For Professionals: Health Care Disparities

A Discussion on Race and Racism: Part I

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Published: March 2005

Part of being an effective advocate for California’s diverse Medicare population is becoming aware of and actively addressing racism. In the U.S., race classifications have a profound impact on people’s daily life experiences, and for people in the “non-white” race classifications, these impacts are mostly negative. An earlier edition of Diversity Connections which focused on outreach strategies to African American communities summarized just a few of these negative impacts in terms of health disparities.

The studies demonstrate that these gross inequalities in health status and treatment are found across most minority populations and diseases regardless of where people live (wealthy versus poor neighborhoods), their age, their income amount, or what their health insurance covers. Access to care, income-level, and neighborhood environment don’t explain the totality of these disparities; racism and its corollary, white privilege do. This article on race and racism is Part One of a two-part series meant to start a conversation about race, racism, and white privilege and to provide a list of resources for future learning and/or in-staff trainings. As advocates, we need to look critically at racism and/or white privilege both in terms of how it affects the lives of our clients and ourselves. In California, where ethnic and racial minorities comprise more than 50 percent of the state’s population, according to U.S. Census Bureau estimates, the problem of racism, unequal health, and racial inequalities in healthcare treatment “isn’t a problem for the few; it places the majority of people living here in California at risk.” (“Unequal Treatment, Unequal Health: What Data Tell Us About the Health Gaps in California” [download PDF] )

What is Race and Racism?

Race: Race is a social construction, a concept people created at a certain point in time. It does not hold any genetic or biological basis. While considerable biological variation exists within human populations, our racial categories fail to capture it. In fact, there is more genetic variation within our existing race groups than between them. Race is a modern idea. In the past, many ancient societies divided people according to religion, status, class or even language, but not according to physical differences. Also, societies enslaved others as a result of conquest or debt but not because of physical differences or a belief in natural inferiority. Due to a unique set of historical circumstances, the U.S. had the first slave system where all the slaves shared a common appearance and ancestry. (“Ten Things Everyone Should Know about Race” (download PDF),

Thomas Jefferson was the first person to write about “race” when introducing the idea of an inferior people. In a country founded both on the principle that “all men are created equal,” and on the economic base of slavery, the idea of “race” helped explain why some people could be denied the rights and freedoms that others took as a given. In the first census of 1790, racial categories were specifically spelled out as not being equal; blacks were only considered three-fifths of a person in comparison to whites. The thirteenth amendment finally ended this three-fifths rule, and over time new racial categories were added to the census to keep track of new immigrants.

Racial categorization is rooted in racism and our racial groupings importantly capture differences in power, status and resources. Through U.S. history, racial classification has ranked the various racial groups implicitly or explicitly with whites on the top, blacks on the bottom, and other groups in between.


Racism was born when the concept of race was created. It is a phenomenon that affects everyone, whether in terms of creating and maintaining unearned privileges for some; creating social, economic, and health disparities for many; and/or dividing a society into the ‘haves’ and have-nots’ in regard to income, education, health, government representation and voice. Racism is complex and it involves both unconscious and conscious forms of discrimination and institutionalization in which one ‘group’ has:

  • Power: the capacity to make and enforce decisions is disproportionately or unfairly distributed;
  • Resources: unequal access to such resources as money, education, information, etc.;
  • Standards: standards for appropriate behavior are ethnocentric, reflecting and privileging the norms and values of the dominant race/society; and the
  • Ability to define problems: involves defining "reality" by naming "the problem" incorrectly, and thus misplacing it (for example, attributing poverty and the negative health effects of racism on people of color to “laziness” and “genetics.”)

A former professor from the Harvard School of Public Health, Camara Phyllis Jones, wrote an excellent article, Levels of Racism: a Theoretic Framework and a Gardener’s Tale (PDF), that outlines racism in terms of 3 defined levels. She explains how these levels of racism are expressed, experienced, and maintained through the metaphor of a garden and its gardener. These 3 levels include:

  • Institutionalized racism — differential access to the goods, services, and opportunities of society by race;
  • Personally mediated racism — prejudice (differential assumptions) and discrimination (differential action/treatment) by individuals towards others; and
  • Internalized racism — acceptance by members of the stigmatized races of negative messages about their own abilities and intrinsic worth.

As mentioned earlier, since many of the health disparities experienced by people of color are due in large part to the direct and indirect effects of racism, part of being an effective advocate for Medicare beneficiaries of color, is to first develop an awareness of these levels of racism, begin a dialogue, and work together for change.


Listed below are some resources advocates can use for personal learning and/or organizational staff trainings on undoing racism. People who would like to share additional resources/trainings, please email and I will include the information in the next edition of CalMedicare Advocate. Wherever one is along the spectrum of color and awareness, this is an important dialogue to start, continue, and expand into action.

  • Unequal Treatment, Unequal Health: What Data Tell Us About the Health Gaps in California (download PDF), a joint report by the National Academy of Sciences Institute of Medicine, Cause Communications and The California Endowment.
  • Levels of Racism: a Theoretic Framework and a Gardener’s Tale (download PDF)– an article from the American Journal of Public Health, by Camara Phyllis Jones, that describes in detail three levels of racism and how they inform and support one another.
  • Race: the Power of an Illusion - this three-part film documentary series demonstrates how race is both a biological myth and a social invention. It uncovers the history of race, including the 'science' that justified it, and traces how these beliefs became engrained in people’s minds. The series shows that while race may be a biological fiction, the consequences of racism are very real.
  • Undoing Racism in Public Health: a Blueprint for Action in Urban MCH (PDF) — this guide provides an overview of racism and institutional racism and offers tools for health departments and organizations in the areas of anti-racism education, awareness and change.
  • The Way Home – this educational video produced by Dr. Shakti Butler is an appropriate tool for diversity training, professional development, organizational retreats and educational seminars. It features voices of sixty-four women from a cross-section of cultures who share their experiences of systematic oppression through the lens of racism in the United States. Information on organizational/professional trainings is also available on World Trust website.
  • The People’s Institute – this organization is recognized as one of the foremost anti-racism training and organizing institutions in the nation. It was created in 1980 to develop more analytical, culturally-rooted and effective community organizers. The website contains information on their trainings and staff and has an excellent list of recommended readings on the topics of race and white privilege.

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