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Policy Points Cultural racism—or the widespread values that privilege and protect Whiteness and White social and economic power—permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the “tip of the iceberg,” whereas structural and institutional racism represent its base. This paper advances cultural racism as the “water surrounding the iceberg,” allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity. Context Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism. Methods We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities. Findings Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course. Conclusions More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence‐based policy interventions to reduce cultural racism and promote health equity.

Although it is often acknowledged that social and environmental factors interact to produce racial and ethnic environmental health disparities, it is still unclear how this occurs. Despite continued controversy, the environmental justice movement has provided some insight by suggesting that disadvantaged communities face greater likelihood of exposure to ambient hazards. The exposure-disease paradigm has long suggested that differential \"vulnerability\" may modify the effects of toxicants on biological systems. However, relatively little work has been done to specify whether racial and ethnic minorities may have greater vulnerability than do majority populations and, further, what these vulnerabilities may be. We suggest that psychosocial stress may be the vulnerability factor that links social conditions with environmental hazards. Psychosocial stress can lead to acute and chronic changes in the functioning of body systems (e.g., immune) and also lead directly to illness. In this article we present a multidisciplinary framework integrating these ideas. We also argue that residential segregation leads to differential experiences of community stress, exposure to pollutants, and access to community resources. When not counterbalanced by resources, stressors may lead to heightened vulnerability to environmental hazards.

To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites. Data from 2,958 participants aged 30-64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models. We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p's < .05. Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.

Objectives. This study examined whether individual (self-perceived) and institutional (segregation and redlining) racial discrimination was associated with poor health status among members of an ethnic group. Methods. Adult respondents (n = 1503) in the cross-sectional Chinese American Psychiatric Epidemiologic Study were geocoded to the 1990 census and the 1995 Home Mortgage Disclosure Act database. Hierarchical linear modeling assessed the relationship between discrimination and scores on the Medical Outcomes Study Short-Form 36 and revised Symptom Checklist 90 health status measures. Results. Individual and institutional measures of racial discrimination were associated with health status after control for acculturation, sex, age, social support, income, health insurance, employment status, education, neighborhood poverty, and housing value. Conclusions. The data support the hypothesis that discrimination at multiple levels influences the health of minority group members.

Background Despite persistent racial disparities in maternal health in the USA, there is limited qualitative research on women’s experiences of discrimination during pregnancy and childbirth that focuses on similarities and differences across multiple racial groups. Methods Eleven focus groups with Asian American and Pacific Islander (AAPI), Black, Latina, and Middle Eastern women ( N  = 52) in the USA were conducted to discuss the extent to which racism and discrimination impact pregnancy and birthing experiences. Results Participants across groups talked about the role of unequal power dynamics, discrimination, and vulnerability in patient-provider relationships. Black participants noted the influence of prior mistreatment by providers in their healthcare decisions. Latinas expressed fears of differential care because of immigration status. Middle Eastern women stated that the Muslim ban bolstered stereotypes. Vietnamese participants discussed how the effect of racism on mothers’ mental health could impact their children, while Black and Latina participants expressed constant racism-related stress for themselves and their children. Participants recalled better treatment with White partners and suggested a gradient of treatment based on skin complexion. Participants across groups expressed the value of racial diversity in healthcare providers and pregnancy/birthing-related support but warned that racial concordance alone may not prevent racism and emphasized the need to go beyond “band-aid solutions.” Conclusion Women’s discussions of pregnancy and birthing revealed common and distinct experiences that varied by race, skin complexion, language, immigration status, and political context. These findings highlight the importance of qualitative research for informing maternal healthcare practices that reduce racial inequities.

