Culture, Race, and Health: Implications for Racial Inequities and Population Health.

Publisher: Blackwell Publishers Country of Publication: United States NLM ID: 8607003 Publication Model: Print Cited Medium: Internet ISSN: 1468-0009 (Electronic) Linking ISSN: 0887378X NLM ISO Abbreviation: Milbank Q Subsets: MEDLINE

Publication: Malden, MA : New York, NY : Blackwell Publishers ; Milbank Memorial Fund
Original Publication: New York, NY : Published for the Milbank Memorial Fund by Cambridge University Press, c1986-

Culture* ; Health Status Disparities* ; Population Health* ; Racism*; Humans ; Social Determinants of Health ; United States

Policy Points Racism is a fundamental cause of health inequities and disease, which requires policy solutions that address this cause directly rather than only targeting mechanisms. Cultural systems, such as cultural racism, undergird the social conditions that shape racial inequities in health, including social and health policy decision making, governance, practice, and public reception. Policies targeting racial health equity benefit from integrating social theory and meaningful assessments of the social context concerning race, racism, and health.
Context: Improving the health of the total population may be insufficient in eliminating racial disparities in population health. An expanding commitment to understanding social determinants of health aims to address the social conditions that produce racialized patterns in health inequity. There is also a resurging and evolving interest in the influence of cultural barriers and assets in shaping racial inequities in health. The meaning and function of culture, however, remains underspecified.
Methods: This paper synthesizes analogous but fragmented concepts of cultural threat related to social and racial inequity as examined in public and population health, psychology, sociology, communications, media studies, and law. It draws on an existing typology of culture and social inequity to organize concepts related to cultural racism. Employing a transdisciplinary approach, the paper integrates multiple scholarly perspectives on cultural threat to frame cultural racism as cultural systems that promote false presumptions of white superiority relative to non-whites.
Findings: The lack of shared conceptual grounding and language regarding cultural threats to health hinders a more precise identification and measurement of cultural processes as well as comparisons of relative prevalence and influence of pathways linking cultural processes and social inequity. Evaluating intersections among culture, structures, and racism is a valuable analytical tool for understanding the production of social and racial inequities in health. To adequately address health inequities rooted in systemic racism, it is imperative to discuss the function of cultural racism in shaping population health in the United States.
Conclusions: Building a culture of health and achieving health equity requires that we assess cultural racism in a more meaningful way. Cultural processes are commonly referenced in health inequity scholarship, but the empirical literature generally lags behind the conceptual emphasis. A rich literature across disciplines has substantively engaged conceptualizations of culture and cultural processes, the importance of these processes as part of a system of racism, and mechanisms that may link cultural threats to health. When integrated, this literature offers essential insights for ways population health may address the complex issue of eradicating racial disparities in health.
(© 2019 Milbank Memorial Fund.)

Am Psychol. 2007 May-Jun;62(4):271-86. (PMID: 17516773)
J Pers Soc Psychol. 2008 Feb;94(2):292-306. (PMID: 18211178)
Arch Gen Psychiatry. 2009 Feb;66(2):181-8. (PMID: 19188540)
Am J Public Health. 2013 May;103(5):813-21. (PMID: 23488505)
Am J Public Health. 2012 May;102(5):936-44. (PMID: 22420803)
Am J Orthopsychiatry. 2000 Jan;70(1):42-57. (PMID: 10702849)
Soc Sci Med. 2014 Feb;103:126-133. (PMID: 24507917)
Int J Health Serv. 2014;44(4):643-710. (PMID: 25626224)
Soc Sci Med. 2014 Apr;106:128-36. (PMID: 24561774)
Am J Public Health. 2014 Jan;104(1):117-23. (PMID: 24228644)
Acad Med. 2018 Jan;93(1):25-30. (PMID: 28445214)
Am J Public Health. 2010 Apr 1;100 Suppl 1:S30-5. (PMID: 20147679)
Du Bois Rev. 2011 Apr 15;8(1):143-157. (PMID: 22518195)
Health Aff (Millwood). 2007 Sep-Oct;26(5):1281-92. (PMID: 17848438)
Ethn Dis. 2010 Winter;20(1):71-6. (PMID: 20178186)
Soc Sci Med. 2018 Feb;199:167-180. (PMID: 28571900)
Psychol Sci. 2016 Oct;27(10):1299-1311. (PMID: 27557618)
Am J Public Health. 2012 May;102(5):1020-6. (PMID: 22420818)
Soc Sci Med. 2018 Feb;199:56-66. (PMID: 28438421)
J Behav Med. 2009 Feb;32(1):1-8. (PMID: 19089605)
Health Educ Behav. 2006 Aug;33(4):488-501. (PMID: 16769757)
Int J Epidemiol. 2006 Aug;35(4):888-901. (PMID: 16585055)
Science. 2021 Nov 26;374(6571):1061. (PMID: 34822268)
Race Soc Probl. 2013 Jun 1;5(2):100-112. (PMID: 23894254)
Soc Sci Med. 2018 Feb;199:11-18. (PMID: 29325781)
Psychol Sci. 2001 May;12(3):225-9. (PMID: 11437305)
Lancet. 2017 Apr 8;389(10077):1453-1463. (PMID: 28402827)
PLoS One. 2015 Apr 24;10(4):e0122963. (PMID: 25909964)
J Health Soc Behav. 2010;51 Suppl:S15-27. (PMID: 20943580)
Am Psychol. 1999 Oct;54(10):805-16. (PMID: 10540593)
Am J Public Health. 2006 Nov;96(11):2032-9. (PMID: 17018818)
Ethn Dis. 1996 Winter-Spring;6(1-2):30-46. (PMID: 8882834)
Am J Public Health. 2013 Jan;103(1):50-6. (PMID: 23153125)
J Behav Med. 2009 Feb;32(1):20-47. (PMID: 19030981)
Ann N Y Acad Sci. 1998 May 1;840:33-44. (PMID: 9629234)
Am J Public Health. 2003 Feb;93(2):194-9. (PMID: 12554569)
Am Behav Sci. 2013 Aug 1;57(8):. (PMID: 24347666)
Soc Sci Med. 2014 Feb;103:7-14. (PMID: 24507906)
Souls. 2016;18(2-4):421-445. (PMID: 29187782)
J Health Soc Behav. 1995;Spec No:80-94. (PMID: 7560851)
J Pers Soc Psychol. 2010 Sep;99(3):467-81. (PMID: 20649368)
Am Psychol. 1997 Jun;52(6):613-29. (PMID: 9174398)
Am J Public Health. 2010 Apr 1;100 Suppl 1:S186-96. (PMID: 20147693)
Am J Public Health. 2003 Mar;93(3):380-3. (PMID: 12604476)
Annu Rev Clin Psychol. 2015;11:407-40. (PMID: 25581238)
Am J Public Health. 2000 Jun;90(6):867-72. (PMID: 10846503)
Soc Sci Med. 2018 Feb;199:157-166. (PMID: 28372829)
Am J Public Health. 2003 Feb;93(2):243-8. (PMID: 12554577)
Annu Rev Public Health. 2011;32:399-416. (PMID: 21219164)
Soc Sci Med. 2014 Feb;103:42-50. (PMID: 24507909)
Psychol Sci. 2003 May;14(3):287-90. (PMID: 12741756)

Keywords: culture; disparities; population health; racism

Date Created: 20190913 Date Completed: 20200310 Latest Revision: 20231013

20231013

PMC6739606

10.1111/1468-0009.12411

31512293