The ‘R’ Word!

It’s a word not spoken in most settings. But when it is, it often brings silence. Faces turn red, people look into space, the atmosphere fills with tension, people become noticeably uncomfortable and no one dares to acknowledge it. The conversation quickly moves to some other topic. The word? Racism.

Most Americans like to think that racism is “old school”; that it’s something in the distant past. We find comfort in believing that it does not exit. And, since we choose to believe it does not exist, it doesn’t. But for many Americans, its existence is all too real. It permeates almost every aspect of life, especially health.

Dr. Camara Jones, physician researcher at the Centers for Disease Control and Prevention (CDC), identifies three components of racism—personally mediated, internalized and institutional.

Personally Mediated

Personally mediated racism is the form of racism that results from the discriminatory actions or words of individuals towards others of a stigmatized racial or ethnic group. This is what we usually think of when we talk about racism. While this level of racism has become less common and less blatant, it still exists and has been shown to affect health. Research has demonstrated a positive association between self-reported experiences of personally mediated racism and poorer physical and mental health and unhealthy behaviors.

Internalized

Internalized racism is the acceptance by members of a stigmatized racial or ethnic group of negative messages about their own abilities or intrinsic worth. This form of racism may lead to health damaging behaviors and a sense of helplessness or hopelessness. It can also be seen in the sometimes detrimental behaviors (e.g. unhealthful eating, substance abuse, violence) and attitudes displayed by members of stigmatized groups towards themselves and others of that same group.

Institutionalized

Institutionalized racism occurs when institutional, social and economic policies restrict opportunities for racial & ethnic minorities. Typically, it cannot be traced to the acts of a single individual, but rather produces and sustains its effects through policies and practices that may or may not have an explicit intent to discriminate.

Institutionalized racism can include home mortgage policies that create and continue to sustain under resourced segregated minority communities; locality based funding for public education that underfunds school systems in segregated communities with limited tax bases; economic policies that charge higher interest rates and costs in impoverished communities; law enforcement policies that target racial and ethnic minorities; lower quality healthcare and resulting poorer outcomes experienced by racial and ethnic minorities. The results of these and other policies severely impact racial and ethnic minorities. They are more likely to live in communities with limited job opportunities, low quality public education and housing, unhealthy environmental exposures, higher rates of crime, limited access to health care, and other detrimental social and economic factors. In addition, such environments often lack access to healthy foods, safe and affordable places to be physically active, and sufficient social support. While, however, they are disproportionately burdened by the availability of tobacco, alcohol, drugs, and fast food restaurants. These exposures are barriers to healthful behaviors and enabling factors for unhealthful behaviors. In short, it’s no coincidence that the same people whose ancestors were enslaved, treated as second class citizens or were forcefully placed on reservations and denied their historic way of life, are the same people who disproportionately bare the social, economic, political, and health burdens in our society.

Moving Forward

Accepting the existence of racism in earnest is difficult. That’s why so many people choose denial. Getting the majority of Americans to pull their “heads out of the sand” is essential for the health of millions of their fellow citizens. Let’s move all of the people in our sphere of influence to participate in honest discussions about “the ‘R’ Word!”

The first step is to begin to talk about racism openly, identify its health and social consequences, and draw attention to the changes we all need to make to eliminate it. Talk about it with your family, your friends, your neighbors, your co-worker, your local newspapers and your elected officials. Next, advocate for a national dialogue on racism. While support is growing, much, much more is needed.

Don’t tolerate any form of racism, whether it’s from family, friends, or co-workers who still perpetrate it; find an effective strategy to relieve stress when you experience or see the effects of racism; challenge family and friends who buy into or promote detrimental stereotypically self images; make sure your workplace policies promote an inclusive environment; let your legislators know that you want them to engage in a national dialogue on racism; let public policy makers know that you support policies and programs that assure that everybody has the same opportunities to live a healthy, meaningful, and productive life.