Columbia University School of Social Work and Columbia Population Research Center.
Milbank Q. 2019 Sep;97(3):736-761. doi: 10.1111/1468-0009.12411.
Policy Points Racism is a fundamental cause of health inequities and disease, which requires policy solutions that address this cause directly rather than only targeting mechanisms. Cultural systems, such as cultural racism, undergird the social conditions that shape racial inequities in health, including social and health policy decision making, governance, practice, and public reception. Policies targeting racial health equity benefit from integrating social theory and meaningful assessments of the social context concerning race, racism, and health.
Improving the health of the total population may be insufficient in eliminating racial disparities in population health. An expanding commitment to understanding social determinants of health aims to address the social conditions that produce racialized patterns in health inequity. There is also a resurging and evolving interest in the influence of cultural barriers and assets in shaping racial inequities in health. The meaning and function of culture, however, remains underspecified.
This paper synthesizes analogous but fragmented concepts of cultural threat related to social and racial inequity as examined in public and population health, psychology, sociology, communications, media studies, and law. It draws on an existing typology of culture and social inequity to organize concepts related to cultural racism. Employing a transdisciplinary approach, the paper integrates multiple scholarly perspectives on cultural threat to frame cultural racism as cultural systems that promote false presumptions of white superiority relative to non-whites.
The lack of shared conceptual grounding and language regarding cultural threats to health hinders a more precise identification and measurement of cultural processes as well as comparisons of relative prevalence and influence of pathways linking cultural processes and social inequity. Evaluating intersections among culture, structures, and racism is a valuable analytical tool for understanding the production of social and racial inequities in health. To adequately address health inequities rooted in systemic racism, it is imperative to discuss the function of cultural racism in shaping population health in the United States.
Building a culture of health and achieving health equity requires that we assess cultural racism in a more meaningful way. Cultural processes are commonly referenced in health inequity scholarship, but the empirical literature generally lags behind the conceptual emphasis. A rich literature across disciplines has substantively engaged conceptualizations of culture and cultural processes, the importance of these processes as part of a system of racism, and mechanisms that may link cultural threats to health. When integrated, this literature offers essential insights for ways population health may address the complex issue of eradicating racial disparities in health.
种族主义是健康不平等和疾病的根本原因，需要制定直接针对这一原因的政策解决方案，而不是仅仅针对机制。文化体系，如文化种族主义，为塑造健康方面的种族不平等的社会条件提供了基础，包括社会和卫生政策决策、治理、实践和公众接受。针对种族健康公平的政策受益于整合社会理论和对与种族、种族主义和健康有关的社会背景进行有意义的评估。
仅仅改善总人口的健康状况可能不足以消除人口健康方面的种族差异。越来越多的人致力于理解健康的社会决定因素，旨在解决造成健康不平等的种族化模式的社会条件。文化障碍和资产在塑造健康方面的种族不平等方面的影响也重新引起了人们的兴趣，并不断发展。然而，文化的含义和功能仍未得到明确说明。
本文综合了公共和人口健康、心理学、社会学、传播学、媒体研究和法律中研究社会和种族不平等时涉及的与文化威胁类似但分散的概念。它借鉴了现有的文化和社会不平等分类法，将与文化种族主义有关的概念组织起来。本文采用跨学科方法，将关于文化威胁的多种学术观点整合在一起，将文化种族主义定义为促进相对于非白人的白人至上的虚假假定的文化体系。
缺乏关于文化对健康的威胁的共同概念基础和语言，阻碍了对文化过程进行更准确的识别和衡量，以及对将文化过程与社会不平等联系起来的途径的相对普遍性和影响进行比较。评估文化、结构和种族主义之间的交叉点是理解健康方面的社会和种族不平等产生的有价值的分析工具。为了充分解决根植于系统性种族主义的健康不平等问题，必须讨论文化种族主义在塑造美国人口健康方面的作用。
建立健康文化和实现健康公平需要我们以更有意义的方式评估文化种族主义。文化过程在健康不平等研究中经常被提及，但实证文献通常落后于概念重点。跨学科的丰富文献实质性地参与了文化和文化过程的概念化，这些过程作为种族主义体系的一部分的重要性，以及可能将文化威胁与健康联系起来的机制。这些文献综合起来，为实现人口健康解决消除健康方面的种族差异这一复杂问题提供了重要的见解。
