Department of Sociology, Texas A&M University, College Station, TX 77845, USA.
Department of Sociology, Texas A&M University, College Station, TX 77845, USA.
Soc Sci Med. 2014 Feb;103:7-14. doi: 10.1016/j.socscimed.2013.09.006.
This article draws upon a major social science theoretical approach-systemic racism theory-to assess decades of empirical research on racial dimensions of U.S. health care and public health institutions. From the 1600s, the oppression of Americans of color has been systemic and rationalized using a white racial framing-with its constituent racist stereotypes, ideologies, images, narratives, and emotions. We review historical literature on racially exploitative medical and public health practices that helped generate and sustain this racial framing and related structural discrimination targeting Americans of color. We examine contemporary research on racial differentials in medical practices, white clinicians' racial framing, and views of patients and physicians of color to demonstrate the continuing reality of systemic racism throughout health care and public health institutions. We conclude from research that institutionalized white socioeconomic resources, discrimination, and racialized framing from centuries of slavery, segregation, and contemporary white oppression severely limit and restrict access of many Americans of color to adequate socioeconomic resources-and to adequate health care and health outcomes. Dealing justly with continuing racial "disparities" in health and health care requires a conceptual paradigm that realistically assesses U.S. society's white-racist roots and contemporary racist realities. We conclude briefly with examples of successful public policies that have brought structural changes in racial and class differentials in health care and public health in the U.S. and other countries.
本文借鉴了一种主要的社会科学理论方法——系统种族主义理论，来评估几十年来关于美国医疗保健和公共卫生机构种族维度的实证研究。从 17 世纪开始，对有色人种美国人的压迫是系统性的，并通过白人种族框架合理化，其中包含构成种族主义刻板印象、意识形态、形象、叙述和情感的内容。我们回顾了关于种族剥削性医疗和公共卫生实践的历史文献，这些实践有助于产生和维持这种种族框架，以及针对有色人种美国人的相关结构性歧视。我们研究了当代关于医疗实践中的种族差异、白人临床医生的种族框架以及有色人种患者和医生的观点的研究，以证明系统种族主义在整个医疗保健和公共卫生机构中的持续存在。我们从研究中得出结论，几个世纪的奴隶制、隔离和当代白人压迫所带来的制度化的白人社会经济资源、歧视和种族化框架，严重限制和限制了许多有色人种美国人获得足够的社会经济资源，以及获得足够的医疗保健和健康结果。要公正地解决医疗保健中持续存在的种族“差异”问题，需要一个概念范式，该范式要现实地评估美国社会的白人种族主义根源和当代种族主义现实。我们最后简要介绍了在美国和其他国家成功实施的公共政策的例子，这些政策在医疗保健和公共卫生方面带来了种族和阶级差异的结构性变化。
