Racism: The Impact on Health

A recent article in the American Journal of Public Health presents findings on experiences of everyday racism and HIV testing which are consistent with those from two other studies examining experiences of everyday racism’s relationship to preventive behaviors (condom use behaviors & mammography screening).  The greater the level of everyday racism, the less likely people are to engage in health prevention behaviors.   (Full citation for the article, which is behind a paywall: Ford CL, Daniel M, Earp JL, Kaufman JS, Golin CE, Miller WC. Perceived Everyday Racism, Residential Segregation and HIV Testing in an STD Clinic Sample. American Journal of Public Health Apr 2009 99;(Supp 1):S137-S143.)

The fact that racism takes a toll on the lives of people of color, and in particular on African Americans, is not especially new information.   There’s a literature on this that’s been growing for some years.  For example, Joe’s book with Karyn McKinney, The Many Costs of Racism, details the physical and psychological toll of racism on African American’s health.

What seems to be new here is that scholars in public health are increasingly documenting racism as an important underlying factor, if not a causal variable, in creating a number of specific health hazards and pathways to disease and mortality.   In the past, public health – like many other fields – had attributed racial inequality to the vagueness of social determinants phrased in the passive voice.   A research agenda that now explicitly includes racism is a step forward.

However, researchers are still overly cautious in their use of the term “perceived” as an ubiquitous qualifier to “everyday racism.”   Calling the experiences of everyday racism “perceived” leaves open the possibility that these experiences were not, in fact, racism but instead, a misundertanding of the actual situation.  If there is a “perception” of racism, then perhaps there is room for “misperception.”

Why does this matter?  It leaves unsettled then what the root cause is:  is it white racism that’s inflicting real harm on real people?  Or, is it the “perceptions” of black folks and other people of color that need to be adjusted?

Make no mistake, this burgeoning field of studying the impact on health of racism is important.  Yet, still largely missing here is a robust analysis of the cost of racism to whites.  A colleague of mine, Amy J. Schultz and I wrote a book chapter on this “Whiteness and the Construction of Health Disparities,” (Jessie Daniels and  Amy J. Schulz, pp. 89-127,  in Gender, Race, Class, and Health, (Jossey-Bass, 2006), Leith Mullings and Amy J. Schulz, Eds.).  Also missing here is what might be effective interventions, to use the public health language, to reduce the level of racism so that black and brown people might live longer, healthier lives.

Updated 6/26 to add: There’s an important piece on Racism’ Health Toll at Miller-McCune (from 6/15) that I should have referenced here.   Highly recommended.


  1. Julie Netherland

    Interesting and important issue. Often studies either exclude racism as a variable or, worse, conflate race and racism. Too few public health studies address the impact of racism. One of the difficulties I’ve heard from researchers is agreement on how to measure racism. Resources?

  2. Joe

    Julie, good point. There is a good bit of work that tries to measure racist events and experiences. See the work of David Williams and Nancy Krieger that we cite in the Many Costs of Racism book.

  3. Randy B.

    With the health care debate raging in America these days, it is surprising that race and racism has again been ignored as part of the issue, even with studies like this one. When it comes to interactions with people in a society, perception is reality. So the idea that there was only perceived daily racism and not actual daily racism is just ludicrous, especially if the overall thinking is sound. It makes sense that if you believe that you are going to receive half-assed care because of your race, if you go to a health care facility, then you are less likely to take the time and spend the money to have a medical professional investigate what seems to you as a minor irritant. The minor irritant that could have been handled with minor medical attention early on now will require major medical treatment to fix. This is one of the reasons, according to some, that health care costs in America are so high, an utter lack of preventative medical care.

    So if we know racism can be a factor in African-Americans not pursuing preventative medical treatment, then why doesn’t the American government start enacting programs to fight it? 1) The medical system is in America is already strained, and an influx of patients seeking preventative medical care would swamp the already over tasked system. 2) If African-Americans and others minorities start getting more frequent preventative medical treatment, they will likely live longer, increasing their dependency on other government programs, like Medicare. If a health issue is never diagnosed, no treatment is given, and no claim to the Medicare system is billed. And since the patient died, not future claims will be billed either. 3) If racism is formally recognized in the area of preventive medicine, we will have to look for its existence in other areas as well.

  4. Shari

    “so that black and brown people might live longer healthier lives.”

    I’m for it. If they live longer will they then include those of us who are not black and brown. We may be extinct by then.

  5. Jessie Author

    Interesting discussion here, and welcome to new folks who are just joining the discussion.
    Julie, excellent point about conflating race/racism. That’s a common error. Joe is right about Krieger and Williams work on race/health. See also the updated link I just added for further resources.
    Dave – thanks so much!
    SinTx – see today’s post for more on MJ.
    RandyB – Yes, indeed – why isn’t there more of an emphasis on racism and health at the national level? A lack of political will, is the short answer.
    Shari, thanks for sharing your fears of racial extinction here. Would that it were true.

  6. Great article. The literature shows that both perceived and actual racism matters for health, particularly for mental health. Gilbert Gee (2002) examines these constructs simultaneously and shows that living in areas that are redlined and reporting discrimination are associated with poorer health. Living in redlined areas also predicted poorer general health. One of the challenges that the discrimination and health literature faces is deriving measures of “actual” discrimination that can be attached to individual-level reports. Gee’s work is a good example of the few studies that have been able to do this. With regards to the cost of racism to whites, there is a lot less research. However, Tony Brown (2003) lays out an outline for thinking about the subject in relation to mental health.

  7. Bambi

    Medical Apartheid by Harriet A. Washington boldy confronts racism in the health care arena. Perhaps we should look at the history of health care in America. Blacks were used primarily as guinea pigs for dangerous drugs not safe enough to use on White patients. Most of this done through deception. Today this type of medical racism continues as chronicled in the sterilization of thousands of minority women. The distrust of the medical system due to blatant racism has, sadly, contributed to the declining health care of many minorities.

  8. Kristen

    Jessie, important post. It’s sad that researchers find it difficult to give validity to black Americans’ experiences, calling them “perceptions.” It has been documented many times that white Americans misjudge the level of discrimination in society and that black Americans come closer- and often underestimate it. When researchers won’t call it what it is, they not only dismiss the knowledge of African Americans, they also dismiss a whole lot of research conducted by social scientists. I understand it’s hard to figure out how to “measure” racism in a way that seems conclusive to everyone, but the real problem it seems to me is that white people won’t get on board with the general truth that racism is real and work from there.

    I think Bambi brings up a great point – We should include in the discussion the phenomenon that African Americans tend to experience lower-quality care within the medical system, and have for a long time now. I’m glad that the medical community is starting to consider the health effects of everyday racism, but I’d love to see them also acknowledge their own racist practices.

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