Healing Our Social Wounds

The last two decades of health research have produced many crucial studies documenting the association between perceived discrimination and ill health.12Suffice to say, the United States still has a stony road to trod to approach its post-racial aspirations.

Consider these studies of hiring practices. Resumes with white sounding names (e.g. Kristen or Brad) were evaluated more favorably than resumes with black sounding names such as Tanisha or Jermaine.3 A black applicant with a clean record not only had a lower chance of getting a job than a white applicant with a clean record, but also had job chances comparable to a white felon.4 Researchers not only discovered that Latinos with a clean record also had similar job chances as a white felon, they also found evidence of race-based job channeling, as applicants are steered to jobs different than the original job.5 Black applicants reported more experiences of downward channeling compared to whites (i.e., less customer contact, clearer hierarchy, manual rather than white-collar positions), while whites reported more offers channeling up.

Comparisons between highly selective vs. less selective college credentials uncover similar inequalities.6 A black graduate from a highly selective university (e.g., Harvard, Stanford, or Duke) had better prospects than a black graduate from a less selective university (e.g., University of Massachusetts-Amherst, University of California-Riverside, and University of North Carolina-Greensboro), but had the same chances as a white graduate from a less selective university. Work harder for less indeed.

In another arena, policies – and individuals’ actions and inaction – are driving re-segregation in cities like Charlotte, North Carolina. This comes at a time when health researchers highlight the importance of place for health outcomes, shining a spotlight on processes of neighborhood and school segregation. Place-based health risk factors have a social history. They are the downstream effects of individual attitudes and behaviors that increase social distance from non-whites, abetted by institutional policies.7

Employers discriminate against non-whites in one instance; residents flee non-whites in the other. Yet there are underlying factors shared by both. To the extent that these processes involve stereotypes, prejudice, and racial ideologies, social psychological research offers explanations for these phenomena. Studies of prejudice and racial ideologies have explained white opposition to school desegregation, affirmative action, welfare, neighborhood integration, and less punitive criminal justice policy.8910111213 They also suggest that prejudice could signal health risks for those who hold negative emotions directed at vulnerable groups.14 Presidential campaigns are not the only domains in which anger or resentment finds an outlet.

As researchers and clinicians seek preventions and interventions to improve population health and address health disparities, these studies beg a question: can public health responses help reduce discrimination by targeting the individuals and institutions responsible for preferring Kristen to Tanisha, for valuing a white felon as equally as a black or Latino applicant with a clean record, and for giving a black Harvard graduate the same job chances as a white graduate from a less selective university?

In her book, Why are All the Black Kids Sitting Together in the Cafeteria, Beverly Daniel Tatum quoted Wendell Berry, a white writer who asserted:

“If white people have suffered less obviously from racism than black people, they have nevertheless suffered greatly; the cost has been greater perhaps than we can yet know. If the white man has inflicted the wound of racism upon black men, the cost has been that he would receive the mirror image of that wound into himself. As the master, or as a member of the dominant race, he has felt little compulsion to acknowledge it or speak of it; the more painful it has grown the more deeply he has hidden it within himself. But the wound is there, and it is a profound disorder, as great a damage in his mind as it is in his society.”15

Perhaps healing the wounds of historical and contemporary discrimination and racism among vulnerable populations requires that public health responses address the discriminatory individuals, institutions, and ideologies that inflict these health burdens on others. If Berry is correct, health interventions tackling the dominant group’s “profound disorder” may ultimately reduce the damage done to society and the health of its vulnerable populations.

“The most fruitful orientation at a time like our own, when racism is generally condemned in principle, is a clinical one. It is legitimate to assume, at the beginning of the twenty-first century—as it might not have been at the beginning of the twentieth—that racism is an evil analogous to a deadly disease. But the responsibility … is not to moralize and condemn but to understand this malignancy so that it can be more effectively treated, just as a medical researcher studying cancer does not moralize about it but searches for knowledge that might point the way to a cure.”

— George M. Fredrickson, Racism: A Short History16

Tené T. Lewis is a National Advisory Committee member of the Robert Wood Johnson Foundation’s Health & Society Scholars program. Courtney D. Cogburn is a former Robert Wood Johnson Foundation Health & Society Scholar. David R. Williams is a former National Advisory Committee member of the Robert Wood Johnson Foundation’s Investigator Awards in Health Policy Research and has worked with the Robert Wood Johnson Foundation in numerous other capacities.

Darrell L. Hudson is a Robert Wood Johnson Foundation New Connections Junior Investigator.

Harold W. Neighbors is a former recipient of the Robert Wood Johnson Foundation Investigator Award and other RWJF funded research. Arline T. Geronimus is a former recipient of the Robert Wood Johnson Foundation Investigator Award in Health Policy Research. James S. Jackson is a former recipient of the Robert Wood Johnson Foundation Investigator Award and was co-chair of the Robert Wood Johnson Foundation New Connections Seventh Annual Symposium.

S. Michael Gaddis is a former Robert Wood Johnson Foundation Scholar in Health Policy Research.

Lawrence D. Bobo is a former National Advisory Committee member of the Robert Wood Johnson Foundation’s Scholar in Health Policy Research program.


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