Measuring institutionalized racism

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Levels of RacismA Theoretic FrameworkandA
Gardeners Tale

• Camara Phyllis Jones, MD, MPH, PhD
• Founding Director
• Epidemiology and Clinical Trials Center
• Association of Black Cardiologists, Inc.

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Levels of racism

• Institutionalized
• Personally-mediated
• Internalized

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Institutionalized racism

• Differential access to the goods, services, and
  opportunities of society, by race
• Examples
• Housing, education, employment, income
• Medical facilities
• Clean environment
• Information, resources, voice
• Explains the association between SES and race

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Personally-mediated racism

• Differential assumptions about the abilities,
  motives, and intents of others, by race
• Prejudice and discrimination
• Examples
• Police brutality
• Physician disrespect
• Shopkeeper vigilance
• Waiter indifference
• Teacher devaluation

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Internalized racism

• Acceptance by the stigmatized races of negative
  messages about our own abilities and intrinsic
  worth
• Examples
• Self-devaluation
• White mans ice is colder
• Resignation, helplessness, hopelessness
• Accepting limitations to our full humanity

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Levels of Racism

• A Gardeners Tale

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Institutionalized racism

• Initial historical insult
• Structural barriers
• Inaction in face of need
• Societal norms
• Biological determinism
• Unearned privilege

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Personally-mediated racism

• Intentional
• Unintentional
• Acts of commission
• Acts of omission
• Maintains structural barriers
• Condoned by societal norms

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Internalized racism

• Reflects systems of privilege
• Reflects societal values
• Erodes individual sense of value
• Undermines collective action

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Who is the gardener?

• Power to decide
• Power to act
• Control of resources
• Dangerous when
• Allied with one group
• Not concerned with equity

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Acknowledge the present-day existence and impacts
of racism

• Develop explicit measures of institutionalized,
  personally-mediated, and internalized racism
• Examine the impacts of racism on health

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Module on Reactions to Race

• Piloted on 2002 Behavioral Risk Factor
  Surveillance System
• California
• Delaware
• District of Columbia
• Florida
• New Hampshire
• New Mexico
• North Carolina

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Measures of institutionalized racism

• Policies allowing segregation of resources and
  risks
• Policies creating inherited group disadvantage
• Policies favoring the differential valuation of
  human life by race
• Policies limiting self-determination

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Initiate a national conversation on racism

• Poor health of the stigmatized
• Diminished health for all
• Waste of human resources

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Module on Reactions to Race

• Earlier you told me your race.
• Now I will ask you some questions about
  reactions to your race.

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Question 1

• How do other people usually classify you in this
  country?
• Would you say White, Black or African American,
  Hispanic or Latino, Asian, Native Hawaiian or
  Other Pacific Islander, American Indian or Alaska
  Native, or some other group?

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Question 2

• How often do you think about your race?
• Would you say never, once a year, once a month,
  once a week, once a day, once an hour, or
  constantly?

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Question 3

• For those who are employed for wages,
  self-employed, or out of work for less than one
  year
• Within the past 12 months at work, do you feel
  you were treated worse than, the same as, or
  better than people of other races?

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Question 4

• Within the past 12 months when seeking health
  care, do you feel your experiences were worse
  than, the same as, or better than for people of
  other races?

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Question 5

• Within the past 30 days, have you felt
  emotionally upset, for example angry, sad, or
  frustrated, as a result of how you were treated
  based on your race?

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Question 6

• Within the past 30 days, have you experienced
  any physical symptoms, for example a headache, an
  upset stomach, tensing of your muscles, or a
  pounding heart, as a result of how you were
  treated based on your race?

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Measures of institutionalized racism

• Document evidence
• Routinely monitor outcomes by race
• Identify mechanisms
• Examine written policies
• Query unwritten norms and practices

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Policies allowing segregation of resources and
risks

• Residential (redlining, zoning, toxic dump
  siting)
• Educational (public school tax base)
• Occupational (discretion in hiring)

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Policies creatinginherited group disadvantage

• Estate inheritance
• Lack of social security for children
• Lack of reparations for historical injustices

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Policies favoring the differential valuation of
human life by race

• Curriculum
• Media invisibility/hypervisibility
• Myth of meritocracy and denial of racism

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Policies limitingself-determination

• De jure limitations to voting rights
• Limits to representation/participation
• Majority rules when there is a fixed minority

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