While it is easy to say that racism is simply the personal bias of one group of people towards another, I believe that racism is much more insidious and permeating than that. Camara Jones states that “racism is a system”(2002, 9), and I agree with her. The system of racism does consist of individuals, but it also includes policies, laws, structures, social norms, and structures. It flows through all parts of government, education, and the health care system, impacting where people live, how they live, and their health outcomes. The system of racism places individuals and communities at an unfair disadvantage while simultaneously giving other groups an unfair advantage.
Jones discusses the three levels of racism: Institutionalized, which are the structures, policies, and norms that keep racial power differentials in place; personally mediated racism, which can also be defined as discrimination and stereotyping assumptions about individuals or communities based on race, and; internalized racism, in which members of the group who are discriminated against begin to believe the negative messages about ability and worth that surround them every day. This can manifest in many ways, one being a feeling of helplessness and hopelessness, another being the embracing of “whiteness” or rejection of one’s culture (Jones 2002, 10-11). The “groundwater metaphor” (Green and Love 2018) is a very helpful way of explaining that racism exists on a structural level and impacts everything that it surrounds and flows through. The system of racism impacts all the people in the system, and therefore it is the system that much is changed, not the individuals.
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According to Ford and Airhihenbuwa, race was first used to classify people by skin color by a French doctor names Francois Bernier, and was continued by Carolus Linnaeus’s Natural History in 1735. These racial groupings devalued those who were classified as “non-European”, and unfortunately became the structure on which many countries, including the US, built their racial policies (2010a). After this, various scholars such as Josiah Nott lent “scientific” credibility to these racist policies and reinforced white supremacy through articles written for well-respected medical journals (2010a). Additionally, “Prevailing notions about race shaped early scientific research, but because investigators were not critical about their relationships to their racialized social contexts, they were unable to perceive the insidious influence of racism in their work” (Ford and Airhihenbuwa 2010a, s30)
Alan Goodman states in the film “Race- The Power of Illusion”, that race is “a biological myth” (Adelman 2003). In America, we have a long history of searching for racial differences and trying to prove that there are differentials in performance and behavior that can be attributed to them. During the 20th century, white people were in power while black people, indigenous people, and immigrants were segregated into neighborhoods and reservations and lived under harsh, discriminatory laws (Adelman 2003). Because of these factors and many others, rates of illness and death were higher for these populations than for whites. It was easy for white people to look at this and blame inferior genetics and racial differences for the differences in mortality. Eugenicists in the 1920s used this “science” to advance racist agendas focused on breeding strong, healthy white children while doing everything in their power to keep “inferior” races from having children at all (Adelman 2003).
As explained in “The Color of Wealth”, “the most persistent racist ideologies tend to be those actively promoted by governments” (2006, 21). Even though the GI Bill was devastating to communities of color, to me, racial redlining in neighborhoods has had the greatest impact on the racial wealth gap in the United States. Redlining denies loans, mortgages, and insurance to residents of certain neighborhoods regardless of their qualifications. These loans are often essential for a secure home, retirement, and college education. Redlining destroyed economic opportunities for people in many neighborhoods, even when the US as a whole was going through periods of economic growth. Denial of these loans prevented people in redlined areas from building and having wealth, educational opportunities, job opportunities, and ultimately the chance to retire and have wealth to pass down to future generations (Medoff and Sklar 1994).
This kind of discrimination and inequality has been in the fabric of Massachusetts since its founding. Governor John Winthrop, exclaimed “In all times some must be rich, some poor, some high and eminent in power and dignity; others mean and in subjection” (Medoff and Sklar 1994, 7). Puritans had free reign to punish “blasphemers” and Native Americans, who, in their eyes, “had no legal standing in the colonial domain” (Medoff and Sklar 1994, 8). African slaves first came to Boston around 1638, and the slave trade in New England increased after 1644 but was abolished in 1780 when a Declaration of Rights was added to the Constitution. Despite this, Boston was the most segregated city in the northern US in 1850. (Medoff and Sklar 1994).
During WWI, fear of immigrants coming to the US increased and caused upper-middle-class people in Boston to flee to the suburbs while immigrants and other working-class people moved into multi-family units in different parts of the city. When southern agriculture became more mechanized, many blacks/African Americans moved north to Boston and the surrounding areas. However, Boston was just as discriminatory as the South. Black/African American folks in Boston were excluded from jobs and housing and faced job and educational segregation (Medoff and Sklar 1994). This was all reinforced by a lack of political power and representation. Mel King wrote “...the ghetto allowed the ruling elite to blame the Black community for what they had systematically imposed on us” (Medoff and Sklar 1994, 13).
“White Flight” from areas that had an increasing black population was subsidized by the government by moving private and public investment from those areas to follow white people wherever they went, simultaneously disinvesting in black communities and blaming the decay on people of color. In an effort to increase tax revenue in the city and “reverse urban decline” (Medoff and Sklar 1994, 17), the city of Boston essentially destroyed low-income neighborhoods in locations that were considered desirable, which made room for offices, stores, hotels, and upscale housing (Medoff and Sklar 1994). By 1985, Boston had areas of persistent poverty, unemployment, and a shortage of safe, affordable housing. The continuing disinvestment in communities of color and people of low SES was made worse by redlining and being denied credit from banks. These practices continue to this day. Johnson (2017) explains that in Boston, people of color are still being denied home loans and banks are still lending disproportionately to middle and upper-class people, exacerbating segregation and the racial wealth gap. Racism experienced by people of color in other neighborhoods makes some afraid to live amongst whites for fear of discrimination.
