedge issues such as “family values,” “personal responsibility,” abortion, and threats to gun ownership, Reagan – and every Republican presidential candidate since then – employed the dog-whistle politics of the “Southern Strategy” on a nationwide level to help generate support for a platform largely based on racial discrimination.

In 1988, George H.W. Bush followed in Reagan’s footsteps, surging ahead of Michael Dukakis whenBeFunky_CodedRacialAppeals.jpg he released the infamous Willie Horton ad. The campaign spot played to White fears, using the release of a Black man on parole from prison to represent a racialized stereotype of the “dangerous Black criminal.” Not surprisingly, Lee Atwater had a role in this maneuver, too: “Willie Horton has star quality,” exclaimed Atwater, “Willie’s going to be politically furloughed to terrorize again. It’s a wonderful mix of liberalism and a big black rapist.”

In April 2010, then-Republican Party chairman, Michael Steele, an African-American, acknowledged — and later apologized — that the party had pursued the Southern Strategy for 40 years.

In the latest presidential election, the strategy was present again — In lieu of saying “n*gg*er,” euphemisms applied to President Obama have a mostly Atwaterian ring. During the GOP primaries, candidate Newt Gingrich rarely passed up an opportunity to refer to Obama as the “food stamp” president. In April of that year, it was clear that Mitt Romney would be the Republican nominee come November, due in part to a nostalgic catchphrase used in TV ads on his behalf during the primaries: “Keep America America” — just one letter removed from “Keep America American,” the venerable Ku Klux Klan slogan. Coincidence? In August at a campaign rally, Romney joked to an audience that “no one ever asked me for my birth certificate.” That was a crass reference to the unfounded controversy surrounding Obama’s birthplace, a rallying cry for the racist “birther” crowd. John Sununu, an adviser to the Romney campaign, commented that Obama needed to “learn how to be an American.” Fox News commentator Brent Bozell referred to the President as a “skinny ghetto crackhead.” Texas Governor Rick Perry, once considered odds-on favorite to oppose Obama that November, frequently hosted Republican moneymen at his family’s hunting camp, known for years by its stone marker at the entry gate: N*ggerhead. Yes, that was actually the name of Rick Perry’s family vacation home. Oh, and then there was the particularly disturbing “slip” by Rick Santorum, who caught himself in the middle of calling President Obama a “government n*gg*r.”

There are entire articles devoted to the plurality of racist incidents and comments made by opponents of Obama’s Presidency.  And in case you were wondering – yes, every single word in that sentence is linked to a different article describing incidents of racism directed at the President.

Dog-Whistle Politics: Modern Manifestations and Costly Consequences

BeFunky_DogWhistlePolitics2.jpgSince Reagan first successfully exploited subtly racialized campaign tactics, conservative politicians have used the same strategies not only for elections, but also to elicit support for policies that would otherwise be unpopular. By framing affirmative action, welfare, school busing, housing policy, among others, as evidence of how the government was taking money and resources away from “good hard working Americans” to give to others (ostensibly lazy and Black) who were somehow less deserving, the Republican Party exploits racism to undermine the role of government in promoting equality. The Democratic Party, because it attempted to implement inclusive policies, became the “party of special interests.” The terminology of this is interesting because it connotes that African-Americans are not really American, but rather some sort of outside group trying to force their issues onto the American public.

Unfortunately, the subtle-but-obvious strategy of exploiting racism to demolish the social safety net and dismantle key government programs has been effective, at least among Republican voters: a 2012 Washington Post poll found that Republicans believe that African Americans consistently vote Democratic because they are dependent on government or looking for a handout. Just last month, Republican Congressman Paul Ryan blamed poverty on a “real culture problem” among lazy men “in inner cities,” saying that men from urban areas come from “generations of men not even thinking about working or learning the value and culture of work.” During the same discussion, Ryan also cited Charles Murray, a conservative social scientist who believes African-Americans are, as a population, less intelligent than Whites due to genetic differences, and that poverty remains a national problem because “a lot of poor people are born lazy.” Many Americans – of all races – were offended by the Congressman’s comments, which were widely interpreted as a racially charged attack. Members of the Congressional Black Caucus (CBC) branded his remarks as “highly offensive,” and Representative Barbara Lee of California, a member of the CBC, called Ryan’s remarks a “thinly veiled racial attack.”

