Naming, Measuring, and Addressing

1. Naming, Measuring, and Addressing the Impacts of Racism on Health

2. What is racism? A system

3. What is racism? A system of structuring opportunity and assigning value

4. What is racism? A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”)

5. What is racism? A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”) • Unfairly disadvantages some individuals and communities

6. What is racism? A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”) • Unfairly disadvantages some individuals and communities • Unfairly advantages other individuals and communities

7. What is racism? A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”) • Unfairly disadvantages some individuals and communities • Unfairly advantages other individuals and communities • Saps the strength of the whole society through the waste of human resources Source: Jones CP, Phylon 2003

8. “Reactions to Race” module Six-question optional module on the Behavioral Risk Factor Surveillance System Piloted by six states in 2002 Now available to all states

9. States using the “Reactions to Race” module Arkansas2004 California2002 Colorado2004 Delaware200220042005 District Columbia2004 Florida2002 Indiana 2009 Michigan2006 Mississippi2004 Nebraska 2008 2009 New Hampshire2002 New Mexico2002 North Carolina2002 Ohio20032005 Rhode Island20042007 South Carolina20032004 Virginia 2008 Washington2004 Wisconsin200420052006

10. States using the “Reactions to Race” module on 2004 BRFSS Arkansas, Colorado, Delaware, District of Columbia, Mississippi, Rhode Island, South Carolina, Wisconsin

11. Socially-assigned “race” How do other people usually classify you in this country? Would you say: White Black or African-American Hispanic or Latino Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Some other group

12. General health status Would you say that in general your health is: Excellent Very good Good Fair Poor

16. General health status and “race” “White” social experience associated with better health

17. Self-identified ethnicity Are you Hispanic or Latino? Yes No

18. Self-identified “race” Which one or more of the following would you say is your race? White Black or African-American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Other Which one of these groups would you say best represents your race?

19. Self-identified “race”/ethnicity Hispanic “Yes” to Hispanic/Latino ethnicity question Any response to race question White “No” to Hispanic/Latino ethnicity question Only one response to race question, “White” Black “No” to Hispanic/Latino ethnicity question Only one response to race question, “Black” American Indian/Alaska Native “No” to Hispanic/Latino ethnicity question Only one response to race question, “AI/AN”

20. Two measures of “race” How usually classified by others How self-identify

21. Two measures of “race” How usually classified by others How self-identify

22. Two measures of “race” How usually classified by others How self-identify

23. General health status, by self-identified and socially-assigned "race", 2004 100 80 60 58.6 53.7 percent of respondents 39.8 40 20 0 Hispanic-Hispanic Hispanic-White White-White Report excellent or very good health

24. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health Hispanic-Hispanic versus White-White p < 0.0001 80 60 58.6 percent of respondents 39.8 40 20 0 Hispanic-Hispanic White-White Report excellent or very good health

25. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health Hispanic-Hispanic versus Hispanic-White p = 0.0019 80 60 53.7 percent of respondents 39.8 40 20 0 Hispanic-Hispanic Hispanic-White Report excellent or very good health

26. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health Hispanic-White versus White-White p = 0.1895 80 60 58.6 53.7 percent of respondents 40 20 0 Hispanic-White White-White Report excellent or very good health

27. Two measures of “race” How usually classified by others How self-identify

28. Two measures of “race” How usually classified by others How self-identify

29. General health status, by self-identified and socially-assigned "race", 2004 100 80 60 58.6 52.6 percent of respondents 40 32 20 0 AIAN-AIAN AIAN-White White-White Report excellent or very good health

30. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health AIAN-AIAN versus White-White p < 0.0001 80 60 58.6 percent of respondents 40 32 20 0 AIAN-AIAN White-White Report excellent or very good health

31. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health AIAN-AIAN versus AIAN-White p = 0.0122 80 60 52.6 percent of respondents 40 32 20 0 AIAN-AIAN AIAN-White Report excellent or very good health

32. General health status, by self-identified and socially-assigned "race", 2004 100 Test of H0: No difference in proportions reporting excellent or very good health AIAN-White versus White-White p = 0.3070 80 60 58.6 52.6 percent of respondents 40 20 0 AIAN-White White-White Report excellent or very good health

33. General health status and “race” “White” social experience associated with better health Even within the same self-identified “race”/ethnic group

38. General health status and “race” “White” social experience associated with better health Even within the same self-identified “race”/ethnic group Even within the same educational level

43. General health status and “race” “White” social experience associated with better health Even within the same self-identified “race”/ethnic group Even within the same educational level “White” social experience associated with higher education

44. Key questions WHY is socially-assigned “race” associated with self-reported general health status? Even within the same self-identified “race”/ethnic group Even within the same educational level WHY is socially-assigned “race” associated with educational level?

45. Racism A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”) • Unfairly disadvantages some individuals and communities • Unfairly advantages other individuals and communities • Saps the strength of the whole society through the waste of human resources Source: Jones CP, Phylon 2003

46. Levels of racism • Institutionalized • Personally-mediated • Internalized

47. Institutionalized racism • Differential access to the goods, services, and opportunities of society, by “race” • Examples • Housing, education, employment, income • Medical facilities • Clean environment • Information, resources, voice • Explains the association between SES and “race”

48. Personally-mediated racism • Differential assumptions about the abilities, motives, and intents of others, by “race” • Prejudice and discrimination • Examples • Police brutality • Physician disrespect • Shopkeeper vigilance • Waiter indifference • Teacher devaluation

49. Internalized racism • Acceptance by the stigmatized “races” of negative messages about our own abilities and intrinsic worth • Examples • Self-devaluation • White man’s ice is colder • Resignation, helplessness, hopelessness • Accepting limitations to our full humanity

50. Levels of Racism: A Gardener’s Tale Source: Jones CP, Am J Public Health 2000