Читать книгу Health Promotion Programs - (SOPHE) Society for Public Health Education - Страница 57

Acknowledge racism as a system of structured inequity and not an individual character flaw. Name racism as a determining force in the distribution of the social determinants of health and equity. Identify the structures, policies, practices, norms, and values in which racism may be operating. Among the variety of causes of racial and ethnic disparities in health, racism is the one factor that needs some explanation. Race is a social construct, not a biological reality. Unlike age, neither race nor ethnicity have fixed, objective referents—that is, they have no scientific markers for anyone to verify but are terms that are self-adopted or imposed (EqualHealth, n.d.). In general in the United States, one is assigned to a race based on the color of one’s skin, which does not begin to capture the genetic and cultural differences among those residing in the United States who are assigned to the racial category of Black (Jones, 2001).

While we often characterize our American society as a great melting pot and while the relationships between individuals assigned to different racial categories have improved dramatically, race still governs the distribution of risks and opportunities in our society to a great degree. Jones (2001) describes three types of racism that affect health outcomes: institutionalized racism, personally mediated racism, and internalized racism. Institutionalized racism is described as differential access to goods, services, resources, and opportunities by race. For example, the majority of minority children attend high-poverty, under-resourced schools, while the percentage of White children attending this type of school is much lower. Personally mediated racism is discrimination in which the majority racial group treats members of a minority group as inferior and views the minorities’ abilities, motives, and intents through a lens of prejudice based on race. This type of racism is what most individuals think of when they hear the term racism. It manifests as lack of respect, suspicion, devaluation, scapegoating, and dehumanizing. Internalized racism is acceptance by members of the stigmatized race of negative messages about their own abilities and intrinsic worth. It manifests as self-devaluation, helplessness, and hopelessness, potentially leading to risky behaviors that can endanger a person’s health.

Racism has brought suffering and misery to the United States and the world, and has had a direct effect on health inequity. The Campaign Against Racism led by the Social Medicine Consortium states that is critical that we implement an anti-racist agenda that overcomes the legacy of colonialism and racism through: 1) naming racism; 2) asking how racism is operating; and 3) organizing and strategizing to act (EqualHealth, n.d.).

The difference between past and present calls for racial equity is that advocates are demanding that Americans choose sides: are you racist or antiracist? This concept has roots in critical race theory, which was developed in the 1970s in law schools (Delgado & Stefancic, 2017). Its supporters say that America is fundamentally racist and call for white people to acknowledge the advantages of being born white. A consequence of COVID-19 in the United States was to intensify the conversation on race that has not been a priority since the 1970s, when a series of court orders forced urban school districts around the nation to bus students to integrate schools. While the term “antiracist” has long been used by activists and academics to mean that a person or organization doesn’t solely condemn racism, they actively fight it, little consensus exists on what antiracism means in other sectors including human services, education, and business. It could include building more-diverse leadership teams, paying livable wages, and supporting policies to change policing. However, the term is little more than marketing if not accompanied by years of deliberate work.

Prior to the pandemic, in health promotion programs efforts such as diversity and cultural diversity training for health promotion program staff were institutionalized responses that were accepted as standard practice without broader organizational and societal support to address racism. Expectations have now changed with multiple levels of systematic actions including policy, operating procedures, and training. An example of such work is the Roots of Health Inequity Project, which explores the root causes of inequity in the distribution of disease, illness, and death. Funded by the National Center for Minority Health and Health Disparities, National Institutes of Health, its audience is primarily the local public health and health promotion workforce. It seeks to ground participants in the concepts and strategies that lead to effective action for organizations and professionals to be anti-racist to lead the broad efforts to impact health promotion program planning, implementation, and evaluation (NACCHO, 2021).