This type of racialized politics explains how the modern Republican Party still exists, despite pushing for legislation that is unequivocally harmful for the majority of voters — both Democratic and Republican. Reagan and the GOP learned a powerful lesson from Barry Goldwater’s devastating defeat in 1964 and the Southern strategy implemented by Nixon: that race was a powerful tool in securing the white vote, even if it meant convincing working-class Whites to vote against their own economic interests.

Of the 46 million people living in poverty in America in 2010, the U.S. census revealed that 31 million were White. Ten million were Black. Of the 49 million people without health insurance coverage, 37 million were White; 8 million were Black. The face of poverty is overwhelmingly White, but conservatives have succeeded in racializing poverty, convincing poor Whites that government anti-poverty programs are only for that other kind of poverty – the kind caused by “inner city culture,” as Paul Ryan articulated just last month.  The “black welfare queen” image Reagan touted only served to strengthen the resolve of white voters, and continues to do so today. As Paul Krugman pointed out in his 2007 article “Republicans and Race,” Southern Whites still vote for the GOP at a ratio of 2 to 1. But for poor Whites voting Republican, it’s a strategy that only serves to keep them in poverty.

Like everyone struggling to provide for their families amid the nation’s economic challenges, poor whites are a demographic sorely in need of progressive answers to their socioeconomic ills. Yet many remain adherent to a racially polarizing Republican Party that has taught them to fear Obama as “alien” or “other.” From Reagan to Gingrich to Santorum, and most recently Paul Ryan, race-baiting has only profited the Republican leaders who have sold it — while those at the bottom are left to pay the price.

The Public Health Impact

By now you’re probably wondering what all of this has to do with health. That’s what the rest of this series will focus on. As I mentioned earlier, there are innumerable mechanisms through which racial prejudice, racialized politics and colorblind ideology, and institutional discrimination affect health — and we are still learning about new ones to this day. But one thing is clear — from the impact of individual racial prejudice on stress and physiological functioning to the underrepresentation of racial minorities in clinical trials and the poorer quality of patient-provider relationships for people of color; from the disproportionate impact of (conservative) political agendas (such as Republicans’ refusal to expand Medicaid) to the staggering disparities in access to health care — racial discrimination not only persists in modern society, but is evidenced by objective, measurable harm to the physical and mental health and wellbeing of those targeted by discrimination.

While race is a socially constructed concept, the effects of racism are all too real. In fact, the health-related impact of racial discrimination is, quite literally, a life-or-death matter.

More on that coming soon.


Be Well, my friends.



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2 thoughts on “An In-Depth Look At The Scientific Evidence On Racism And Health, Part 1: Getting Real About Race In American Society

  1. I really appreciate this. I was thinking about racism as a comorbidity, and googled the term to see if this was anything actually studied. I am quite ill, have very good health insurance, and am considered “good-looking”. But I am “black”– even though I am actually mixed race. The last three times I was hospitalized; I was put in a room with a patient with tuberculosis. I rejected a room with a white woman who was psychotic- she was acting out sexually, and screaming profanities… I say that to say that I am going to go ahead and die, rather than go through the ordeal of being ‘raced’ while ill. But you keep doing what you’re doing- if you still are…

    Posted by Veraci Nullataneous | December 22, 2015, 5:25 pm
    • Thank you for commenting and sharing your personal experience of how race and racism have affected your health and your treatment in the health care system. I’m so sorry to hear that you have had such terrible experiences with health care, but honestly I can’t say I am surprised by it, given how pervasive racial disparities are in our health care system. How is your health right now? Have you been able to access better care than what you received during those hospitalizations?
      These issues — racial disparities in health and health care, and the role of racism as a determinant of health — definitely remain among my top priorities both professionally and personally. Much of my own research focuses on racial disparities in maternal and infant health, but I am also involved in a few studies looking at racial bias in media coverage of various events and issues, and the role of racism as a determinant of public support for policies and programs such as Medicaid, SNAP (food stamps), and gun control.

      There are so many mechanisms through which race and racism influence health, and we are still learning about many of them, such as the role of racism as a toxic physiological stressor and the genetic vulnerabilities it can produce. I try to write about these issues frequently, so I hope you’ll come back and continue to read and comment on new articles. I also hope your health is improving.

      Take care,
      -C 🙂

      Posted by publichealthwatch | December 29, 2015, 3:52 pm

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