an essay on institutional racism

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institutional racism

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• National Center for Biotechnology Information - PubMed Central - Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis
• BBC - What is institutional racism and why is it being talked about?
• Social Sciences Libretexts - Racism as Structural/Institutional
• National Association of Social Workers - Institutional racism and the social work profession: A call to action

institutional racism , the perpetuation of discrimination on the basis of “ race ” by political, economic, or legal institutions and systems. According to critical race theory , an offshoot of the critical legal studies movement, institutional racism reinforces inequalities between groups—e.g., in wealth and income, education , health care, and civil rights—on the basis of the groups’ perceived racial differences. Institutional racism became a particular focus of scholarly investigation in the 1980s, especially in the United States .

Since the late 20th century the notion of biological race has been recognized as a cultural invention that is entirely without scientific basis. Nevertheless, racism categorizes people by skin colour, ethnicity , and culture to distribute societal goods and resources in a fashion that unfairly disadvantages members of some groups and, without merit, benefits others. The concept of institutional racism is predicated on the supposition that racism is not always conscious, intentional, explicit, or obvious but instead is frequently ingrained in systems, laws, policies, beliefs, and practices that result in, condone , and perpetuate inequitable treatment and oppression of people of colour, especially Black Americans. Although many scholars use the terms institutional racism , systemic racism , and structural racism synonymously, others distinguish between them, noting that the emphasis of systemic racism is on the systems involved—e.g., legal, political, educational, and criminal justice systems—whereas the emphasis of structural racism is on the elements that provide the foundation for those systems, including policies, laws, and institutional practices. Institutional racism , on the other hand, has been used as an overarching term that encompasses the roles played by both systems and structures in discrimination and oppression based on “race.”

Arguably, institutional racism has been prevalent in American society since colonial times, beginning with its overt expressions in the institution of slavery , Black codes , and Jim Crow segregation . As early as the turn of the 20th century, sociologist and activist W.E.B. Du Bois described racial discrimination as being institutionalized within multiple sectors of society and as self-perpetuating. In contrast to the nakedly discriminatory policies and practices of the Jim Crow era, the aspects of contemporary systems and structures that have created social, political, and economic inequities and injustice for Black, Indigenous , Hispanic ( Latinx ), and Asian Americans are increasingly hidden—ingrained in the standard operating procedures of institutions and eschewing racial terminology. Many whites are unaware of them.

Institutional racism is often identified through examples that are cited as proof of its existence. On average, Black Americans and Hispanic Americans are less likely than similarly qualified white Americans to be hired for jobs or to receive loans. Disenfranchisement through voter suppression and disempowerment through gerrymandering are prime examples of political marginalization that are said to result from institutional racism. Unsubstantiated or exaggerated allegations of voter fraud have led to changes in voter identification requirements and reduced accessibility to polling places that, voting rights activists argue, have disadvantaged Black Americans and Hispanic Americans.

Residential segregation—explicitly codified in the Jim Crow era but reduced after the Fair Housing Act (1968) outlawed racial discrimination in housing—has persisted in the United States, in no small measure because of discriminatory public and private lending policies and practices that have discouraged loans for individuals living in “ redlined ” neighbourhoods, designated as hazardous. While post-World War II federal loan programs dramatically increased home ownership for whites, people of colour were frequently denied opportunities to buy homes, thus restricting access to the principal method of accruing generational wealth. Many Blacks and Hispanics continue to live in racially segregated and impoverished neighbourhoods, partly as a result of zoning restrictions that effectively exclude lower-income residents from living in many predominantly white neighbourhoods.

Predominantly Black or Hispanic neighbourhoods also tend to receive fewer or inferior public services. Notably, limited access to good public schools further limits opportunities to obtain good jobs with benefits or to pursue higher education , thereby limiting upward mobility. Blacks and Hispanics are more likely than whites to be unjustly suspected of criminal behaviour, not only by white private citizens but also by police officers. Moreover, separate and unequal neighbourhood conditions contribute to abusive policing practices, and Blacks and Hispanics are more likely than whites to be victims of police brutality, including the unjustified use of lethal force. There is also a pervasive pattern of discriminatory sentencing practices. If convicted of a crime, people of colour are generally incarcerated more often and receive longer sentences than whites who are found guilty of the same offense.

Explainer: what is systemic racism and institutional racism?

Senior Lecturer, Indigenous Studies, CQUniversity Australia

Disclosure statement

Mary Frances O'Dowd does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

CQUniversity Australia provides funding as a member of The Conversation AU.

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At the 2020 BAFTA awards, Joaquin Phoenix called out systemic racism in the film industry in his acceptance speech for leading actor.

I think that we send a very clear message to people of colour that you’re not welcome here. I think that’s the message that we’re sending to people that have contributed so much to our medium and our industry and in ways that we benefit from. […] I think it’s more than just having sets that are multicultural. We have to do really the hard work to truly understand systemic racism.

“Systemic racism”, or “institutional racism”, refers to how ideas of white superiority are captured in everyday thinking at a systems level : taking in the big picture of how society operates, rather than looking at one-on-one interactions.

These systems can include laws and regulations, but also unquestioned social systems. Systemic racism can stem from education, hiring practices or access .

Read more: Explainer: what is casual racism?

In the case of Phoenix at the BAFTAs, he isn’t calling out the racist actions of individuals, but rather the way white is considered the default at every level of the film industry.

Stokely Carmichael and Charles V. Hamilton first wrote about the concept in their 1967 book Black Power: The Politics of Liberation .

They wrote:

When a black family moves into a home in a white neighborhood and is stoned, burned or routed out, they are victims of an overt act of individual racism which most people will condemn. But it is institutional racism that keeps black people locked in dilapidated slum tenements, subject to the daily prey of exploitative slumlords, merchants, loan sharks and discriminatory real estate agents. The society either pretends it does not know of this latter situation, or is in fact incapable of doing anything meaningful about it.

Invisible systems

Systemic racism assumes white superiority individually, ideologically and institutionally. The assumption of superiority can pervade thinking consciously and unconsciously.

One most obvious example is apartheid , but even with anti-discrimination laws, systemic racism continues.

Individuals may not see themselves as racist, but they can still benefit from systems that privilege white faces and voices.

Anti-racism activist Peggy McIntosh popularised the understanding of the systemic nature of racism with her famous “ invisible knapsack ” quiz looking at white privilege.

The quiz asks you to count how many statements you agree with, for items such as:

• I can turn on the television or open to the front page of the paper and see people of my race widely represented
• I can be pretty sure of having my voice heard in a group in which I am the only member of my race
• I can worry about racism without being seen as self-interested or self-seeking.

The statements highlight taken-for-granted privileges, and enable people to understand how people of colour may experience society differently.

Cultures of discrimination

Under systemic racism, systems of education, government and the media celebrate and reward some cultures over others.

In employment, names can influence employment opportunities. A Harvard study found job candidates were more likely to get an interview when they “whitened” their name.

Only 10% of black candidates got interview offers when their race could be implied by their resume, but 25% got offers when their resumes were whitened. And 21% of Asian candidates got interview offers with whitened resumes, up from 11.5%.

Systemic racism shows itself in who is disproportionately impacted by our justice system. In Australia, Indigenous people make up 2% of the Australian population, but 28% of the adult prison population.

Read more: As Indigenous incarceration rates keep rising, justice reinvestment offers a solution

A study into how systemic racism impacts this over-representation in Victoria named factors such as over-policing in Aboriginal communities, the financial hardship of bail, and increased rates of drug and alcohol use.

Australia’s literature, theatres and art galleries are all disproportionately white , with less than 10% of artistic directors from culturally diverse backgrounds.

Read more: Australia's art institutions don't reflect our diversity: it's time to change that

A way forward

Systemic racism damages lives, restricting access and capacity for contribution.

It damages the ethical society we aspire to create.

When white people scoop all the awards, it reinforces a message that other cultures are just not quite good enough.

Public advocacy is critical. Speaking up is essential.

Racism is more than an individual issue. When systemic injustices remain unspoken or accepted, an unethical white privilege is fostered. When individuals and groups point out systemic injustices and inequities, the dominant culture is made accountable.

Find out if your children’s school curriculum engages with Indigenous and multicultural perspectives. Question if your university course on Australian literature omits Aboriginal authors. Watch films and read books by artists who don’t look like you.

As Phoenix put it in his speech:

I’m part of the problem. […] I think it is the obligation of the people that have created and perpetuate and benefit from a system of oppression to be the ones that dismantle it. That’s on us.

Understanding systemic racism is important. To identify these systemic privileges enables us to embrace the point of view of people whose cultures are silenced or minimised.

When we question systemic racism, worth is shared and ideas grow.

• White privilege
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Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis

Belinda l. needham.

1 Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI USA

2 Department of Internal Medicine, Yale School of Medicine, New Haven, CT USA

Kristi L. Allgood

3 Department of Health, Society, and Behavior, University of California-Irvine Program in Public Health, Irvine, CA USA

Jana L. Hirschtick

Nancy l. fleischer, associated data.

Not applicable.

Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40615-022-01381-9.

While most prior research on racism and health has focused on interpersonal racism, public health scholars have begun to explore the ways in which institutional policies and practices—both historic and contemporary—contribute to minority health and health disparities [ 1 , 2 , 3 , 4 , 5 , 6 ]. This trend in public health scholarship reflects a broader societal shift toward thinking about racism as a structural problem rather than solely as an interpersonal phenomenon. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. Building on recent papers calling for greater conceptual clarity, increased consideration of historical context, and enhanced methodologic rigor in this area of research [ 7 , 8 , 9 , 10 ], we begin by providing definitions of key concepts, such as racialization, racism, and racial inequity, and explaining linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. Finally, we propose a framework to guide methodologic considerations for future studies, informed by a literature review of measures and analytic approaches used in prior research on institutional racism and health.

Framing the Problem

Definitions and conceptual model.

Although studies examining institutional racism as a determinant of health have become increasingly common in recent years for reviews, see 2, [ 11 , 12 , 13 ], conceptual ambiguity remains widespread. Thus, we begin by defining relevant concepts. First, racialization refers to the social construction of racial categories, such as White, Black, Latino, 1 and Asian [ 14 , 15 , 16 ]. While racial categories vary across place and time, they are typically based on phenotypic characteristics, such as skin color, eye shape, and hair texture, that reflect differences in continental ancestry [ 17 ]. Importantly, phenotypic differences are commonly believed to reflect other important differences between the so-called races, including differences in intelligence and morality [ 17 ]. Thus, in racialized social systems, the process of racial differentiation is inextricably intertwined with the process of racial stratification (i.e., the hierarchical ranking of people according to race), which results in differential access to power and other resources [ 18 , 19 ].

We use the general term racism to refer to both the ideology of racial superiority/inferiority (i.e., ideological racism , including internalized racism 2 ), as well as the resulting inequitable treatment of individuals according to race (i.e., actualized racism ). We distinguish between two forms of actualized racism: institutional and interpersonal. Institutional racism refers to racially discriminatory policies and practices 3 embedded in social institutions such as the government, the economy, the education system, the healthcare system, religious institutions, the family, and the media. Institutional racism is said to be systemic [ 20 ] or structural [ 2 , 21 ] when it operates as a system across multiple interconnected institutions. Interpersonal racism refers to discriminatory treatment by race among individual actors. Finally, racial inequity refers to inequitable, or unjust, outcomes by race, including inequities in education, economic mobility, and health outcomes. Relationships among these concepts are shown in Fig.  1 .

