Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 109 Observatory Street, SPH I, Ann Arbor, MI 48109-2029, USA.
Ethn Dis. 2010 Winter;20(1):71-6.
The science of eliminating racial health disparities requires a clear understanding of the underlying social processes that drive persistent differences in health outcomes by self-identified race. Understanding these social processes requires analysis of cultural notions of race as these are instantiated in institutional policies and practices that ultimately contribute to health disparities. Racism provides a useful framework for understanding how social, political and economic factors directly and indirectly influence health outcomes. While it is important to capture how individuals are influenced by their psychological experience of prejudice and discrimination, racism is more than an intrapersonal or interpersonal variable. Considerable attention has focused on race-based residential segregation and other forms of institutional racism but less focus has been placed on how cultural values, frameworks and meanings shape institutional policies and practices. In this article, we highlight the intersection of cultural and institutional racism as a critical mechanism through which racial inequities in social determinants of health not only develop but persist. This distinction highlights and helps to explain processes and structures that contribute to racial disparities persisting across time and outcomes. Using two historical examples, the National Negro Health Movement and hospital desegregation during the Civil Rights Era, we identify key questions that an analysis of cultural racism might add to the more common focus on overt policy decisions and practices.
消除种族健康差异的科学需要清楚地理解导致自我认同的种族在健康结果上持续存在差异的潜在社会过程。理解这些社会过程需要分析种族的文化观念，因为这些观念体现在最终导致健康差异的制度政策和实践中。种族主义为理解社会、政治和经济因素如何直接和间接地影响健康结果提供了一个有用的框架。虽然捕捉个人如何受到偏见和歧视的心理体验的影响很重要，但种族主义不仅仅是一个个人或人际变量。人们已经相当关注基于种族的居住隔离和其他形式的制度种族主义，但对文化价值观、框架和意义如何塑造制度政策和实践的关注较少。在本文中，我们强调了文化和制度种族主义的交叉，这是社会决定健康的种族不平等不仅发展而且持续存在的关键机制。这种区别突出并有助于解释导致种族差异随着时间和结果持续存在的过程和结构。我们使用两个历史例子，即全国黑人健康运动和民权时代的医院去隔离化，确定了文化种族主义分析可能会增加对更常见的公开政策决策和实践的关注的关键问题。