BackgroundStudent loans are the second largest source of personal debt in the USA and may represent an important source of financial strain for many young adults. Little attention has been paid to whether debt is associated with sleep duration, an important health-promoting behaviour. We determine if student loans are associated with sleep duration. Since black young adults are more likely to have student debt and sleep less, we also consider whether this association varies by race.MethodsData come from the US National Longitudinal Survey of Youth 1997. The main analytic sample includes 4714 respondents who were ever enrolled in college and who reported on sleep duration in 2010. Most respondents had completed their college education by 2010, when respondents were 25 to 31 years old. Multivariable linear regression models assessed the cross-sectional association between student loans accumulated over the course of college and sleep duration in 2010, as well as between student debt at age 25 and sleep duration in 2010.ResultsBlack young adults with greater amounts of student loans or more student debt reported shorter sleep duration, controlling for occupation, hours worked, household income, parental net worth, marital status, number of children in the household and other sociodemographic and health indicators. There was no association between student loans or debt with sleep for white or latino adults and other racial/ethnic groups.ConclusionsStudent loans may contribute to racial inequities in sleep duration. Our findings also suggest that the student debt crisis may have important implications for individuals’ sleep, specifically and public health, more broadly.

Objectives. To examine the extent to which the phrases, “COVID-19” and “Chinese virus” were associated with anti-Asian sentiments. Methods. Data were collected from Twitter’s Application Programming Interface, which included the hashtags “#covid19” or “#chinesevirus.” We analyzed tweets from March 9 to 23, 2020, corresponding to the week before and the week after President Donald J. Trump’s tweet with the phrase, “Chinese Virus.” Our analysis focused on 1 273 141 hashtags. Results. One fifth (19.7%) of the 495 289 hashtags with #covid19 showed anti-Asian sentiment, compared with half (50.4%) of the 777 852 hashtags with #chinesevirus. When comparing the week before March 16, 2020, to the week after, there was a significantly greater increase in anti-Asian hashtags associated with #chinesevirus compared with #covid19 (P < .001). Conclusions. Our data provide new empirical evidence supporting recommendations to use the less-stigmatizing term “COVID-19,” instead of “Chinese virus.”

Recent studies show that racism may influence health inequities. As individuals grow from infancy into old age, they encounter social institutions that may create new exposures to racial bias. Yet, few studies have considered this idea fully. We suggest a framework that shows how racism and health inequities may be viewed from a life course perspective. It applies the ideas of age-patterned exposures, sensitive periods, linked lives, latency period, stress proliferation, historic period, and cohorts. It suggests an overarching idea that racism can structure one’s time in asset-building contexts (e.g., education) or disadvantaged contexts (e.g., prison). This variation in time and exposure can contribute to racial inequities in life expectancy and other health outcomes across the life course and over generations.

The adage “time is money” signifies that time itself is a major social resource, but the role of time as a determinant of health inequities remains underappreciated. Time is fundamental to health promotion and human agency, as in having time to exercise and maintain social relationships. Further, scarcity in time is related to stress and illness. Time is also racialized, such that racial/ethnic minorities often have less free time and suffer a time penalty in multiple facets of life. Such penalties manifest in problems such as greater time in prison or more time spent accessing services. We argue that time may be a social determinant of health that is shaped by racism across the life course. We focus on three aspects: time as age, time as exposure, and time as a resource and privilege. We distinguish between chronological age, biological age, and social age. We discuss issues of accelerated aging and potential interconnections with critical periods. We also examine racial inequities in time. By more deeply considering time, we may advance our understanding of racial inequities in health.

Although research investigating ethnic differences in mental health has increased in recent years, we know relatively little about how mental health trajectories vary across ethnic groups. Do these differences occur at certain ages but not others? We investigate ethnic variation in trajectories of depressive symptoms, and we examine the extent to which disadvantages in family background, high school experiences, and adult characteristics explain these differences. Employing random-coefficient modeling using the National Longitudinal Survey of Youth, we find that blacks and Hispanics experience higher symptom levels in early adulthood in comparison to whites, but equivalent levels by middle age. Ethnic differences remained in early adulthood after including all covariates, but those differences were eliminated by middle age for Hispanics after controlling for demographics only, and for blacks after accounting for the age-varying relationship between income and depressive symptoms. These results highlight the importance of integrating a life course perspective when investigating ethnic variations in mental health.