Conceptual model linking racialization to racial inequity via ideological and actualized racism

Racism and Health: Mechanisms

Racism may negatively impact health through both psychosocial and material pathways. For example, the internalization of ideological racism could affect mental health (e.g., depression, anxiety) by decreasing self-esteem among members of stigmatized minority groups [ 22 , 23 ], while repeated exposure to acts or threats of interpersonal racism could affect mental and physical health by triggering chronic activation of physiologic stress response systems [ 24 ]. Institutional racism is hypothesized to negatively affect health and well-being through material pathways by shaping access to health-promoting resources [ 25 , 26 ]. For example, the institutional practice of redlining drove residential segregation and depressed home values and homeownership rates in minority neighborhoods [ 27 ]. By restricting where Black families could live, redlining contributed to overcrowding, which was then used as a rationale for demolishing homes in Black communities to make way for interstate highways [ 27 ]. Along with dividing minority communities, the highways contributed to environmental injustice by increasing air pollution [ 28 ]. Additionally, while not explicitly racist, programs such as the GI Bill, which was designed to provide resources such as higher education and mortgage lending to those returning after World War II, had disparate impacts by race because the program relied upon racist institutional policies, including redlining and racially discriminatory college admissions processes [ 27 ]. Though redlining is no longer legal, residential segregation is firmly entrenched in the United States and is a powerful determinant of access to a broad range of health-promoting resources, including education, employment, housing, and healthcare [ 29 ]. In addition to its effects on material pathways, restricted access to socially valued resources resulting from institutional racism may further harm health through psychosocial mechanisms, such as perceived injustice or feelings of hopelessness [ 30 ].

While redlining is the most often cited racially discriminatory policy in health research, it is not the only racist policy or set of policies that have affected non-White populations in the USA. Other examples include the seizure of American Indian lands [ 31 ], Reconstruction era Black Codes/vagrancy laws [ 32 ], Jim Crow/American Apartheid policies [ 33 ], failure of Congress to protect Black Americans from lynching [ 34 ], exclusion of specific occupations in the receipt of social security benefits [ 35 ], internment of specific ethnic groups [ 36 ], the War on Drugs [ 32 ], removal of desegregation orders in public education [ 37 ], and public charge rules [ 38 ], among many others. It is important to note that institutional policies, including some of those listed above, are often enacted by individual agents of institutions, such as judges, poll workers, and police officers, who may or may not also engage in acts of interpersonal racism when interacting with racial or ethnic minorities. Thus, while we can distinguish between ideological, interpersonal, and institutional racism conceptually , they operate simultaneously and interactively, making it difficult to disentangle the effects of various forms of racism empirically .

Framework for Advancing Institutional Racism and Health Research

In this section we discuss key considerations in advancing institutional racism and health research. As shown in Fig.  2 , the framework outlines six conceptual and analytic considerations when empirically examining questions on institutional racism and health: (1) institutional racism policy identification, (2) population of interest, (3) institutional racism exposure measurement, (4) health outcome measurement, (5) study design, and (6) analytic approach. This framework aligns with research calling for a historical/contextual and theoretical link between historical racist policies and contemporary health outcomes [ 7 , 8 , 9 , 10 , 39 ], strong measurement of institutional racism [ 8 , 9 ], and methodological approaches that can strengthen the causal evidence base [ 9 ]. However, this framework builds on previous work [ 9 , 10 ] by incorporating and focusing on research methods such as linking the network of policies that created a racially disparate impact in resources, the exposure and outcome measurement, matching the timing and geographic region of the policy and outcome, and the design of the research. This framework for the study of institutional racism allows for modern racist policies (e.g., Muslim bans, modern voting restrictions, attacks on “Critical Race Theory”) and changing definitions of race (e.g., person of Hispanic/Latinx or Middle Eastern nationalities forming new racial groups), and is broad enough to incorporate research on any racial or ethnic group.

Conceptual framework to guide institutional racism and health research

To inform our framework, we conducted a systematic literature review, building on a recent review by Groos and colleagues [ 12 ], to summarize and critically assess current approaches to the measurement and analysis of institutional racism in quantitative health research. The Groos et al. review [ 12 ] includes articles published between January 1, 2007 and December 31, 2017. The authors searched PubMed and EMBASE databases to identify studies that included the terms “structural racism,” “systemic racism,” “institutional racism,” and/or “institutionalized racism” in the title or abstract. 4 Out of 255 abstracts identified in the search, 20 met the authors’ inclusion criteria: original research, conducted in the United States, explicitly measured an indicator of structural racism, included a health-related outcome, full-text available, and used quantitative methods. Given growing interest in research on institutional racism in recent years, we conducted an updated search using the methods described in Groos et al. [ 12 ]. As shown in Figure S1 , we identified 36 additional papers published between January 1, 2018 and December 15, 2020 that met the authors’ inclusion criteria. Table ​ Table1 1 summarizes the 20 papers included in the Groos et al. [ 12 ] systematic review, as well as the 36 papers from our updated search.

Summary of institutional racism measures used in quantitative health research published between January 1, 2007 and December 31, 2020

* Article included in the Groos et al. (2018) systematic review.

BN performed the initial review of each abstract to determine whether the paper met the Groos et al. [ 12 ] inclusion criteria. Next, BN extracted information on the measures used, domains examined, levels of measurement for exposures and outcomes, racial and ethnic groups examined, analytic approaches, and links to policy. A second coauthor (T.A or K A) then reviewed each paper to verify the accuracy of the information. In the event of a disagreement, a third coauthor reviewed the paper, and all three coauthors involved in the literature review met to make a final determination about the information in Table ​ Table1 1 .

Identifying Institutional Racism Policies

Making the links between policy and exposure measurement explicit can help advance empirical research on institutional racism and health. First, the closer research is tied to the harm of specific policies, including the enactment and the enforcement of policies, the stronger the evidence base for eliminating racist policies. Second, even if the exposure measurement is not explicitly tied to a specific policy, researchers can provide the past and present policy context of an institutional racism measure. This is important because, historically, institutional racism was enacted through overtly racist policies that were later modified to be covertly racist “color-blind” policies. Recently, scholars have emphasized the importance of better understanding and articulating the policy context in the measurement of institutional racism. For example, Dennis et al. provide a framework that details major periods of structural discrimination in the USA, including specific policies and domains that have affected different racial/ethnic populations [ 10 ]. Hardeman et al. also highlight the importance of understanding the historical context to better understand how structural racism impacts health [ 8 ].

When policies can be measured directly, researchers can consider both the impact of the enactment of a policy as well as the potential for differential enforcement. For example, the Reagan Administration did not adequately enforce all aspects of the Civil Rights Act, such as employment discrimination [ 93 ], which may be important to consider when examining the impact of the policy over different time periods. However, we also recognize that it is not always possible to make direct links between historic policies that have laid the foundation for racial inequities, especially in cases when the legacy of past policies is omnipresent and difficult to measure or disentangle from concurrent policies. Nonetheless, by strengthening the theoretical linkage between specific policies and institutional racism exposure measurement in our framing of the research and interpretation of results, we can improve the quality of research.

In our literature review, few articles mentioned specific policies that form their basis of exposure measurement, and even fewer explicitly incorporated policies in their analyses. For example, only 15 out of 39 papers that used area-level indicators of institutional racism included more than a cursory discussion of discriminatory policies or practices related to the indicator(s), while 13 papers included a minimal or generic discussion of policy, and 11 papers did not discuss policy at all. Out of 18 papers that included at least one individual- or family-level indicator of institutional racism, only four included a detailed discussion of discriminatory policies or practices related to the indicator(s), while two included a minimal or generic discussion of policy, and 12 did not discuss policy at all. It is noteworthy that three of the four papers with detailed policy discussions were in the immigration domain, where overtly discriminatory policies remain legal. Only one paper that used individual- or family-level indicators of institutional racism directly measured exposure to a discriminatory policy [ 76 ].

Population of Interest

The population of interest should be well defined. Researchers must decide whether to take a minority health approach, in which people who identify as a specific racial/ethnic group are the focus of the analysis [ 94 ], or to compare differences in exposure to or effect of discriminatory policies for different racial/ethnic groups . Studies that include a single racial/ethnic group in the analytic sample are appropriate when the focus is on understanding the health effects of varied exposure to institutional racism for racial or ethnic minorities or when the focus is on identifying potential moderation in causal mechanisms between institutional racism and health. These kinds of analyses acknowledge that the experience of institutional racism can vary within the same racial/ethnic group, either in exposure or in moderating variables that mitigate its health effect. For instance, exposure to institutional racism may vary by geographic location, such as among Hispanic populations who reside in states that differ in their immigration enforcement policies. Researchers could also identify how coping strategies, such as social support through extended family or “fictive kin” networks, mitigate the health risks of institutional racism within Black Americans [ 95 ].

In contrast, studies on the extent to which differences in exposure to or effect of discriminatory policies or practices contribute to racial/ethnic health disparities require analytic samples with more than one racial/ethnic group. For example, a multi-racial/ethnic population would be needed to determine the differential impact of a specific criminal justice policy on health outcomes across racial/ethnic groups. Multi-racial/ethnic populations are also needed to test hypotheses on whether institutional racism can actually benefit Whites while being detrimental to racial/ethnic minorities [ 65 , 70 , 89 , 96 ].

In our literature review, we found that just over one third of papers took a minority health approach, examining a single racial/ethnic group, while approximately two thirds of papers took a health disparities approach, examining two or more racial/ethnic groups. Of the 21 papers that took a minority health approach, 17 included Black respondents only, three included Hispanic respondents only, and one included Chinese American respondents only. Of the 35 papers that took a health disparities approach, 27 included Black and White respondents, one included Black and Hispanic respondents, and seven included multiple racial/ethnic groups. Just 23 of the 35 papers that included more than one racial/ethnic group examined effect modification by race, which is important for understanding group differences in vulnerability to institutional racism. While neither the minority health approach nor the health disparities approach is inherently superior, we recommend that researchers employing a health disparities approach include as many racial/ethnic groups as possible and examine effect modification by race if the study is adequately powered to test interactions.

Finally, whether studies focus on a single racial/ethnic group or multiple groups, to best define their population of interest, researchers should also consider the timing and historic context of the research question (related to the policy discussion above, and Timing of Exposure Measurement , below). For example, policy impacts may compound across an individual’s life course, resulting in greater health impacts for older individuals, and may also compound across generations, resulting in the intergenerational transmission of poor health, beginning at birth. In addition, for specific racial/ethnic groups, immigration wave and immigration generation may be important considerations when defining the population of interest for a given study.

Institutional Racism Exposure Measurement

Improving exposure measurement for institutional racism is a key component of our framework. Below we consider five elements to specify for measures: (1) single vs. multiple domains, (2) area vs. individual level, (3) direct vs. proxy, and (4) timing of measurement.

Single vs. Multiple Domains

Institutional racism is considered structural or systemic when multiple institutions work together to produce and sustain a racist system [ 2 , 10 , 20 , 21 , 97 ]. As such, researchers must first determine whether to examine the relationship between one institutional domain, or multiple domains, and health. To capture the systemic, largely latent (i.e., covert and not directly observable) nature of structural racism, researchers should consider ways to incorporate multiple domains into their work.

The 56 papers from the literature review included measures of institutional racism in seven domains: criminal justice, economics and labor, education, healthcare, housing/residential segregation, immigration, and political participation/representation. Just over half of the papers measured institutional racism in a single domain, while slightly less than half included measures across multiple domains—an approach that is more consistent with the conceptualization of institutional racism as a “race discrimination system” that operates across many domains [ 20 ]. Housing-related measures, including residential segregation, were the most commonly used indicators of institutional racism (37 papers), followed by measures in economics and labor (22 papers), criminal justice (15 papers), education (13 papers), healthcare (4), political participation/representation (4), and immigration (3). We recommend that researchers focusing on a single domain identify causal mechanisms within that domain that impact health, while researchers examining measures from multiple domains incorporate theoretical and analytic approaches (e.g., latent models) that treat the measures as part of a connected system as opposed to discrete systems.

