A Discussion on Race and Racism: Part I

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), www.itvs.org)

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 instituti onalization
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
(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
newsletter@cahealthadvocates.org 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 in the nation. It was created in 1980 to develop more analytical, culturally-rooted and effective community organizers. The website contains information on their training sand staff and has an excellent list of recommended readings on the topics of race and white privilege.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.