Definitions

Anti-racism Action is a process of actively challenging racism and changing the policies, practices, and beliefs that perpetuate racism at the individual, institutional, and structural levels. The goal of anti-racism is to challenge racism and actively change the policies, behaviors, and beliefs that perpetuate racist ideas and actions.

Critical Race Theory, or CRT, is an academic and legal framework that identifies that systemic racism is part of American society, embedded in laws, policies and institutions that uphold and reproduce racial inequalities. CRT recognizes that racism is more than the result of individual bias and prejudice.

Discrimination is treating someone more or less favorably based on the group, class or category they belong to resulting from biases, prejudices and stereotyping. It can manifest as differences in care, clinical communication and shared decision-making.

Equity is assurance of the conditions for optimal health and well-being for all people.  Achieving equity requires valuing all individuals and populations equally, recognizing and rectifying historical injustices, and providing resources according to need.  “Group”-based disparities in health and well-being will be eliminated when equity is achieved.

Health Disparities are preventable differences in health outcomes that are experienced by socially, economically, and environmentally disadvantaged populations. Health disparities are linked to discrimination based on race and ethnicity, age, gender, sexual orientation and gender identity, ability, socioeconomic status, or other characteristics.    

Racial Equity is assurance of the conditions for optimal health and well-being for all people, with a focus on valuing all individuals and populations equally, recognizing and rectifying historical injustices, and providing resources according to need.  Racial equity requires monitoring for differences in outcomes and opportunities by “race” (the social interpretation of how one looks in a “race”-conscious society).

Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call “race”), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources. There are three levels of racism: cultural racism, structural racism, and interpersonal racism.

• Cultural racism is the presence of societal beliefs and customs that promote the concept that White culture is superior and that denigrates other cultures through stereotyping and framing the cause of disparities as biological, genetic, or cultural.
• Structural racism is “the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. These patterns and practices in turn reinforce discriminatory beliefs, values, and distribution of resources. … [A]      focus on structural racism offers a concrete, feasible, and promising approach towards advancing health equity and improving population health.” Law (political process, statutes, regulations, policies, guidance, advisory opinions, cases, budgetary decisions, as well as the process of or failure to enforce the law) is one tool for perpetuating structural racism.
• Interpersonal racism operates through individual interactions, where an individual’s conscious (explicit) and/or unconscious (implicit) racial prejudice limits equal access to resources in spite of anti-discrimination laws.

Social Determinants of Health are the social and environmental conditions in which people are born, live, learn, work, play, worship, and age. These are the non-medical factors that impact overall health, well-being, and quality of life. Structural discrimination (racism, ageism, sexism, etc.) is a driver of differences in these conditions for different populations.

Upstream/Macro-level efforts seek systemic change to benefit entire communities, rather than interventions targeting specific individuals or groups.

References
Bailey et al. (2017). Structural racism and health inequities in the USA: Evidence and interventions. The Lancet, 389, (10077), 1453-1463. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30569-X.pdf.

Centers for Disease Control and Prevention [CDC]. (2022, June 24). What is Health Equity.https://www.cdc.gov/healthequity/whatis/index.html

CDC. (2021, September 30). Social determinants of health: Know what affects health. https://www.cdc.gov/socialdeterminants/index.htm

Critical race theory FAQ. NAACP Legal Defense and Educational Fund. (2022, April 21). https://www.naacpldf.org/critical-race-theory-faq/

Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Smedley, B. D., Stith, A. Y., & Nelson, A.R. (Eds.). (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press (US).

Jones, C.P. (2003). Confronting institutionalized racism. Phylon, 50(1-2), 7-22. https://unnaturalcauses.org/assets/uploads/file/Jones-Confronting-Institutionalized-Racism.pdf

Jones, C. P., Truman, B. I., Elam-Evans, L. D., Jones, C. A., Jones, C. Y., Jiles, R., Rumisha, S. F., & Perry, G. S. (2008). Using “socially assigned race” to probe white advantages in health status. Ethnicity & disease, 18(4), 496–504.

Jones, C.P. (2014). Systems of power, axes of inequity: parallels, intersections, braiding the strands. Medical Care, 52(10 Suppl 3): S71-S75. https://doi.org/10.1097/MLR.0000000000000216

Schulz, A.J. & Mullings, L. (Eds.) (2006). Gender, Race, Class, and Health: Intersectional Approaches. Jossey-Bass.

Williams D.R., Lawrence, J.A., & Davis, B.A. (2019). Racism and health: Evidence and needed research. Annual Review of Public Health, 40, 105-125. https://doi.org/10.1146/annurev-publhealth-040218-043750

Yearby, R. (2020, September 22). Structural racism: The root cause of the social determinants of health. Harvard Law Bill of Health. https://blog.petrieflom.law.harvard.edu/2020/09/22/structural-racism-social-determinant-of-health/