Complementary to focusing on a single or multiple domains is determining whether a single or multiple indicators will be used to represent a particular domain. Measurement approaches that combine multiple indicators across multiple domains have the potential to capture the systemic nature of institutional racism [ 2 , 20 , 21 ] but may obscure the effects of individual policies or practices that greatly influence health. In our literature review, we found that 17 papers included a single indicator of institutional racism, while 11 included multi-item scales assessing experiences of discrimination within institutional settings, and 28 included multiple indicators of institutional racism, either within a single domain or across multiple domains. We recommend using multiple indicators when trying to capture a more comprehensive measure of institutional racism that may be related to multiple historical policies, and thus difficult to isolate as a single policy measure (e.g., arrests, encounters, and probations to measure institutional racism in the criminal justice system). A single indicator may be appropriate when trying to isolate the effect of a specific policy or practice (e.g., presence/absence of a drug policy or drug-related arrests after implementation of a drug policy).

Area-Level vs. Individual-Level Measures

The level of exposure measurement is also critical. Researchers may consider measurement at the area level (e.g., state or Census tract) or individual level. In most cases, to capture the structural nature of institutional racism, we recommend using area-level exposure measures rather than individual-level measures, such as experiences of discrimination in institutional settings. There may be exceptions where the individual-level exposure represents a structural policy, such as immigration status for individuals from different countries, but these exceptions should consider the policies that led to the individual-level status.

When considering area-level measures, the geographic level of enactment or enforcement of the racially discriminatory policy should ideally match the geographic level of the exposure to minimize exposure misclassification. For example, if exposure is operationalized as racial disparities in police use of force, and policing policies regarding use of force are primarily made at the district or city level, then exposure should be measured at the district or city level rather than the county or state level. Other specific policies, such as voting rights restrictions, are often at the state level.

In our literature review, we found that 39 of the 56 papers we reviewed included at least one area-level measure of exposure to institutional racism, which is consistent with the conceptualization of institutional racism as a macro-level phenomenon. Area-level indicators in the housing/residential segregation domain included contemporary measures of residential segregation, such as the index of dissimilarity, the isolation index, and the index of concentration at the extremes [ 45 , 46 , 47 , 48 , 52 , 53 , 54 , 61 , 63 , 69 , 70 , 71 , 72 , 77 , 78 , 79 , 80 , 84 , 86 , 90 , 91 , 92 ]; historical measures of residential segregation based on Home Owner’s Loan Corporation (HOLC) redlining maps [ 44 , 60 , 62 ]; and contemporary measures of mortgage discrimination and redlining [ 49 , 54 , 67 , 69 , 70 , 71 , 92 ]. These measures were assessed at a variety of geographic levels, including HOLC-defined neighborhoods, Census tracts, zip codes, metropolitan areas, counties, and states. Other area-level measures of institutional racism included Black-White inequities in the domains of economics and labor, criminal justice, education, and political participation/representation [ 42 , 43 , 46 , 47 , 53 , 58 , 63 , 72 , 73 , 74 , 75 , 85 , 89 , 91 , 97 , 98 ]. These measures were assessed at the city, county, and state levels. In the criminal justice domain, two recent studies used the number of police killings of Black people in the county [ 51 ] and metropolitan statistical area [ 59 ] as an indicator of institutional racism. The measurement of area-level racism at different geographic scales makes it challenging to compare results across studies but may be justified based on theoretical or policy considerations. Thus, we recommend that researchers using area-level measures provide an explicit rationale for the geographic level examined.

Seventeen of the papers we reviewed included at least one individual-level measure of exposure to institutional racism. Most of these studies asked respondents to report experiences of discrimination in multiple institutional settings, such as schools, workplaces, and the criminal justice system [ 40 , 50 , 55 , 56 , 57 , 64 , 68 , 82 , 83 , 87 , 99 , 100 ]. One study asked parents to report concerns about their children’s exposure to racism in institutional settings [ 88 ], while two studies used individual-level characteristics like income and access to healthcare as indicators of exposure to institutional racism [ 41 , 85 ]. Studies in the immigration domain included individual-level measures of immigration status [ 76 ] and reports of sightings and interactions with immigration officials [ 81 ] as indicators of exposure to institutional racism, while one study measured fear of deportation at the family level [ 66 ].

We note that it is not possible at the individual level to distinguish between experiences of institutional racism and experiences of interpersonal racism that occur within an institutional setting. For example, if an individual responds “yes” to the question, “Were you ever treated unfairly during the job hiring process because of your race?” it is hard to determine to what extent this unfair treatment was due to institutional policies/practices (e.g., institutional practice of asking job candidates about their conviction history — because non-Whites are disproportionately more likely to have a conviction history compared to Whites, this practice precludes non-Whites from having a fair chance at employment) versus interpersonal racism (e.g., an employer choosing not to call back non-White applicants for a job interview because of their subconscious bias that non-White persons are less competent or less professional than White persons, despite laws in place that make it illegal for an employer to discriminate based on someone’s race/ethnicity). The distinction between experiences of institutional racism and experiences of interpersonal racism that occur within an institutional setting is important to make in order to sufficiently address racism, which requires a multi-level approach. For instance, within employment, efforts to address interpersonal racism (e.g., anti-racism training for employers) may prevent individual employers from discriminating against non-White employees. However, without institutional policies in place (e.g., an amendment to the Civil Rights Act that prevents employers from discriminating against people with criminal records or requiring employers to delay a criminal background check until after an offer is made or addressing racism within the criminal justice system), non-White persons will not have a fair chance at employment and will continue to face institutional racism within employment and its subsequent health impacts. It is also not possible to determine the extent to which an individual’s education or income is the result of exposure to discriminatory policies or practices. Thus, we recommend against using such measures to assess exposure to institutional racism.

Direct vs. Proxy Measures

Another consideration is the use of direct or proxy measures of exposure to discriminatory policies or practices. In some cases, direct measures of exposure to specific policies may be preferable to strengthen the connection to a health outcome. For proxy measures, researchers must clearly articulate the conceptual link between institutional policies, whether historic or contemporary, and the exposure measurements. For example, a direct measure of a policy exposure would be living in a state with restrictive voter ID laws, whereas a proxy measure in the political participation/representation domain could be the Black:White ratio of the population proportion who voted in the last presidential election. In the immigration domain, a direct measure may be living in a county where local law enforcement work closely with immigration enforcement (e.g., Secure Communities [ 101 ]), whereas a proxy measure could be fear of deportation.

In our literature review, we found that, with the exception of three papers that used HOLC maps to measure exposure to a specific racially discriminatory policy [ 44 , 62 , 102 ], the studies in Table ​ Table1 1 that used area-level indicators of institutional racism relied on proxy measures, rather than direct measures of exposure to discriminatory policies or practices. Given the challenges inherent in measuring institutional racism in an era of color-blind policies, researchers have increasingly come to rely on measures of racial inequality in domains, such as education or political participation/representation, as proxies for exposure to institutional racism. Though rarely stated explicitly, the rationale for this approach is that contemporary racial inequalities are the result of discriminatory policies and practices and, therefore, are a reasonable proxy for exposure to the policies and practices themselves. Explicitly linking policies to proxy measures is crucial to support the claim that racial/ethnic inequalities in specific domains are due to institutional factors rather than individual choices. Recent work by Agenor et al. provides a template for considering specific state-level policies in different institutional domains, which can be examined in future health studies [ 103 ].

Timing of Exposure Measurement

Lastly, researchers should consider the timing of their exposure measures within the context of the disease processes for their health measures. Historic timing is critical in linking exposure to health outcomes. As researchers, in order to provide the strongest evidence for causal inference, we must ensure that the timing of the policy precedes specific health outcomes in ways that allow for any latency period in disease progression [ 104 ]. For example, prior empirical studies have incorporated administrative data on school quality from the Jim Crow South and linked it with later life cognitive functioning [ 105 , 106 ]. The historic timing of policies has further implications for measurement, as more proximal events will be easier to measure directly. For example, it may be easier to link recent immigration policies that vary across states in their design and implementation [ 107 ] to acute health outcomes (e.g., birth outcomes, heart attacks) than to link older policies like the 1984 Immigration Reform and Control Act to chronic health outcomes. It is useful to consider a few specific questions when thinking about the timing of exposure measurement: are contemporary exposure measure(s) appropriate to adequately capture the link between policy and the health outcome? Are historic measures during a particular period of the life course more appropriate? And, accordingly, are intergenerational measures needed to capture the relevant exposures for specific health outcomes? For example, sensitive periods, such as gestation, may require a particular timing for specific birth outcomes, as in research that examines the timing of immigrant raids during different trimesters of pregnancy on low birth weight [ 108 ].

Health Outcome Measurement

As in other areas of epidemiologic research, health outcomes are best measured at the individual level. Area-level health outcome data, analyzed in an ecologic framework, can provide initial evidence on the extent to which institutional racism measures affect health, but cannot be used to identify causal relationships [ 109 ]. Area-level health outcome measurement may mask the influence of the exposure on the health outcome for different racial/ethnic minority populations, depending on the distribution of race/ethnicity in a particular Census tract, state, or other geographic area. Moreover, measuring health outcomes at the individual level allows for an examination of effect modification of the institutional racism-health relationship by race/ethnicity, to help elucidate differences in the relationships across racial/ethnic populations.

Study Design

The study design will be determined by the type of data a researcher has, as well as the level of exposure and outcome measurement. Ecologic studies examine associations between area-level exposures and area-level outcome measures. Multi-level study designs can be used when the exposure measurement is at the area level, and the outcome measurement is at the individual level. Individual-level study designs are needed when both the exposure and outcome are measured at the individual level. Because institutional racism is a contextual phenomenon, the strongest study designs will be multi-level in nature to enable researchers to estimate the contextual effects of area-level institutional racism on individual-level health.

Study designs may be purely observational or quasi-experimental. Observational studies examine the relationship between existing exposures and outcomes, based on observed patterns within or between populations. When longitudinal observational data are available, researchers should take a counterfactual approach to isolate the impact of structurally racist policies over time and as they operate within and across domains to produce racial disparities in health. For instance, causal mediation approaches that model time-varying relationships between variables allow researchers to treat “race” as part of the time-varying reciprocal or mutually reinforcing processes of racialization and racial discrimination within and across various socioeconomic, political, and cultural systems [ 110 ]. These approaches also allow researchers to decompose racial health disparities into different types of cumulative life course effects of institutional racism including unobserved racism (i.e., operating through unmeasured pathways), racial discrimination (i.e., the effect of an underlying system that first racialized individuals and then discriminated against them based on those racial categories), and emergent discrimination (i.e., system-wide race discrimination arising from pervasive racial disparities collectively across multiple domains). For a detailed discussion of these approaches, see Graetz et al. [ 110 ]. Quasi-experimental designs take advantage of an intervention, such as a policy change, that disrupts the ongoing pattern of health [ 111 ]. In quasi-experimental designs, in contrast to experimental designs, the researcher does not define the intervention. However, quasi-experimental designs can enhance causal inference if adequate comparison groups can be identified to represent a counterfactual comparison of what would have happened if the intervention had not occurred [ 111 ]. Recent examples include evaluating the impact of immigration raids or the 2017 Executive Order of the travel ban targeting individuals from Muslim majority countries [ 108 , 112 ].

In our literature review, we found examples of multi-level, ecologic, and individual-level study designs. Among papers that included at least one area-level measure of institutional racism, 22 were multi-level studies, while 17 were ecologic studies. In both the multi-level and ecologic studies, institutional racism was measured at the group level (e.g., the state-level Black:White ratio of felony disenfranchisement). This is appropriate given that discriminatory policies and practices are a property of institutions, not individuals. In the ecologic studies, health outcomes were also measured at the group level, despite being a property of individuals. The lack of individual-level data necessary to control for confounding can introduce bias when estimating the contextual effect of institutional racism on health in ecologic studies [ 113 ]. Thus, we recommend that researchers use multi-level study designs when possible. We also found 16 papers that measured exposures and outcomes at the individual level, and one paper that measured exposure and outcome at the family level. As discussed in detail above, we recommend against measuring institutional racism at the individual level due to challenges inherent in measuring a macro-level phenomenon at the individual level.

