In recent weeks, tragedies took the lives of Americans in Baton Rouge, Louisiana; St. Paul, Minnesota; and Dallas. They brought to light a significant danger to American well-being: the presence of hate, often fueled by fear, resentment, displaced anger — and also racism. Interactions between police and black Americans have driven nationwide discussion this summer, prompting U.S. President Barack Obama to join a nationally televised ABC News town hall earlier this month focusing on racial disparities that exist in the criminal justice system.

Camara JonesAPHA President Camara Jones, MD, MPH, PhD, has helped APHA elevate the impact of racism on the health and well-being of the nation, joining numerous distinguished public health leaders in a four-part webinar series that brought into focus the many ways racism worsens population health outcomes. In a conversation with Public Health Newswire, Jones underscored the need for a robust national conversation on racism as a first step to creating a healthier nation.

Q: You’ve helped APHA identify the impacts of racism on the health and well-being of the nation. Why does the United States have an urgent need for a national conversation on racism?

A: Many in this country consider racism to be a thing of the past. They see the progress in race relations that has been made on some fronts, including the election of our nation’s first African-American president, and conclude that racism was just an unfortunate chapter in our nation’s history that has no relevance today. However, recent events have reminded us — again — that racism is very much alive and well in this country.

But it is crucial to recognize that racism is NOT simply an individual character flaw or a personal moral failing.

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.

It is very important to acknowledge that racism is a SYSTEM that involves structures, policies, practices, norms and values. Our laws and our customs, even our inaction in the face of need, perpetuate historical injustices without the need for identifiable perpetrators. Racism manifests as more than the unjust killing of black men by a few “bad apple” police officers. It manifests as structures which do not include citizen review boards for police oversight; policies that require grand juries for indictments of police officers; practices like the over-policing of black communities; norms like the blue code of silence; and values that do not recognize the basic humanity and worth of black men.

The United States has an urgent need for a national conversation on racism — not simply race — because racism is sapping the strength of the whole society through the waste of human resources. But conversation is just the starting point, not the goal. We need to clearly name racism as a threat to the health and well-being of the whole society, but then we need to organize and strategize to act.

Q: You’ve made the distinction between institutionalized racism, personally mediated racism and internalized racism. How do all three impact our health?

A: Institutionalized racism is the constellation of structures, policies, practices, norms and values that result in differential access to the goods, services and opportunities of society by race.

This is the type of racism that does not require an identifiable perpetrator. Institutionalized racism often shows up as inherited disadvantage or its reciprocal inherited advantage, and we see its impacts on both material conditions and access to power. With regard to material conditions, examples include differential access by race to quality education, sound housing, gainful employment, appropriate medical facilities and a clean environment. With regard to access to power, examples include differential access by race to information, including information about one’s own history; resources, including wealth and organizational infrastructure; and voice, including voting rights, representation in government and control of the media.

It is important to note that it doesn’t “just so happen” that people of color in the United States are over-represented in poverty, while white people in the United States are over-represented in wealth. That is not just a happenstance. The association between socioeconomic status and race in the United States has its origins in discrete historical events but persists because of present-day structural factors that perpetuate those historical injustices. Those present-day structural factors are part and parcel of institutionalized racism. In other words, it is because of institutionalized racism that we see an association between socioeconomic status and race in this country.

Institutionalized racism can be through acts of commission, or acts of doing, as well as acts of omission, or acts of not doing, and very often institutionalized racism shows up as inaction in the face of need.

Personally-mediated racism includes differential assumptions about the abilities, motives and intents of others by race, as well as differential actions based on those assumptions. This is what most people think of when they hear the word “racism” — somebody did something to somebody. It includes the different idea, the prejudice, as well as the different action, the discrimination.

Some people would describe this level of racism as interpersonal racism. I describe it as personally-mediated racism because I am still understanding racism as a system, and this is the system mediated through people.

Examples of personally-mediated racism include:

  • lack of respect: including poor or no service, or failure to communicate health care options;
  • suspicion: including shopkeepers’ vigilance;
  • everyday avoidance: including street crossing, purse clutching and standing when there are empty seats on public transportation;
  • devaluation: including surprise at competence, stifling of aspirations, scapegoating; and
  • dehumanization, including police brutality, sterilization abuse and hate crimes.

Personally-mediated racism manifests as micro-aggressions and subtle communication of disrespect that some people call “everyday” racism, as well as the gross violations of human life that occur when a police officer assumes that you are reaching for a gun — even when you are fully restrained — or when a self-appointed neighborhood watchman assumes that you don’t belong in the neighborhood.

Like institutionalized racism, personally-mediated racism includes acts of commission as well as acts of omission. Perhaps more important is to realize that personally-mediated racism can be unintentional as well as intentional. Even if you do not intend to do something racist, you can have a racist impact.

Internalized racism, from the point of view of members of the stigmatized races, is acceptance by members of the stigmatized races of negative messages about our own abilities and intrinsic worth.

Internalized racism is characterized by a person not believing in others who look like oneself, and not believing in oneself. 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, like the use of hair straighteners and bleaching creams; stratification by skin tone within communities of color, and “the white man’s ice is colder” syndrome; self-devaluation, including racial slurs as nicknames, rejection of ancestral culture and fratricide; and resignation, helplessness and hopelessness, including dropping out of school, failing to vote and engaging in risky health practices.

Internalized racism is ultimately about members of stigmatized races accepting the limitations of the box into which we have been placed.

I use a teaching story, my “Gardener’s Tale” allegory, to illustrate the relationship between these three levels of racism. Visit APHA’s racism and health page to find out more about this relationship.