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The author presents a theoretic framework for understanding racism on 3 levels: institutionalized, personally mediated and internalized. This framework is useful for raising new hypotheses about the basis of race-associated dif ferences in health outcomes, as well as for designing effective interventions to eliminate those differences.
She then presents an allegory about a gardener with 2 flower boxes, rich and poor soil, and red and pink flowers. This allegory illustrates the relationship between the 3 levels of racism and may guide our thinking about how to intervene to mitigate the impacts of racism on health. It may also serve as a tool for starting a national conversation on racism. (Am J Public Health. 2000-90: 1212-1215)
Race-associated differences in health outcomes are routinely documented in this country, yet for the most part they remain poorly explained. Indeed, rather than vigorously exploring the basis of the differences, many scientists either adjust for race or restrict their studies to one racial group.1 Ignoring the etiologic clues embedded in group differences impedes the advance of scientific knowledge, limits efforts at primary prevention, and perpetuates ideas of biologically determined dif ferences between the races.
The variable race is only a rough proxy for socioeconomic status, culture, and genes, but it precisely captures the social classification of people in a race-conscious society such as the United States. The race noted on a health forth is the same race noted by a sales clerk, a police officer, or a judge, and this racial classification has a profound impact on daily life experience in this country. That is, the variable "race" is not a biological construct that reflects innate differences,2-4 but a social construct that precisely captures the impacts of racism.
For this reason, some investigators now hypothesize that race-associated differences in health outcomes are in fact due to the effects of racism.5,6 In light of the Department of Health and Human Services' Initiative to Eliminate Racial and Ethnic Disparities in Health by the Year 2010,7,8 it is important to be able to examine the potential effects of racism in causing race-associated differences in health outcomes.
Levels of Racism
I have developed a framework for understanding racism on 3 levels: institutionalized, personally mediated, and internalized. This framework is useful for raising new...