Analytic Approaches

Finally, analytic approaches must incorporate the specific aspects of exposure and outcome measurement and study design. An important decision point will be whether to model indicators of institutional racism separately or together; the former allows researchers to better identify specific policies that matter for health, while the latter better captures the systemic nature of multiple interconnected policies. If the latter approach is chosen, researchers must decide if they want to pre-specify institutional racism domains of interest (e.g., criminal justice, economics and labor) or use data reduction techniques to generate profiles of institutional racism. One approach for pre-specifying indicators within given domains is confirmatory factor analysis (CFA), where each domain is treated as a latent construct. CFA is used to understand how each individual indicator of institutional racism loads onto the latent construct of the specified domain. CFA can also be used to generate single summary measures of institutional racism, as in a recent paper by Dougherty et al. [ 53 ]. Other data reduction techniques, such as latent class analysis, may be useful to generate profiles of institutional racism without pre-specifying domains of interest.

Importantly, if examining institutional racism and health through a health disparities lens, effect modification of the relationship by race/ethnicity should be incorporated. For example, if researchers are examining the relationship between redlining and cardiovascular disease, testing for effect modification by race/ethnicity will help the research community understand if redlining affected the health of Black individuals only and/or to a greater extent than White individuals, as we would hypothesize given the targeting of the policy. As highlighted in our review, testing for effect modification of the relationship between institutional racism and health by race/ethnicity has not always been incorporated into recent research. Testing these types of hypotheses are essential to provide evidence for differential effects of policy.

In this paper we defined key concepts relevant to the study of institutional racism and proposed a framework for advancing institutional racism and health research, supported by a review of recent literature examining the relationship between institutional racism and health. We hope this framework will inform future examination of the impacts of institutional racism on health, and that it will help promote the consideration of structural interventions to improve minority health and to reduce and eliminate health disparities [ 114 ].

Below is the link to the electronic supplementary material.

Author Contribution

Nancy Fleischer and Belinda Needham developed the idea for the manuscript and wrote the first draft. Belinda Needham performed the literature search. All authors critically revised the work and read and approved the final manuscript.

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD016046. T A was supported by a National Institute on Aging training grant (T32AG019134). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Data Availability

Code availability, declarations.

The authors declare no competing interests.

1 While the US government classifies Latino as an ethnic group rather than a racial group, we include it in this list to acknowledge that Latinos have been historically racialized as non-White through legislation, immigration enforcement practices, and media framing.

2 Internalized racism is a specific type of ideological racism in which members of stigmatized racial or ethnic groups accept negative stereotypes about their own group.

3 In the post-Civil Rights era, institutional policies or practices are considered racially discriminatory if they result in inequitable outcomes by race, regardless of intent.

4 An important limitation of the search strategy, as noted by Groos et al., is that papers must have included the terms structural racism, systemic racism, institutional racism, or institutionalized racism in the title or abstract. It is likely that many more health-related papers measured similar constructs but failed to label them using these key terms.

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Lead Essay—Institutional Racism, Whiteness, and the Role of Critical Bioethics

• Symposium: Institutional Racism, Whiteness, and Bioethics
• Published: 06 April 2021
• Volume 18 , pages 9–12, ( 2021 )

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• Christopher Mayes   ORCID: orcid.org/0000-0003-2674-6225 1 ,
• Yin Paradies 1 &
• Amanuel Elias 1  

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Institutional racism can be defined as differential access to power, resources, and opportunities by race that further entrenches privilege and oppression (Paradies 2016 ). Along with similar concepts such as systemic, structural, cultural, and societal racism, this form of racism profoundly shapes almost all aspects of our lives, including health and healthcare (Williams, Lawrence, and Davis 2019 ). Yet, racism more broadly and institutional racism in particular has been a neglected subject in bioethical discourse and scholarship (Danis, Wilson, and White 2016 ).

Bioethics has the potential to make important contributions to anti-racist programmes and strategies addressing institutional racism, yet as scholars have argued, the “whiteness” of bioethics undermines its capacity to attend to institutionalized forms of racism (Mayes 2020 ; Russell 2016 ; Danis, Wilson, and White 2016 ). Catherine Myser argues that bioethics depends on social and ethical theories that normalize whiteness and that “we risk repeatedly re-inscribing white privilege—white supremacy even—into the very theoretical structures and methods we create as tools to identify and manage ethical issues in biomedicine” (Myser 2003 , 2). As such, whiteness not only contributes to bioethical problems such as discriminatory patient care, but it shapes the reality of what is considered an ethical problem and the way bioethicists think ethically about such problems.

To address institutional racism, and the compounding problem of whiteness, we need a bioethics that is reflexive and critical of whiteness and its relationship with institutional racism. This symposium brings together scholars and researchers from a variety of disciplines to examine how racism has been institutionalized in healthcare, how whiteness manifests in healthcare, and what bioethics can contribute towards anti-racism.

In October 2019, we invited researchers to consider the following questions:

What are the historical and material processes that contributed to the institutionalization of racism in medicine and healthcare settings?

What role can Indigenous knowledges play in de-centering whiteness and addressing racism?

Does bioethics have a role in addressing racism or is it too entangled with histories of racism and whiteness?

The articles in this issue respond to these questions and articulate the affective dimension of race in clinical spaces, the economic and social costs of racialized health inequalities, the continuing effects of colonialism and complicity of bioethics in institutional racism.

The context in which this issue came together should also be noted. By early 2020, COVID-19 was quickly emerging as a global pandemic. In May 2020, the killing of George Floyd by Minneapolis police officers re-ignited Black Lives Matter protests globally. Racism associated with the COVID-19 pandemic has impacted minority groups worldwide, exacerbating pre-existing social, economic, and health vulnerabilities within an environment of populism, rampant neo-liberal capitalism, resurgent exclusionary ethno-nationalism, and retreating internationalism (Elias et al. 2020 ). These events prompted medical journals to publish editorials addressing the medical consequences of racism and highlighted the entanglement of medical institutions with racism (Hardeman, Medina, and Boyd 2020 ; Bond et al. 2020 ). Bioethicists also began to reflect on whether bioethics was complicit with institutional racism and racialized health disparities, in addition to questioning the silence of bioethics on issues of racial justice and re-thinking the role of bioethics in society (Mithani, Cooper, and Boyd 2020 ).

Many of the authors in this symposium were actively involved in organizing and responding to the racialized impacts of COVID-19. Some were also actively engaged in Black Lives Matter protests and events. We commend the authors for researching and writing under these conditions and extend our gratitude to the anonymous peer reviewers and editorial team at the Journal of Bioethical Inquiry who worked under these conditions.

Overview of the Issue

This symposium opens with an article from Yolonda Wilson arguing for the need to broaden the role and scope of bioethics to address contemptuous racism, which she defines as “disdain for the contemned patient that cannot be overcome” (Wilson 2021 , ¶6). Part of this broadening involves taking the social determinants of health seriously and recognizing the role racism plays in determining health outcomes. Wilson also argues that bioethics needs to be based on a commitment to justice that centres anti-racism.

Like Wilson’s attention to contempt, Belinda Borell critically examines the role of emotion in hospital spaces and the value placed on stoic ideals of individualism and controlled emotion. Borell argues the stoic ideal can make “hospitals emotionally unsafe spaces for Māori and other groups who place high importance in the collective sharing of emotion” (Borell 2021 , “Abstract”). Borell contends that bioethicists need to contribute to anti-racist interventions that “reclaim emotion as a measure of health” (Borell 2021 , “Conclusion”).

Bryan Mukandi’s paper draws on literature, art, and philosophy to reveal the function and effects of the racialized gaze in the clinical context. Mukandi outlines “a Canaanite reading” “to draw some of the lines that mark the Black person’s experience of the medical system” (Mukandi 2021 , ¶5). The lines that Mukandi tangles and disentangles serve to challenge bioethical thinking and writing, as well as critically analyses medical power and the way it denotes who is seen and who can speak in clinical spaces.

A series of articles expand the focus from the clinical to the institutional, constitutional, and legislative contexts. Amanuel Elias and Yin Paradies ( 2021 ) use a multidisciplinary approach to highlight the variety of costs associated with racism at the institutional level. They demonstrate that institutional racism imposes both social and economic costs that have significant ethical implications, such as avoidable disparities in healthcare, which to-date have beeng neglected by bioethicists.

Heather Came, Maria Baker, and Tim McCreanor ( 2021 ) provide a conceptual article that explores the Matike Mai Aotearoa report on constitutional transformation in New Zealand as a novel means to address structural racism within the health system. They argue that “constitutional transformation and decolonization are potentially powerful ethical sources of disruption to whiteness and structural racism,” which can help “to eliminate entrenched health disparities” (Came, Baker, and McCreanor 2021 , “Abstract”).

Thailia Anthony and Harry Blagg draw on Giorgio Agamben’s biopolitical theory to argue that settler-colonial legal and medical institutions rendered First Nations peoples as “bare life”; that is, lives “unworthy of the standard of care we owe to human beings” (Anthony and Blagg 2021 , “Aboriginal Deaths in Custody: Settler Colonial Thanatopower”). These institutions operate with and produce a “regime of truth” that denigrate Indigenous peoples, knowledges, and their bodies. Anthony and Blagg argue for a decolonizing bioethics that rethinks the colonial truths about Indigenous people, which results in the health system’s discriminatory disregard for their lives.

Chelsea Bond, David Singh, and Claudette Tyson offer a powerful article that centre stories as told by Black people that “bring Black bodies into full focus and serve as testaments to the racial violence that is meted out in the absence of care” (Bond, Singh, and Tyson 2021 , “Introduction” ¶5). They highlight the failure of bioethics and the assumed beneficence of Indigenous health research agendas to take Indigenous sovereignty and the experiences of black bodies more seriously. They argue that “the extent to which a radical bioethics can be put to service in the name of more just outcomes is dependent upon bringing Black bodies and lives into full view” (Bond, Singh, and Tyson 2021 , “Background” ¶5).

Warwick Anderson offers an insightful set of reflections on his career as a medical anthropologist and historian. Anderson notes the way ethical regimes that govern research have shifted over time and have been shaped by a (white) bioethical judgement that has an imperative for “white universal” or global application of ethical protocols. Anderson contends that we need a more flexible understanding of ethics and argues “we should recognize others as ethical agents and authorities, not just as moral subjects. We need wide-ranging bioethical reasoning, but must it be a white mythology?” (Anderson 2021 , ¶10).

In his review essay of Catherine Mills’s Biopolitics ( 2016 ) and Camisha Russell’s Assisted Reproduction of Race ( 2016 ) Christopher Mayes shows how biopolitical theory and critical philosophy of race can be useful in looking at bioethical problems from a new perspective that opens up different kinds of analyses, particularly around historically embedded problems like institutional racism and the legacies of colonialism in healthcare (Mayes 2021 ).

The symposium concludes with a provocation by Camisha Russell ( 2021 ) that bioethicists need to help scientists think about race. We sought responses from Mandy Truong and Mienah Sharif ( 2021 ) who argued that bioethics and public health can collectively advance scientific efforts towards addressing racism; and from Tessa Moll ( 2021 ) who recounted issues of medical mistrust and enduring racism in South Africa.

In 2016, John Hoberman argued that “[b]ioethicists have not embraced the opportunity to create a sociologically and historically informed bioethics that might be applied to the lives of [racial minorities] and their unending health crisis” (Hoberman 2016 , 13). Indeed, the issue of institutional racism represents a long overdue topic of interest that requires attention within the discipline. We hope that this symposium may provide some impetus to explore the possibilities for bioethics to address institutional racism more broadly and to be more aware of, and attenuate, its influence within bioethical thinking and research. More profoundly, there is a need to engage with decolonial ways of thinking, doing, and being that de-centre and rupture the largely unexamined foundations of whiteness within bioethics.

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Bond, C.J., D. Singh, and C. Tyson. 2021. Black bodies and bioethics: Debunking mythologies of benevolence and beneficence in contemporary Indigenous health research in colonial Australia. Journal of Bioethical Inquiry 18(1).  https://doi.org/10.1007/s11673-020-10079-8 .

