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Racism and Health: A Reading List

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Long-standing, systematic, and unjust health inequities have sparked decades of interdisciplinary science and scholarship to detect, understand, and eliminate them.  

For racial and ethnic health inequities, specifically, the study of racism as a root cause has received significant attention.

This nonexhaustive collection of select research articles and books, both seminal and new, describes how racism affects health and well-being and offers a starting place for further exploration.
 

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Race

A specious classification of human beings created by White Europeans that assigns human worth and social status using “White” as the model of humanity and the height of human achievement for the purpose of establishing and maintaining privilege and power. 

Power

Having legitimate access to systems sanctioned by the authority of the state.


 

Racism

Race prejudice plus power.

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Source: Chisom R, Washington M. Undoing Racism: A Philosophy of International Social Change. People’s Institute Press. People’s Institute for Survival and Beyond. New Orleans, LA: People's Institute Press; 1997.

Racism and Health: Historical Context

The roots of racism in health and health care reach back as far as racism itself, to the founding of our medical and political systems. The cumulative effects of this history impact individuals, communities, and institutions today.

Byrd WM, Clayton LA. Race, medicine, and health care in the United States: a historical survey. J Natl Med Assoc. 2001;93(suppl 3): 11S-34S. 

Savitt TL. Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia. Vol. 82. Urbana, IL: University of Illinois Press; 2002.  

DuBois W, Anderson E, Eaton I. The Philadelphia Negro: A Social Study. Philadelphia, PA: University of Pennsylvania Press; 1996.

Washington HA. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York, NY: Harlem Moon; 2006.

Thomas SB, Casper E. The burdens of race and history on Black people's health 400 years after Jamestown. Am J Public Health. 2019;109(10): 1346-1347.

deShazo RD. The Racial Divide in American Medicine: Black Physicians and the Struggle for Justice in Health Care. Jackson, MS: University Press of Mississippi; 2018.

Pathways Linking Racism to Health Outcomes

Racism works on multiple levels and through multiple pathways to erode both mental and physical well-being over time. These pathways occur at both individual and systemic levels (e.g., health care systems, social structures, policy). Individuals also carry multiple intersecting identities that have implications for health.

Similarly, individual and social correlates of health are distinct yet connected. The many ways racism impacts the health of individuals and communities of color are interwoven. No aspect of racism travels on just one pathway, and many take several pathways or all. Importantly, this complexity requires that interventions to undo racism work on all levels, from interpersonal to sociopolitical.

Harrell CJP, Burford TI, Cage BN, et al. Multiple pathways linking racism to health outcomes. Du Bois Rev. 2011;8(1):143-157.

Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40:105-125.

Paradies Y, Ben J, Denson N, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS ONE. 2015;10(9): e0138511.


Psychological Pathway

Overview


Williams DR, Williams-Morris R. Racism and mental health: the African-American experience. Ethnicity & Health. 2000;5(3-4):243-268.

Pieterse AL, Todd NR, Neville HA, Carter RT. Perceived racism and mental health among black American adults: A meta-analytic review. J Counseling Psychol. 2012;59(1):1-9.

Internalized Racism


James D. Health and health-related correlates of internalized racism among racial/ethnic minorities: a review of the literature. J Racial Ethnic Health Disparities. 2020;7(4):785-806.

Stereotype Threat


Burgess DJ, Warren J, Phelan S, Dovidio J, van Ryn M. Stereotype threat and health disparities: what medical educators and future physicians need to know. J Gen Intern Med. 2010;25(suppl 2):169-177.

Steele CM, Aronson J. Stereotype threat and the intellectual test performance of African Americans. J Pers Soc Psychol. 1995;69(5):797-811.

Spencer SJ, Logel C, Davies PG. Stereotype threat. Annu Rev Psychol. 2016;67(1):415-437.


Physiological Pathway

Overview


Harrell JP, Hall S, and Taliaferro J. Physiological responses to racism and discrimination: an assessment of the evidence. Am J Public Health. 2003;93(2):243-248.

