If these ethnic group disparities in health are not secondary to genetic or biological differences between the ethnic groups (American Anthropological Association, 1998; Barnett et al., 2001; Casper et al., 2000; Lewontin, 1995; Lieberman and Jackson, 1995; Williams, 1997), to what could the ethnic group disparities in health be attributed? Recent research suggests that behavioral risk profiles (NCHS, 1998) as well as direct and indirect effects of environmental and sociopolitical conditions are among the factors that contribute to these health disparities (Smith, Shipley, and Rose, 1990; Tennstedt and Chang, 1998). Racism is one environmental and sociopolitical condition that might help to explain the persisting disparities (Barnett et al., 2001; Casper et al., 2000; Krieger, 1999). The primary purpose of this chapter is to examine probable associations between racism and interethnic group health differences in the later years. Toward this end, the first section explores the ways in which racism has been conceptualized. In the context of a proposed conceptual model, the second section reviews research investigating the relationship of racism to different indices of health, and the final section highlights several directions for future research.
Throughout this chapter, racism is used to refer to “beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics [e.g., skin color, hair texture, width of nose, size of lips] or ethnic group affiliation” (Clark, Anderson, Clark, and Williams, 1999, p. 805). Defined in this way, racism can exist at both the individual and institutional levels and include subjective and more objective experiences of racism. Consistent with Clark et al. (1999), perceived racism involves perceptions of prejudiced attitudes and discriminatory behaviors, and is not limited to more overt expressions of behaviors (e.g., being called a “nigger”). That is, perceived racism may also include perceptions of subtler forms of racism (e.g., symbolic beliefs and behaviors) (McConahay and Hough, 1976; Sears, 1991; Yetman, 1985). Although perceived racism will be the focus of this chapter, institutional racism (discussed in detail elsewhere in this volume), which may not be perceived, is also included, given its complex and often overlooked relationship to perceived racism and health status.
Although several terms have been used in the scientific literature to describe perceived racism, it is important to note that using the definition of racism forwarded by Clark et al. (1999), perceived racism is not necessarily characterized by feelings of racial superiority, an ethnic group’s control over valued resources, or the power of an ethnic group to impose its beliefs and values on others. Any member of a given ethnic group has the capacity to be racist against members of other ethnic groups (interethnic group