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Chris Mayes receives funding from the Australian Research Council (DE170100550).

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Mayes, C., Paradies, Y. & Elias, A. Lead Essay—Institutional Racism, Whiteness, and the Role of Critical Bioethics . Bioethical Inquiry 18 , 9–12 (2021). https://doi.org/10.1007/s11673-021-10103-5

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Research co-authored by SIEPR’s Peter Klenow and Chad Jones measures the welfare gap between Black and white Americans and provides a way to analyze policies to narrow the divide.

How an ‘impact mindset’ unites activists of different races

A new study finds that people’s involvement with Black Lives Matter stems from an impulse that goes beyond identity.

For democracy to work, racial inequalities must be addressed

The Stanford Center for Racial Justice is taking a hard look at the policies perpetuating systemic racism in America today and asking how we can imagine a more equitable society.

The psychological toll of George Floyd’s murder

As the nation mourned the death of George Floyd, more Black Americans than white Americans felt angry or sad – a finding that reveals the racial disparities of grief.

Seven factors contributing to American racism

Of the seven factors the researchers identified, perhaps the most insidious is passivism or passive racism, which includes an apathy toward systems of racial advantage or denial that those systems even exist.

Scholars reflect on Black history

Humanities and social sciences scholars reflect on “Black history as American history” and its impact on their personal and professional lives.

The history of Black History Month

It's February, so many teachers and schools are taking time to celebrate Black History Month. According to Stanford historian Michael Hines, there are still misunderstandings and misconceptions about the past, present, and future of the celebration.

Numbers about inequality don’t speak for themselves

In a new research paper, Stanford scholars Rebecca Hetey and Jennifer Eberhardt propose new ways to talk about racial disparities that exist across society, from education to health care and criminal justice systems.

Changing how people perceive problems

Drawing on an extensive body of research, Stanford psychologist Gregory Walton lays out a roadmap to positively influence the way people think about themselves and the world around them. These changes could improve society, too.

Welfare opposition linked to threats of racial standing

Research co-authored by sociologist Robb Willer finds that when white Americans perceive threats to their status as the dominant demographic group, their resentment of minorities increases. This resentment leads to opposing welfare programs they believe will mainly benefit minority groups.

Conversations about race between Black and white friends can feel risky, but are valuable

New research about how friends approach talking about their race-related experiences with each other reveals concerns but also the potential that these conversations have to strengthen relationships and further intergroup learning.

Defusing racial bias

Research shows why understanding the source of discrimination matters.

Many white parents aren’t having ‘the talk’ about race with their kids

After George Floyd’s murder, Black parents talked about race and racism with their kids more. White parents did not and were more likely to give their kids colorblind messages.

Stereotyping makes people more likely to act badly

Even slight cues, like reading a negative stereotype about your race or gender, can have an impact.

Why white people downplay their individual racial privileges

Research shows that white Americans, when faced with evidence of racial privilege, deny that they have benefited personally.

Clayborne Carson: Looking back at a legacy

Stanford historian Clayborne Carson reflects on a career dedicated to studying and preserving the legacy of civil rights leader Martin Luther King Jr.

How race influences, amplifies backlash against outspoken women

When women break gender norms, the most negative reactions may come from people of the same race.

Examining disparities in education

Scholar Subini Ancy Annamma is studying ways to make education more equitable for historically marginalized students. Annamma’s research examines how schools contribute to the criminalization of Black youths by creating a culture of punishment that penalizes Black children more harshly than their white peers for the same behavior. Her work shows that youth of color are more likely to be closely watched, over-represented in special education, and reported to and arrested by police.

“These are all ways in which schools criminalize Black youth,” she said. “Day after day, these things start to sediment.”

That’s why Annamma has identified opportunities for teachers and administrators to intervene in these unfair practices. Below is some of that research, from Annamma and others.

New ‘Segregation Index’ shows American schools remain highly segregated by race, ethnicity, and economic status

Researchers at Stanford and USC developed a new tool to track neighborhood and school segregation in the U.S.

New evidence shows that school poverty shapes racial achievement gaps

Racial segregation leads to growing achievement gaps – but it does so entirely through differences in school poverty, according to new research from education Professor Sean Reardon, who is launching a new tool to help educators, parents and policymakers examine education trends by race and poverty level nationwide.

School closures intensify gentrification in Black neighborhoods nationwide

An analysis of census and school closure data finds that shuttering schools increases gentrification – but only in predominantly Black communities.

Ninth-grade ethnic studies helped students for years, Stanford researchers find

A new study shows that students assigned to an ethnic studies course had longer-term improvements in attendance and graduation rates.

Teaching about racism

Stanford sociologist Matthew Snipp discusses ways to educate students about race and ethnic relations in America.

Stanford scholar uncovers an early activist’s fight to get Black history into schools

In a new book, Assistant Professor Michael Hines chronicles the efforts of a Chicago schoolteacher in the 1930s who wanted to remedy the portrayal of Black history in textbooks of the time.

How disability intersects with race

Professor Alfredo J. Artiles discusses the complexities in creating inclusive policies for students with disabilities.

Access to program for black male students lowered dropout rates

New research led by Stanford education professor Thomas S. Dee provides the first evidence of effectiveness for a district-wide initiative targeted at black male high school students.

How school systems make criminals of Black youth

Stanford education professor Subini Ancy Annamma talks about the role schools play in creating a culture of punishment against Black students.

Reducing racial disparities in school discipline

Stanford psychologists find that brief exercises early in middle school can improve students’ relationships with their teachers, increase their sense of belonging and reduce teachers’ reports of discipline issues among black and Latino boys.

Science lessons through a different lens

In his new book, Science in the City, Stanford education professor Bryan A. Brown helps bridge the gap between students’ culture and the science classroom.

Teachers more likely to label black students as troublemakers, Stanford research shows

Stanford psychologists Jennifer Eberhardt and Jason Okonofua experimentally examined the psychological processes involved when teachers discipline black students more harshly than white students.

Why we need Black teachers

Travis Bristol, MA '04, talks about what it takes for schools to hire and retain teachers of color.

Understanding racism in the criminal justice system

Research has shown that time and time again, inequality is embedded into all facets of the criminal justice system. From being arrested to being charged, convicted and sentenced, people of color – particularly Black men – are disproportionately targeted by the police.

“So many reforms are needed: police accountability, judicial intervention, reducing prosecutorial power and increasing resources for public defenders are places we can start,” said sociologist Matthew Clair . “But beyond piecemeal reforms, we need to continue having critical conversations about transformation and the role of the courts in bringing about the abolition of police and prisons.”

Clair is one of several Stanford scholars who have examined the intersection of race and the criminal process and offered solutions to end the vicious cycle of racism. Here is some of that work.

Police Facebook posts disproportionately highlight crimes involving Black suspects, study finds

Researchers examined crime-related posts from 14,000 Facebook pages maintained by U.S. law enforcement agencies and found that Facebook users are exposed to posts that overrepresent Black suspects by 25% relative to local arrest rates.

Supporting students involved in the justice system

New data show that a one-page letter asking a teacher to support a youth as they navigate the difficult transition from juvenile detention back to school can reduce the likelihood that the student re-offends.

Race and mass criminalization in the U.S.

Stanford sociologist discusses how race and class inequalities are embedded in the American criminal legal system.

New Stanford research lab explores incarcerated students’ educational paths

Associate Professor Subini Annamma examines the policies and practices that push marginalized students out of school and into prisons.

Derek Chauvin verdict important, but much remains to be done

Stanford scholars Hakeem Jefferson, Robert Weisberg and Matthew Clair weigh in on the Derek Chauvin verdict, emphasizing that while the outcome is important, much work remains to be done to bring about long-lasting justice.

A ‘veil of darkness’ reduces racial bias in traffic stops

After analyzing 95 million traffic stop records, filed by officers with 21 state patrol agencies and 35 municipal police forces from 2011 to 2018, researchers concluded that “police stops and search decisions suffer from persistent racial bias.”

Stanford big data study finds racial disparities in Oakland, Calif., police behavior, offers solutions

Analyzing thousands of data points, the researchers found racial disparities in how Oakland officers treated African Americans on routine traffic and pedestrian stops. They suggest 50 measures to improve police-community relations.

Race and the death penalty

As questions about racial bias in the criminal justice system dominate the headlines, research by Stanford law Professor John J. Donohue III offers insight into one of the most fraught areas: the death penalty.

Diagnosing disparities in health, medicine

The COVID-19 pandemic has disproportionately impacted communities of color and has highlighted the health disparities between Black Americans, whites and other demographic groups.

As Iris Gibbs , professor of radiation oncology and associate dean of MD program admissions, pointed out at an event sponsored by Stanford Medicine: “We need more sustained attention and real action towards eliminating health inequities, educating our entire community and going beyond ‘allyship,’ because that one fizzles out. We really do need people who are truly there all the way.”

Below is some of that research as well as solutions that can address some of the disparities in the American healthcare system.

Stanford researchers testing ways to improve clinical trial diversity

The American Heart Association has provided funding to two Stanford Medicine professors to develop ways to diversify enrollment in heart disease clinical trials.

Striking inequalities in maternal and infant health

Research by SIEPR’s Petra Persson and Maya Rossin-Slater finds wealthy Black mothers and infants in the U.S. fare worse than the poorest white mothers and infants.

More racial diversity among physicians would lead to better health among black men

A clinical trial in Oakland by Stanford researchers found that black men are more likely to seek out preventive care after being seen by black doctors compared to non-black doctors.

A better measuring stick: Algorithmic approach to pain diagnosis could eliminate racial bias

Traditional approaches to pain management don’t treat all patients the same. AI could level the playing field.

5 questions: Alice Popejoy on race, ethnicity and ancestry in science

Alice Popejoy, a postdoctoral scholar who studies biomedical data sciences, speaks to the role – and pitfalls – of race, ethnicity and ancestry in research.

Stanford Medicine community calls for action against racial injustice, inequities

The event at Stanford provided a venue for health care workers and students to express their feelings about violence against African Americans and to voice their demands for change.

Racial disparity remains in heart-transplant mortality rates, Stanford study finds

African-American heart transplant patients have had persistently higher mortality rates than white patients, but exactly why still remains a mystery.

Finding the COVID-19 Victims that Big Data Misses

Widely used virus tracking data undercounts older people and people of color. Scholars propose a solution to this demographic bias.

Studying how racial stressors affect mental health

Farzana Saleem, an assistant professor at Stanford Graduate School of Education, is interested in the way Black youth and other young people of color navigate adolescence—and the racial stressors that can make the journey harder.

Infants’ race influences quality of hospital care in California

Disparities exist in how babies of different racial and ethnic origins are treated in California’s neonatal intensive care units, but this could be changed, say Stanford researchers.

Immigrants don’t move state-to-state in search of health benefits

When states expand public health insurance to include low-income, legal immigrants, it does not lead to out-of-state immigrants moving in search of benefits.

Excess mortality rates early in pandemic highest among Blacks

The impact of the COVID-19 pandemic has been starkly uneven across race, ethnicity and geography, according to a new study led by SHP's Maria Polyakova.

Decoding bias in media, technology

Driving Artificial Intelligence are machine learning algorithms, sets of rules that tell a computer how to solve a problem, perform a task and in some cases, predict an outcome. These predictive models are based on massive datasets to recognize certain patterns, which according to communication scholar Angele Christin , sometimes come flawed with human bias . 

“Technology changes things, but perhaps not always as much as we think,” Christin said. “Social context matters a lot in shaping the actual effects of the technological tools. […] So, it’s important to understand that connection between humans and machines.”

Below is some of that research, as well as other ways discrimination unfolds across technology, in the media, and ways to counteract it.

IRS disproportionately audits Black taxpayers

A Stanford collaboration with the Department of the Treasury yields the first direct evidence of differences in audit rates by race.

