3.3 Racism and its Effects on Health
Katie Baker
Racism is the belief that one group of people is superior or inferior to another based on perceived physical and cultural characteristics. Although race has no biological basis, it has very real repercussions for its victims. Genetic variance within a given geographic population is greater than that between populations, and there are no genetic variables that can be identified and labeled as markers of race, yet race is used to justify unequal treatment around the world.
While racism has existed for as long as there have been societies, the racism against Black, Indigenous, and People of Color (BIPOC) in the United States was intentionally woven into its founding. This began with the forced removal of Native nations, the establishment of slavery, and the denial of representation for anyone other than white male landowners. While enslaved people were part of colonial society from the time Europeans first landed on the U.S. east coast, the U.S. Constitution’s Thirteenth Amendment, which abolished slavery, was not ratified until 1865, almost 100 years after the country’s founding. Racism against Asian immigrants was institutionalized through laws such as the Page Act of 1875 and the Chinese Exclusion Act of 1882, which explicitly restricted immigration from certain Asian countries. Additionally, mob violence and forced deportations of Latinx individuals have been persistent features of U.S. history since its inception.
Today, legal racism is less overt but still prevalent in laws that disproportionately affect people from different backgrounds. While individual acts of racism can have profound effects on their targets, the societal impact of racism is embedded in institutions such as the justice system, healthcare, education, and all levels of government. It is this systemic and institutional racism that primarily influences the social determinants of health discussed in this chapter.
Structural and Institutional Racism in Healthcare
Racism within the healthcare system can be both overt, through practitioner prejudices in patient interactions, or hidden and well-intentioned, such as when treatment protocols for BIPOC patients differ from those of white patients. In healthcare education, there is, unfortunately, still much much work to be done to address disparities in diagnosis and treatment that are taught at our institutions. Racism contributes to both mortality and morbidity rates in BIPOC populations.
A recent study (Hoffman et al., 2016) indicates that over half of the 418 students sampled from the University of Virginia medical school system believed in myths about biological differences between Black and white patients. While this is just a sample of students at one institution, it is not hard to imagine what harm these beliefs could cause if not addressed in early medical education. Indeed, unexamined biases can lead to unintentional outcomes that negatively affect patient care.
Tackling bias