Minority Stress


Calabrese SK, Meyer IH, Overstreet NM, Haile R, Hansen NB. Exploring discrimination and mental health disparities faced by Black sexual minority women using a minority stress framework. Psychol Women Q. 2014;39(3):287-304.

Goosby BJ, Heidbrink C. The transgenerational consequences of discrimination on African-American health outcomes. Sociol Compass. 2013;7(8):630-643.

Belcourt-Dittloff A, Stewart J. Historical racism: implications for Native Americans. Am Psychol. 2000;55(10):1166-1167.

Weathering


Geronimus AT, Hicken M, Keene D, Bound J. “Weathering” and age patterns of allostatic load scores among Blacks and Whites in the United States. Am J Public Health. 2006;96(5):826-833.


Health Care Pathway

Mistrust


Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical mistrust, racism, and delays in preventive health screening among African-American men. Behav Med. 2019;45(2):102-117.

LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57(suppl 1): 146-161.

LaVeist TA, Isaac LA, Williams KP. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res. 2009;44(6):2093-2105.

Technology


Obermeyer Z, Powers B, Vogeli C, Mullainathan S. Dissecting racial bias in an algorithm used to manage the health of populations. Science. 2019;366(6464):447-453.  

Benjamin R. Race After Technology: Abolitionist Tools for the New Jim Code. Cambridge, UK: Polity Press; 2019.

Medical Education


Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Soc Sci Med. 2018;202:38-42.

Ackerman-Barger K, Boatright D, Gonzalez-Colaso R, Orozco R, Latimore D. Seeking inclusion excellence: understanding racial microaggressions as experienced by underrepresented medical and nursing students. Acad Med. 2020;95(5):758-763.

Racial Bias
 

Parsons S. Addressing racial biases in medicine: a review of the literature, critique, and recommendations. Int J Health Serv. 2020;50(4):371-386.

Hoffman, KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296-4301.

Hall WJ, Chapman MV, Lee KM, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105(12):e60-e76.

Health Care Quality


Smedley BD, Stith AY, Nelson AR (eds). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.

Agency for Healthcare Research and Quality. National Healthcare Quality and Disparities Reports. Accessed June 2020.


Community Pathway 

Epigenetics


Kuzawa CW, Sweet E. Epigenetics and the embodiment of race: developmental origins of US racial disparities in cardiovascular health. Am J Hum Biol. 2009;21(1):2-15.

Brockie TN, Heinzelmann M, Gill J. A framework to examine the role of epigenetics in health disparities among Native Americans. Nurs Res Pract. 2013;410395.

Social Determinants of Health
 

Hahn RA, Truman BI, Williams DR. Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM - Popul Health. 2018;4:17-24.

Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Annu Rev Sociol. 2015;41:311-330. 


Policy Pathway

Overview


Dawes DE. The Political Determinants of Health. Baltimore, MD: Johns Hopkins University Press; 2020.

Segregation


Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5): 404-416.

Gee GC. A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. Am J Public Health. 2008;98(suppl 1):S48-S56.

Krieger N, Van Wye G, Huynh M, et al. Structural racism, historical redlining, and risk of preterm birth in New York City, 2013–2017. Am J Public Health. 2020;110(7):1046-1053.

Police Violence


Hoekstra M, Sloan C. Does Race Matter for Police Use of Force? Evidence from 911 Calls. Cambridge, MA: National Bureau of Economic Research; 2020.

Edwards F, Lee H, Esposito M. Risk of being killed by police use of force in the United States by age, race–ethnicity, and sex. Proc Natl Acad Sci U S A. 2019;116(34):16793-16798.

The Role of Academic Medicine in Eliminating Racism

Academic medicine has an important role to play in mitigating racism and its effects on health. The AAMC has curated a collection of articles and resources to assist our member institutions, constituents, and the public in exploring strategies to combat racism and make health care more diverse, equitable, and inclusive.