Automated speech recognition less accurate for blacks

The disparity likely occurs because such technologies are based on machine learning systems that rely heavily on databases of English as spoken by white Americans.

New algorithm trains AI to avoid bad behaviors

Robots, self-driving cars and other intelligent machines could become better-behaved thanks to a new way to help machine learning designers build AI applications with safeguards against specific, undesirable outcomes such as racial and gender bias.

Stanford scholar analyzes responses to algorithms in journalism, criminal justice

In a recent study, assistant professor of communication Angèle Christin finds a gap between intended and actual uses of algorithmic tools in journalism and criminal justice fields.

Move responsibly and think about things

In the course CS 181: Computers, Ethics and Public Policy , Stanford students become computer programmers, policymakers and philosophers to examine the ethical and social impacts of technological innovation.

Homicide victims from Black and Hispanic neighborhoods devalued

Social scientists found that homicide victims killed in Chicago’s predominantly Black and Hispanic neighborhoods received less news coverage than those killed in mostly white neighborhoods.

Algorithms reveal changes in stereotypes

New Stanford research shows that, over the past century, linguistic changes in gender and ethnic stereotypes correlated with major social movements and demographic changes in the U.S. Census data.

AI Index Diversity Report: An Unmoving Needle

Stanford HAI’s 2021 AI Index reveals stalled progress in diversifying AI and a scarcity of the data needed to fix it.

Identifying discrimination in the workplace and economy

From who moves forward in the hiring process to who receives funding from venture capitalists, research has revealed how Blacks and other minority groups are discriminated against in the workplace and economy-at-large. 

“There is not one silver bullet here that you can walk away with. Hiring and retention with respect to employee diversity are complex problems,” said Adina Sterling , associate professor of organizational behavior at the Graduate School of Business (GSB). 

Sterling has offered a few places where employers can expand employee diversity at their companies. For example, she suggests hiring managers track data about their recruitment methods and the pools that result from those efforts, as well as examining who they ultimately hire.

Here is some of that insight.

How To: Use a Scorecard to Evaluate People More Fairly

A written framework is an easy way to hold everyone to the same standard.

Archiving Black histories of Silicon Valley

A new collection at Stanford Libraries will highlight Black Americans who helped transform California’s Silicon Valley region into a hub for innovation, ideas.

Race influences professional investors’ judgments

In their evaluations of high-performing venture capital funds, professional investors rate white-led teams more favorably than they do black-led teams with identical credentials, a new Stanford study led by Jennifer L. Eberhardt finds.

Who moves forward in the hiring process?

People whose employment histories include part-time, temporary help agency or mismatched work can face challenges during the hiring process, according to new research by Stanford sociologist David Pedulla.

How emotions may result in hiring, workplace bias

Stanford study suggests that the emotions American employers are looking for in job candidates may not match up with emotions valued by jobseekers from some cultural backgrounds – potentially leading to hiring bias.

Do VCs really favor white male founders?

A field experiment used fake emails to measure gender and racial bias among startup investors.

Can you spot diversity? (Probably not)

New research shows a “spillover effect” that might be clouding your judgment.

Can job referrals improve employee diversity?

New research looks at how referrals impact promotions of minorities and women.

Institutionalized Racism: A Syllabus

How can we help students understand George Floyd’s death in the context of institutionalized racism?

The United States has seen escalating protests over the past week, following the death of George Floyd while in custody of the Minneapolis police. Educators everywhere are asking how can we help students understand that this was not an isolated, tragic incident perpetrated by a few bad individuals, but part of a broader pattern of institutionalized racism. Institutional racism—a term coined by Stokely Carmichael (later known as Kwame Ture) and Charles V. Hamilton in their 1967 book Black Power: The Politics of Liberation in America —is what connects George Floyd and Breonna Taylor with Ahmaud Arbery, Philando Castile, Sandra Bland, Eric Garner, Emmett Till, and the thousands of other people who have been killed because they were “ black in America .”

This context seems vital for discussions both inside and outside the classroom. The following articles, published over the course of JSTOR Daily’s five years try to provide such context. As always, the underlying scholarship is free for all readers. We have now updated this story with tagging for easier navigation to related content, will be continually updating this page with more stories, and are working to acquire a bibliographic reading list about institutionalized racism in the near future. (Note: Some readers may find some of the stories in this syllabus or the photos used to illustrate them disturbing. Teachers may wish to use caution in assigning them to students.)

Racial (In)Justice: Putting Protest into Perspective

The Detroit Rebellion

The devastation of black wall street.

The Mob Violence of the Red Summer

Race and Labor in the 1863 New York City Draft Riots

Did The 1965 Watts Riots Change Anything?

A History of Police Violence in Chicago

The People’s Grocery Lynching, Memphis, Tennessee

How the Body Can Shape Social Protest

Dr. Ossian Sweet’s Black Life Mattered

African American Studies: Foundations and Key Concepts

Video documentation & police brutality: ethical considerations.

Viral Black Death: Why We Must Watch Citizen Videos of Police Violence

How Do I (Not) Look? Live Feed Video and Viral Black Death

Why Didn’t the Rodney King Video Lead to a Conviction?

Racial, economic, and educational disparities go hand in hand.

How Black Artists Fought Exclusion in Museums

Calling the Police, without Trusting the Police

James Baldwin and Nikki Giovanni in Conversation

How Residential Segregation Looked in the South

Environmental Racism and the Coronavirus Pandemic

The Racism of History Textbooks

School Suspensions and the Racial Discipline Gap

How Segregation Hurts Kids

Why Racism Is Terrible for Everyone’s Health

The 1910 Report That Disadvantaged Minority Doctors

COVID-19 Is Hitting Black and Poor Communities the Hardest

The Lasting Fallout of the Tuskegee Syphilis Study

The Latent Racism of the Better Homes in America Program

How Insurance Companies Used Bad Science to Discriminate

How Natural Black Hair at Work Became a Civil Rights Issue

The Case for Reparations Is Nothing New

The History of the History of American Slavery

Project Implicit Reveals Your Hidden Prejudice

Why James Baldwin’s The Fire Next Time Still Matters

Editor’s notes: We welcome reader comments: get in touch with comments, pitch us, or offer recommendations for further coverage here. Submission guidelines (we pay all our writers) here. These articles are just a small selection of the work we publish on JSTOR Daily. We’ve added tags on this article to help you find your way to related content, but are in the process of reviewing our tagging structure so these may change. We encourage you to sign up for our newsletter to get a digest of stories each week. Note: This story was updated June 4 with additional stories and tags for navigation to other related content. Thanks to reader comments, the introduction was updated June 3 with Breonna Taylor and Sandra Bland’s names and the phrase “people of color” was changed to “people.”

To support JSTOR Daily’s work providing historical and scholarly context to the news and current affairs, you can become a member on Patreon .

JSTOR is a digital library for scholars, researchers, and students. JSTOR Daily readers can access the original research behind our articles for free on JSTOR.

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Hover and click on coloured underlined text to it's relevant comment in a popup. Clicking on the icon to see more about the colour coded "Functions and Qualities" of writing. You can show and hide each comment's type by clicking on their colour codes in the sidebar under "Comments Key", this can help make the Extract easier to read.

Essay: Critically analyse the concept of institutional racism in policing and evaluate policy responses to it.

This essay is well structured, with effective signposting, which is helpful to the reader. The argument is outlined and supported by evidence, demonstrating a good level of analysis.

Function: Describe

This is an opening statement presenting an idea which has already been established. It sets the essay in context before moving onto specific details.

Function: Analyse

This is an example of effective referencing, whereby evidence from two other authors is used to back up points.

This is an example of critical analysis whereby the significance of the two reports is outlined.

Quality: Structure

This sentence helps specify more clearly what the essay will cover and relates it to the essay title.

The writer sets out the problem and lists the items to be covered in the essay. This helpfully shows the reader the essay’s structure. The conclusion is mentioned briefly here as it contextualises the whole line of argument.

The paragraph opens with a general sentence about the crisis in modern policing and then moves on to discuss an example. Opening with the general statement sets the example nicely in context. This signposting helps the reader, and introduces the area of the crisis in modern policing as a starting point to be expanded on throughout the essay

Quality: Authority

It is always important to support an argument with information and evidence as has been done here. The argument of widespread racism existing in the Police is supported by this reference, which could be followed up by the reader.

A new term, ’overpolicing’, is presented here. A more interesting way of introducing a definition is to describe a situation or practice first (the previous sentence) and then introduce the term, rather than the other way around.

This sentence offers over-policing as a reason for heightened racial tension.

Quality: Voice (or Style)

The use of the word ‘however’ implies a relationship of difference between the previous sentence and this one: it may be more appropriate to use the word ‘finally’ to bring together the considerations previously outlined.

These final three sentences are well structured: a general point is made, supported by a relevant quotation and then further backed up by a relevant example.

This essay is well structured, with effective signposting, which is helpful to the reader. The argument is outlined and supported by evidence, demonstrating a good level of analysis. View linked text

This is an opening statement presenting an idea which has already been established. It sets the essay in context before moving onto specific details. View linked text

The writer sets out the problem and lists the items to be covered in the essay. This helpfully shows the reader the essay"s structure. The conclusion is mentioned briefly here as it contextualises the whole line of argument. View linked text

A new term, "overpolicing", is presented here. A more interesting way of introducing a definition is to describe a situation or practice first (the previous sentence) and then introduce the term, rather than the other way around. View linked text

This is an example of effective referencing, whereby evidence from two other authors is used to back up points. View linked text

This is an example of critical analysis whereby the significance of the two reports is outlined. View linked text

This sentence offers over-policing as a reason for heightened racial tension. View linked text

This sentence helps specify more clearly what the essay will cover and relates it to the essay title. View linked text

The paragraph opens with a general sentence about the crisis in modern policing and then moves on to discuss an example. Opening with the general statement sets the example nicely in context. This signposting helps the reader, and introduces the area of the crisis in modern policing as a starting point to be expanded on throughout the essay View linked text

These final three sentences are well structured: a general point is made, supported by a relevant quotation and then further backed up by a relevant example. View linked text

It is always important to support an argument with information and evidence as has been done here. The argument of widespread racism existing in the Police is supported by this reference, which could be followed up by the reader. View linked text

Quality: Voice

The use of the word "however" implies a relationship of difference between the previous sentence and this one: it may be more appropriate to use the word "finally" to bring together the considerations previously outlined. View linked text

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The Hal Baron Project

Research about the works of harold (hal) baron.

Tag Archives: Institutional Racism

Public housing, chicago builds a ghetto (hal baron, 1967).

Synopsis by: Briana Gipson

In 1967, Hal Baron delivered “Public Housing, Chicago Builds a Ghetto” as a fiery, anti-colonial speech on the state of Chicago’s public housing system. This speech was delivered to an audience containing Chicago Housing Authority (CHA) leaders and staff at a symposium at the University of Chicago on March 10, 1967. He would use his speech to critique the City of Chicago’s and the CHA’s practices and reveal the negative outcomes they created and forced on Chicago’s Black community. He argued that City transformed its public housing system into a tool that implements and solidifies racism. It essentially became a system that segregated Blacks, decreased their mobility, and altered their community networks and solidarity by social, economic, and political force. He devoted his speech to discussing the federal government’s, Chicago’s and CHA’s role in creating ghettos, or areas with high concentrations of low-income Blacks, through public housing. He organized his discussion into four separate sections.

The first section of Baron’s speech is titled “From Crusade to Containment”. He began this section by discussing the three major periods of public housing from the lens of the Chicago Urban League. His main point is public housing was originally organized as a campaign to rid problems associated with urban life such as overcrowding and poverty by the federal government. Then it became a system to support World War II war workers before finally becoming “a virtually Negro institution” Baron says. In other words, Baron claimed that it became a system designed to reinforce the racial biases of those in power. He used CHA statistics to show that their biases resulted in Chicago’s public housing system being 90% Black, in 90% of CHA’s properties. Baron explained how Jim Crow and anti-black legislation in the League’s three public housing periods led to Chicago’s segregated and predominantly Black public housing system in the 1960s.