Racism also causes health disparities. Camara Jones explains that “racial” health disparities are created at 3 different levels: “Differential care within the healthcare system, differential access to health care, and differences in exposures and life opportunities that create different levels of health and disease” (2002, 8). There are interventions that can be made at each level. The most difficult to tackle is likely the differences in exposures and life opportunities which result in different levels of health and disease. To improve on this, there needs to be a national conversation about racism and the social determinants of health, and the structures and institutions that uphold racism in the United States need to be rebuilt.
Racism impacts health outcomes directly and indirectly, at the individual and community level. Long-term exposure to racism, hate crimes, and other forms of racially-violence can increase stress and raise cortisol levels in the body, which leads to various health issues over time (Adelman 2008c). Racism leads to segregation in cities and neighborhoods, forcing people of color to live in areas that are further from healthy food options, closer to pollutants, and do not have safe spaces to recreate. These areas often have worse schools, and therefore lower socioeconomic status and poorer health outcomes in the long term. Additionally, racism causes social exclusion perpetrated against individuals and communities. Strong community or social support has also been shown to improve and maintain health outcomes, so social isolation can make health outcomes worse for individuals and groups (Adelman 2008a). Racism can overpower other social determinants of health that generally improve health outcomes, like higher levels of education and socioeconomic status. For example, as explained by Greene and Love in the Groundwater Approach, infant mortality rates are lower for white women even when they have a lower level of education than black women (2018).
As Kimbelé Crenshaw explains in her TEDTalk, without frameworks with which we can see how social problems impact all members of a targeted group, people will fall through the cracks and be left to suffer (2016). Intersectionality demonstrates how many different forms of discrimination (racism, sexism, ableism, ageism, etc) overlap and impact each other, and is a crucial framework for our work in public health and social justice because it shows that the causes of injustice are all connected. Intersectionality allows public health practitioners to see the whole picture of how discriminatory structures interact, overlap, and impact the health and well-being of multiple groups (Ford and Airhihenbuwa 2010b).
Critical Race Theory is a helpful framework to help with this as well. The goal of Critical Race Theory is to study racism, examine the historical and sociopolitical roots of current disparities, look at how structural forces and current paradigms within the field uphold those disparities and focus on the intersectionality and antiracism as educational tools and ways to examine white identity and fragility (Ford and Airhihenbuwa 2010a, s32). It is an iterative methodology that requires the investigator to ask questions of oneself and examine their role in upholding racist structures and practices (Ford and Airhihenbuwa 2010a). Critical Race Theory helps the public health practitioner and their projects remain focused on racial equity and the power imbalances that are both the cause and result of racial inequities. Public health practitioners must go further than simply documenting inequities, they must ask questions of themselves, their peers, and the structures and systems that have caused those inequities.
Reflection
My racial identity is white, and my ethnicity is an even split of one-half Polish and one-half Norwegian. Other people identify me racially as white, and most people even guess that I am of Scandinavian descent because of my blonde hair and light eyes. I realize that this is a privilege– I have never really had to explain my racial or ethnic identity to anyone, and I have never had my race or ethnicity misidentified or questioned.
I first became aware of my own racial identity when I went to college. I grew up in Boise, Idaho, which is a predominantly white city inside of a predominantly white state. Throughout elementary school, junior high, and high school, there were only 3 or 4 students of color in my class of several hundred people. I never confronted or was confronted with race or racism while I lived in Idaho. More recently I have reflected on what we were taught in our high school regarding the black history, indigenous history, Latinx history, and Asian history of Idaho and the West in general. We learned about manifest destiny, but not about the indigenous people that land was stolen from during that time. My history classes throughout my education were extremely whitewashed.
I was not truly forced to think about race or white privilege until my college years. There were many people in my life who were honest with me about their experiences as people of color and talked to me about my white privilege and how it impacted their lives. Unfortunately, I was not wise enough to see that was work that I needed to do for myself. For a long time, I relied on people of color to educate me, and I now look back on that with embarrassment, because it is not the role of the oppressed to educate the oppressor.
The field of reproductive health and rights has a long racist and unethical history. The founder of the organization where I work, Planned Parenthood, was a eugenicist and held twisted racist ideas about birth control and who should be allowed to have children. As a white woman that works in this field and at that particular organization, I have to recognize my part in this history and I must be very cognizant of my personal position, values, and biases surrounding race and the work I do. Through the work I do I have had some very uncomfortable moments with myself where I have had to think about my internalized biases because I did not want them to influence interactions with my patients. I have had to consider why I have certain thoughts and feelings about patients, and what the historical context of those feelings could be. It is really hard to admit to yourself and to others that you carry internalized racism and that it influences your actions, even when you don’t want it to.
Many people of color do not trust Planned Parenthood or the people who work there, and I consider it part of my job to help build that trust. I work extremely hard to make sure that all of our patients feel respected and informed, and that they know that they have the power to make decisions regarding their reproductive health. I hope to continue doing reproductive justice work, not just reproductive health work. The goal for my future public health career is to help change policy to create living conditions that create freedom for every person to make the right reproductive choices for themselves and their families.
White people need to talk about racism because racism is why we have power, money, and status. Race is a concept that white people came up with to control people that were different from us. We benefit from racism every single day. Because white people use racism as a tool to create a system that keeps us in power, white people are the ones that need to put in work to dismantle that system.
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