Personally mediated racism is discrimination in which the majority racial group treats members of a minority group as inferior and views the minorities’ abilities, motives, and intents through a lens of prejudice based on race. This type of racism is what most individuals think of when they hear the term racism. It manifests as lack of respect, suspicion, devaluation, scapegoating, and dehumanizing. Internalized racism is acceptance by members of the stigmatized race of negative messages about their own abilities and intrinsic worth. It manifests as self-devaluation, helplessness, and hopelessness, potentially leading to risky behaviors that can endanger a person’s health.
Racism has brought suffering and misery to the United States and the world, and has had a direct effect on health inequity. The Campaign Against Racism led by the Social Medicine Consortium states that is critical that we implement an anti-racist agenda that overcomes the legacy of colonialism and racism through: 1) naming racism; 2) asking how racism is operating; and 3) organizing and strategizing to act (EqualHealth, n.d.).
The difference between past and present calls for racial equity is that advocates are demanding that Americans choose sides: are you racist or antiracist? This concept has roots in critical race theory, which was developed in the 1970s in law schools (Delgado & Stefancic, 2017). Its supporters say that America is fundamentally racist and call for white people to acknowledge the advantages of being born white. A consequence of COVID-19 in the United States was to intensify the conversation on race that has not been a priority since the 1970s, when a series of court orders forced urban school districts around the nation to bus students to integrate schools. While the term “antiracist” has long been used by activists and academics to mean that a person or organization doesn’t solely condemn racism, they actively fight it, little consensus exists on what antiracism means in other sectors including human services, education, and business. It could include building more-diverse leadership teams, paying livable wages, and supporting policies to change policing. However, the term is little more than marketing if not accompanied by years of deliberate work.
Prior to the pandemic, in health promotion programs efforts such as diversity and cultural diversity training for health promotion program staff were institutionalized responses that were accepted as standard practice without broader organizational and societal support to address racism. Expectations have now changed with multiple levels of systematic actions including policy, operating procedures, and training. An example of such work is the Roots of Health Inequity Project, which explores the root causes of inequity in the distribution of disease, illness, and death. Funded by the National Center for Minority Health and Health Disparities, National Institutes of Health, its audience is primarily the local public health and health promotion workforce. It seeks to ground participants in the concepts and strategies that lead to effective action for organizations and professionals to be anti-racist to lead the broad efforts to impact health promotion program planning, implementation, and evaluation (NACCHO, 2021).
Address Root Causes of Health Disparities
There are those who encourage health promotion program staff as they plan, implement, and evaluate their programs and advocacy efforts to consider moving upstream and addressing the social determinants of health. A number of strategies are recommended:
Increase high school graduation rates of poor and minority students: Two major consequences for students living in a high-poverty family include an achievement gap limiting students’ success in school and a health disparities gap. These disparities are interrelated in students from families in the lowest quartile of income: they are about seven times more likely to drop out of high school than are their counterparts who come from families within the highest quartile of income. Children from poor families experience more chronic and infectious disease, childhood injury, social/emotional and behavioral problems, and violence compared to children who do not live in poverty. These health disparities increase absenteeism from school and affect learning. More teachers teaching minority students are not credentialed (U.S. Department of Education, 2016). Students of color also experience disproportionately higher suspension/expulsion rates, which increases the absenteeism rate of these students and which in turn contributes to failing classes and ultimately dropping out of school. To address educational inequities, the local health department and the local education agency could establish a community-wide school health council to coordinate the health promotion activities of the community, linking the various health, social service, juvenile justice, and youth development agencies in the community to ensure that inequities in education are eliminated. Students who receive health interventions and other services have been linked with increasing academic success.
Increase health literacy: Health literacy requires that individuals have the capacity to obtain, process, and understand basic health information in order to make healthy choices and secure those interventions needed to prevent or treat disease. Low health literacy has been associated with poor self-reported health status in many diverse populations, including Latinos and Asian Americans, even when education and other well-established predictors of health status are controlled (Healthy People 2030). The problem is twofold. First, navigating the healthcare and health insurance systems with their jargon and terminology creates barriers to know where to go and what actions to take. Secondly, although there are many sources for health promotion information, individuals with low health literacy frequently have trouble taking the right medication and following prescribed health promotion assignments and programs (Koh & Rudd, 2015). In order to help individuals who have particular difficulty with health literacy, use jargon-free written materials, provide simple and understandable step-by-step instructions about health activities, and consider engaging English as a second language programs to address health literacy levels in their classes (Koh & Rudd, 2015; Soto Mas et al., 2015).
Improve air, water, and soil quality: Environmental toxins that adversely affect health need to be reduced. For example, a healthier environment is achieved by reducing exposure to diesel particulates by prohibiting diesel trucks in residential neighborhoods, enforcing the no-idling law near schools, requiring the use of clean technology in new ships and trucks, reducing emissions in existing fleets, and implementing existing state and federal emissions regulations. Monitoring the impact of trucking and shipping activities needs to be expanded among low-income and vulnerable populations. Input from public health professionals on the impact of air pollution needs to also be incorporated in local land use and development decisions, using such tools as health impact assessments during planning phases (Healthy People 2030).
Improve housing options: High-quality, affordable, stable housing located close to resources leads to reduced exposure to toxins and stress, stronger relationships and willingness to act collectively among neighbors, greater economic security for families, and increased access to services (including healthcare) and resources (such as parks and supermarkets) that influence health. Policies need to be implemented that support transit-oriented development, along with incentives for mixed-use and mixed-income development. View one community’s three-pronged plan to end homelessness at Destination: HOME (Destination: HOME, n.d.).
Improve transit options by providing incentives for use of mass transit and nonmotorized vehicle transportation: Designing streets that are safe and accessible for all users (that is, complete streets) will encourage walking and bicycling. Enhancing the safety, accessibility, and affordability of mass transit is also essential. Increased use of these types of transit will decrease air pollution and increase physical activity, which will lead to healthier individuals and communities.
Support healthy behaviors through increased opportunities to engage in physical activity and to access healthy foods: Because physical activity is key to preventing disease and promoting health, policies are needed to encourage physical activity in school and facilitate after-hours use of school grounds and gyms to improve community access to physical activity facilities. Zoning laws and general plans need to be developed to improve the safety of parks, walking paths, and other recreational facilities in high-crime and low-income communities. In addition, provide support