The next section of Baron’s speech focuses on the influence of federal policies and urban renewal on Chicago’s segregated and Black public housing system. The name of this section is “The Safety Valve for Urban Renewal”. It fundamentally argued that Chicago’s public housing system became segregated and Black because it used its system as a “safety-net” for urban renewal. Baron unpacks this argument by revealing how the federal government’s housing and transportation policies began altering housing supply based on race beginning in the late 1930s. It offered Federal Housing Administration (FHA) and Veteran Affairs loans to Whites, which contributed to mass suburbanization processes and ultimately increased Whites’ housing supply. Baron indicated that suburbanization expanded at the expense of Black neighborhoods as the federal government subsidized expressways to support migrating Whites. These expressways along with urban renewal would displace thousands of Blacks and decrease their already limited housing supply. Baron asserted that this led to Chicago’s public housing properties becoming relocation settlements or “catch-basins” for Blacks who were uprooted from their homes and livelihoods. He provided evidence showing that CHA transitioned from serving mostly low-income, White neighborhoods prior to 1949 to proposing over 95% of its properties in Black neighborhoods from 1950 to 1955. Baron further supported his main argument that Chicago built a segregated and concentrated low-income Black community by ending this section discussing how the CHA came under fire for proposing a housing project development in a White neighborhood. His example showed how firm the City of Chicago was in creating and maintaining segregation through the CHA.

Baron’s third section describes how CHA began to engage in disparate treatment once its public housing system became predominantly Black. He particularly focused on the CHA’s building designs. He explained that CHA’s building designs followed the Garden City movement when it was created for Whites and war-workers. They were often constructed as single family apartments with green space. However, once CHA began building public housing developments for displaced Blacks, Baron witnessed CHA build dense, high-rise buildings that had larger building coverage ratios. He contended that this building design exacerbated Chicago’s spatial segregation. He supported his claim by explaining that this increased residential segregation within central Chicago strengthened school segregation and furthered separated Blacks from jobs. Jobs were often moving to the periphery of cities as a result of expressway and highway construction, which increased employment segregation. Baron ended this section explaining the negative impact of CHA’s high-rise developments on community networks. He mentioned that it does not allow for Blacks to rebuild the institutions they lost in urban renewal to full capacity. It also weakened community connections and leadership opportunities. Baron’s last sentences showcased that Chicago’s public housing system did not even provide the stability needed for Blacks to rebuild and connect. Blacks lost their public housing vouchers once they made it to a certain income, and Baron foreshadows that this only perpetuates the very racism that led Blacks to Chicago’s public housing system in the first place.

Baron’s last section, “The Powerlessness of Black Tenants”, uncovered how he believed CHA acted as Black colonizers. He began this section describing two differences between the private and public housing market. The differences were that Blacks lacked the alternatives the private market offered and the power to make political decisions. Baron credited these differences to the CHA’s failure to treat Blacks as their clients and accommodate their needs like the FHA did for its mostly White clients. Additionally, Blacks could not significantly influence the ways the CHA operated because it was a public entity that did not often act in Blacks’ interests. They instead provided top-down orders Baron implied. He proclaimed that this made organizations like the CHA paternalistic colonizers that managed the public housing system like wards instead of providing opportunity. Baron ended this section and his raw speech summarizing the main idea he wanted the audience to grasp: CHA’s public housing system segregates and disrespects Blacks. His final words share that Blacks felt “hopeless, helpless, and totally manipulated” by CHA’s disparate and disrespectful public housing system.

The Web of Urban Racism (Harold M. Baron, 1968)

Synopsis by Madeleine McQuilling

In this chapter, Hal Baron spends a few pages on each of his main themes  (history, housing, labor, education, politics)  and explains how they all represent  different  aspects of what he terms the “web of urban racism.” The web of urban racism, a phrase Baron uses in his writings from the late 1960s onwards, denotes the network  of  institutional racism intrinsic to American society (1). Baron explains:  

  The impersonal institutions of the great cities have been woven together into a web of urban racism that entraps Negroes much as the spider’s net holds flies – they can wiggle but they cannot move very far. There is a carefully articulated interrelation of the barriers created by each institution. Whereas the single institutional strand standing a l one might not be so strong, together the many strands form a powerful web. But here the analogy breaks down. In contrast to the spider’s prey, the victim of urban racism has fed on stronger stuff and is on the threshold of tearing the web.  

  Written in 1968,  Baron’s sympathies for the black power movement surge beneath his calm prose. The “Long, hot summer of 1967” shone a spotlight on the problematic rac e  relations in America ; by its light, the web of urban racism becomes more visible, and thus, more vulnerable. Baron is confident that its victims have “fed on stronger stuff,” and are now capable of “tearing the web.”  In order for readers to fully appreciate this anticipated moment of liberation, Baron details how the web of urban racism came about, and how it continues to impact every sphere of daily life.    

  Baron starts his history of urban racism in America with the Civil War,  declaring that the  “ a bolition of  slavery did not mean the abolition of racism.”  To the contrary,  the racism decreased only in its visibility , taking  “on a new institutional form in which it was still effective in subjugating blacks and politically disarming poor whites.”  In other words, the racism  starts shifting from  de jure  to  de facto .  Baron sees   d e jure  segregation, or legalized segregation ,   as a  largely southern system ; in contrast, he considers   de facto , or automatic segregation  a predominantly  northern one .   But, Baron observes, “a s the southern population becomes more demographically similar to the northern population, the nature of racism is beginning to assume greater similarities, especially in metropolitan centers. ”  The difference between  de jure  and  de facto  segregation  is the difference between a school that forbids the enrollment of black students, and a school built in such a way that no  black   students  live within its district.   The great migration  of the early 20 th  century  made it painfully clear that racism  survived the Civil War; it  was alive and well –– norther n  as well as southern.   

For  Baron ,   the  demographic shift represented a  “push-pull phenomenon . ” “The push,” he argues , “was the displacement of Negroes from southern agriculture, occasioned first by soil exhaustion, then by boll-weevil destruction and crop diversification .” The  labor opportunities in  the agricultural  south  were further diminished   by  the  rise  of tractors, herbicides, and agricultural machines.  “ The pull of the city ,” Baron continues, “ has primarily been exerted through wartime labor shortages ,” and the demand for unskilled  labor that they occasion. The northern cities further appealed to black people because their system of  de facto  racism  was  “ less obvious than the South’s Jim Crow. ”  Baron emphasizes that the  demographic shift from rural to urban spaces is  just as important as the one from south to north.  This urbanization is important to Baron, because : “ The great racial conflict now so manifest in the city is both generated and restrained by its major institutions. ”    “Indeed,”  as  Baron declares in no uncertain language, “the white suburba n noose around the city is drawing tighter.”  

  In this report, Baron advances the thesis that  de facto  segregation is actually worse than  de jure  segregation: “As the specific barriers become less distinctive and less absolute, their meshing together into an overriding network compensates so that the combined effect of the whole is greater than the sum of the individual institutions.” Baron clarifies:  

  For examples: the school system uses the neighborhood school policy which combined with residential segregation operates as a surrogate for direct segregation; suburbs in creating very restrictive zoning regulations, or urban renewal developments in setting universally high rents can eliminate all but a very few Negro families on the basis of income; given the racial differentials produced by the school system, an employer, by using his regular personnel tests and criteria, can screen out most Negroes from desirable jobs.  

  This is the web of urban racism. Although these racial controls represent a web from a structural standpoint, “from within the Negro community,” Baron explains, “it tends to appear that there is just a massive white sea that surrounds a black island.” This analogy brings to mind Du  Bois’  cave allegory in  Dusk of Dawn  (or Myrdal’s reference to it in  An American Dilemma ), while echoing Martin Luther King’s “lonely island of poverty in the midst of a vast ocean of material prosperity” (2). As though to emphasize this socioeconomic aspect, Baron now moves from a broad discussion of the web of urban racism to its role in the dual labor market specifically.   

  While the education gap between black and white workers had nearly closed by the 1960s, the gap in salary, employment, leadership  opportunities ,   and socioeconomic status has only grown.  Baron notes that even “the  United States Department of Labor has had to conclude that  ‘ social and economic conditions are getting worse, not better ’” for people trapped in slum sectors.   For Baron, this inequality results from a dualism in the labor market  that divides job openings along racial lines.    Contrary to other reports at the time, the Chicago Urban League’s “ own studies indicate that the Negro job-seeker is quite the rational economic man , ”  and thus the financial discrepancy exists  “ because the black worker faces a very differently structured set of opportunities” than his white counterparts .  Baron  elaborates:    

In effect, certain jobs have become designated as “Negro” jobs. Negro workers are hired by certain industries, by particular firms within these industries, and in particular jobs within these firms. Within all industries,  including government service, there is unmistakable evidence of occupational ceilings for Negroes. Within establishments that hire both Negro and white, the black workers are usually limited to specific job classifications and production units. An accurate rule of thumb is that the lower the pay or the  more disagreeable and dirty  the job, the greater the chance of finding a high proportion of Negroes.  

  This dual labor market works in tandem with the dual housing market to keep black people financially  subordinate.   

  It goes without saying that ghettos are suboptimal places to live. As Baron clarifies: “The ghetto is bad not because it is inhabited by black people, but because it operates as a subjected enclave.” It exists specifically to trap black people, both physically and psychologically. As Baron proves for the  Gautreaux v. Chicago Housing Authority case, many black families have little to no choice in their housing arrangements. “Overwhelmingly,” he explains, “real estate brokers refuse to show Negroes properties outside the ghetto or transition neighborhoods. Lending institutions refuse to grant them mortgages for properties beyond these confines.” Furthermore, the CUL found that housing units in the Chicago ghettos cost 10% more than comparable housing in white sectors. This so-called “color tax” extends to retail prices, allowing “merchants operating in the ghetto [to] charge more for goods and credit or sell inferior quality merchandise at regular prices.” When the lower wages and higher cost of living cause black people to depend upon welfare, “the bureaucrat machinery” degrades and infantilizes them, treating them “like wards of the state, rather than responsible adults.” The web of urban racism intentionally erodes black peoples’ power and credibility; the housing market threads are perhaps the most insidious, as physical location dictates one’s political and educational opportunities.  

Neighborhood school districting and gerrymandering systems prevent conditions in the ghetto from improving. As Baron remarks, “educational institutions which provide markedly different [inferior] results for black and white children are key to the structure of urban racism.” Children of black workers are almost always districted to underfunded, overcrowded schools, whose students lag years behind their white peers, thus trapping them in the same unskilled labor market as their parents. “Educational systems have become a major pillar of racism,” Baron observes, “precisely because education has become so important in the total scheme of our society.” That said, Baron is far more concerned about the psychological impact these schools have on their students than he is with reduced academic achievements. For Baron, ghetto schools exist “as extremely efficient training institutions” designed to instill in black children the role of “a subordinate ‘Negro.’” These children grow up surrounded by middle class black teachers and principals who can only maintain their positions of relative power by inculcating their “lower status black charges with the idea that they are unteachable.” This environment “conditions the individual Negro youngster to expect a subordinate position for the rest of his life” and so he is not surprised to find the exact same pattern in the political sphere. Baron describes how black office holders can be elected (in predominantly black districts), but that any effort to improve the lives of their black constituencies represents career suicide. “Even where skillful politicians have risen to the top, as in Harlem with J. Raymond Jones and Adam Clayton Powell,” Baron explains, “they have been cut down or circumscribed basically because they were black.” From this, Baron concludes that people working within urban institutions are unable to dismantle the web of urban racism precisely because they themselves are trapped inside it.   

“The Web of Urban Racism” is one of the last reports Baron wrote for the Chicago Urban League, as he left later that year. This document––which is uncharacteristically radical for the CUL––shows Baron’s shift from the integration model of the civil rights movement to the more radical one of black nationalism. Indeed, Baron argues that the student led black power movements have the greatest chance of tearing through the web.  “ Today, under the  slogans of  ‘ black pride ’  and  ‘ black consciousness ’” Baron observes,   “ we are witnessing a revolution in the role expectations of high school and college  students. ”  They are disrupting the whole racist system by categorically refusing both the role of unteachable student, and that of token official. Baron explains that,  “ t he development of these new role concepts will bring the black youth into conflict with the racist norms and methods of operation in our major institutions ,” and in doing so, places them on the “ the threshold of tearing the web. ” Baron believes that t he success of these youth led movements will “ depend upon the social, economic and political strategies ” implemented, which is perhaps why he supported Detroit’s League of Revolutionary Black Workers after a short stint as a research associate at Northwestern University.   

In the final section, Baron draws on W.E.B. Du  Bois  to detail a possible future in which black and white cultures exist symbiotically. He explicitly rejects “ the assumption that the dominant white society, which exercises racism’s controls, is the healthy organism into which the sick ghetto should dissolve. ”  Baron concludes the article with this evocative, prophetic paragraph:  

  White men and black men are locked together in this nation so that they determine one another’s fate. Since the day has come when the darker brother will no longer suffer trustingly like Job, a new destiny awaits them both. Racism’s cancer, disturbed by the resistance, can feed upon itself and bring greater destruction in its wake. Or, the healthy elements in the two cultures can contend and react upon each other, creatively transforming themselves in the process. The one possibility denied to each culture is to operate in isolation as though the other were not there.  

  This message of hope, tempered as it is with Old Testament style warnings, rhetorically places both white and black cultures on equal footing. They are both valid, they are both locked, and both of their fates will be impacted by the other.   

END NOTES:   

1.Hal Baron uses the phrase “ w eb of  u rban  r acism” in the following works–– “ Public Housing: Chicago Builds a Ghetto ”  (1967),  “ Negroes in Policy-Making Positions in  Chicago:  ‘ A Study in Black Powerlessness in Chicago’” (1968),  “Report on the Chicago Urban League, Annual Meeting 1968,”   “ The Demand for Black Labor: Historical Notes on the Political Economy of Racism ”  (1971),  “ Building Babylon: A Case of Racial Controls in Public Housing ”  ( 1971 ),  “Institutional Racism in Modern Metropolis” (1973),  “ Racism Transformed: The Implications of the 1969s ”  (1982) .

2.W.E.B Du Bois cave analogy: “It is difficult to let others see the full psychological meaning of caste segregation. It is as though one, looking out from a dark cave in a side of an impending mountain, sees the world passing and speaks to it; speaks courteously and persuasively, showing them how these entombed souls are hindered in their natural movement, expression, and development; and how their loosening from prison would be a matter not simply of courtesy, sympathy, and help to them, but aid to all the world. One talks on evenly and logically in this way, but notices that the passing throng does not even tum its head, or if it does, glances curiously and walks on. It gradually penetrates the minds of the prisoners that the people passing do not hear; that some thick sheet of invisible but horribly tangible plate glass is between them and the world. They get excited; they talk louder; they gesticulate. Some of the passing world stop in curiosity; these gesticulations seem so pointless; they laugh and pass on. They still either do not hear at all, or hear but dimly, and even what they hear, they do not understand. Then the people within may become hysterical. They may scream and hurl themselves against the barriers, hardly realizing in their bewilderment that they are screaming in a vacuum unheard and that their antics may actually seem funny to those outside looking in. They may even, here and there, break through  in blood and disfigurement, and find themselves faced by a horrified, implacable, and quite overwhelming mob of people frightened for their own very existence.”  W.E.B Du  Bois .  Dusk of Dawn: An Essay Toward an Autobiography of a Race Concept . Edited by Henry Louis Gates Jr. (Oxford: Oxford University Press, 2007), 66.   

Planning in Black and White (Hal Baron, 1968)

Hal Baron was a strong proponent for anti-racist planning and Blacks’ right to the city during his tenure as Research Director of the Chicago Urban League. In 1968, Hal Baron and the Chicago Urban League would further showcase their advocacy by identifying, evaluating, and challenging the gaps that existed in the City of Chicago’s 1966 Comprehensive Plan. This was the first plan created by City of Chicago planners and influential planning scholars such as Louis B. Wetmore that attempted to address Chicago’s long legacy of racism, anti-Blackness, and segregation. The Chicago Urban League would argue that the Plan failed to significantly challenge Chicago’s infamous racial and class divides in its 1968 critique of the Plan. This critique was titled The Racial Aspects of Urban Planning: An Urban League Critique of the Chicago Comprehensive Plan. Baron served as the critique’s editor and wrote “Planning in Black and White” as an introduction to the critique.

Baron’s introduction makes a strong case for planners and the planning field to support and enforce anti-racist public policies and designs. He begins his article by defining planning as an evolved form of racism. He supports his argument by discussing a significant challenge that still exists within the planning practice today: planners are often obligated to act in the interest of the public but there are different definitions of the public in practice. These definitions do not often include historically disadvantaged communities but instead property owners and predominantly White communities.

Baron discussed how planners were not acting in the interest of Blacks especially property-less Blacks in the 20th century. Blacks often lacked property due to legalized real estate and home-lending theft practices such as contract selling and redlining especially in Chicago. This led to planners being able to intentionally displace Black communities under the guise of urban renewal. Baron claims that urban renewal was the strongest microcosm of planning’s racist roots and practices. He incorporates a quote from prominent 20th century planner and architect Hans Blumfeld that provides an explanation of the latter. Planners engaged in urban renewal to address concentrated urban decay in Black communities. However, the quote explains that urban renewal and planners failed to address the root cause of blight—economic exploitation, racism, and anti-blackness. Instead, planners revitalized the area for those in power, White property owners, and increased costs and distress in Black communities. Baron’s article suggests that planners used planning tools such as urban renewal to maintain racism and subsequently plan segregated Black and White neighborhoods. This is a key theme of Baron’s introduction and the Chicago Urban League’s larger critique of Chicago’s 1966 Comprehensive Plan.

Baron would dedicate the rest of his article to explaining how planners and the field of planning can engage in anti-racist planning and eradicate segregation. He listed four ways planners could carry out this anti-racist work as government officials. He began explaining these four mechanisms by calling out social science researchers on their failure to educate planners on racism. He implied that they must address this issue by producing studies on racial and economic segregation and the racial implications of planning. He encouraged planners to incorporate these studies into their plans and policies. However, he recognized that planners in the 1960s existed within the confines of racist and segregated institutions and organizations. He urged planners to find ways to convince these institutions and organizations to support racially conscious studies. To further challenge the power dynamics of the time, he strongly advised planners to standardize their studies and use large and frequently updated datasets. He also demanded that planners create plans that uncover racism and segregation and clearly describe how planners will chip away at these systems and processes.

Baron made it clear he understood planners faced major limitations to completing this anti-racist work. They were up against power structures that would not adopt and enforce plans due to a lack of support, resources, or jurisdiction powers. Baron implied that these challenges should not stop planners from fighting against racism. He explains that planners have the potential to confront racism through advocacy planning. He describes advocacy planning as planning that is directed by and in the interest of marginalized communities and activist groups. The results of this planning had the opportunity to be presented to and incorporated by planning officials. Baron hoped that planning officials began to serve the interest of Black communities in the 1960s with or without advocacy planning. Black communities were becoming the predominant racial group in central cities due to discriminatory real estate speculation and white flight, and consequently should have been considered the public, in theory.

While history shows that planning officials did not often act in Blacks’ interests in practice as white flight skyrocketed in the 1950s and 1960s, Baron and the Chicago Urban League were adamant and rightfully so that racism cannot be eliminated without anti-racist urban planning practices. Baron ended his article describing that the Chicago Urban League’s 1968 critique was the League’s attempt to shed light on planning’s racial biases and implications. He explained that the critique was designed as debate between the Chicago Urban League and five planners, two of which were planning academics that contributed to Chicago’s 1966 Comprehensive Plan. The League provided a frank critique of the plan and the five planners Baron referenced responded to the critique. Baron and the Chicago Urban League hoped that this debate would fuel new anti-racist practices within the field of planning. The League’s critique provided at least five ways for Chicago and planners across the world to understand and engage in the anti-racism Baron demanded in “Planning in Black and White”.

Report from Chicago: Politics Transformed: Harold Washington Goes to City Hall (Harold M. Baron, 1985)

Synopsis by Donald Planey

Politics Transformed is the empirical counterpart to Baron’s Racism Transformed. Drawn from his own experience in the Washington mayoralty as well as early journalism about the Harold Washington campaign, Baron uses the Chicago context to explore how the Washington movement and mayoralty asserted Black political power while grappling with the profound rightward-turn in U.S. politics. Baron characteristically lays out the political history of Black Chicago, from the New Deal through Black Power era, leading up to Washington’s campaign. He compliments the Chicago context with a history of national-scale Black politics, and its struggles against the rise of Reaganism.

The next part of the essay details the process by which Harold Washington stitched together a constituency and progressive political apparatus, as well as the means by which different factions of opposition-the old white machine guard, business interests, and bureaucrats-reacted to the campaign and mayoralty. Baron concludes with an analysis of the institutional bottlenecks encountered by the Washington mayoralty, and how they represent teachable lessons for grassroots organizing under “advanced” capitalism and racial stratification.

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Examples of Institutional Racism: What It Is and What You Can Do

Here's what you need to know about a term that causes some confusion.

Dr. Anju Goel, MD, MPH, is a public health consultant and physician with more than 10 years of experience in the California public health system.

From healthcare to housing to education to employment, institutional racism is everywhere. The impact of institutional racism is far-reaching, a vicious cycle that takes a toll on individuals and society. 

Here's an overview of the historically prevalent discrimination that affects the Black community.

What Is Institutional Racism?

Policies and power structures rooted in White privilege maintain institutional racism, also known as systemic racism. Interpersonal racism shows up in our biases for and against others based on race. In contrast, institutional racism is embedded into the structures of our society. Institutional racism leads people of different races to have different outcomes when it comes to housing, employment, health, finance, and education.

Here's an example: A White hiring manager decides not to hire a Black job applicant because he doesn't think that Black people work as hard as people from other backgrounds, that's interpersonal racism. 

However, if a company's practice is not to consider applicants from a specific neighborhood school, like predominantly Black public schools in impoverished areas that are inadequately funded, that's institutional racism.

"Institutional racism is different and more implicit than interpersonal racism. It's come to the forefront of the national conversation after the murder of George Floyd and the protests for racial equity across the country [in 2020],"  Beth Beatriz, PhD , a researcher specializing in health equity, told  Health .

In the United States, institutional racism has presented itself more subtly in recent years than in the past, Nance Schick, an attorney and mediator based in New York, told  Health . 

"What was once overt discrimination is now more covert and often hidden until someone speaks up," said Schick.

Legal segregation and Jim Crow laws previously publicly encoded institutional racism across the country. In contrast, today, clear policies and signage do not frequently identify institutional racism. However, biases in favor of White people still exist in coded forms, said Schick.

"Declaring certain hairstyles 'unprofessional' historically restricted qualified Black candidates from gainful employment," added Schick. "Despite the CROWN Act of 2020 [which prohibits discrimination based on hair texture or style], there are still employers who have restrictions on hair, particularly dreadlocks and natural hair." 

Often, those restrictions have an unfair outcome in Black communities.

How Does Institutional Racism Affect the U.S.?

Institutional racism is prevalent in the United States across just about every sector,  Nora Demleitner , president of St. John's College's Annapolis campus and researcher specializing in criminal justice and higher education, told  Health . 

School funding based on property values and residential taxes, combined with racial segregation in housing, led to systemic underfunding of predominantly Black schools.

In contrast, primarily White low-poverty districts spend almost $2,000 more per student than low-poverty districts where most students are people of color. That results in poor test scores and learning outcomes for Black students at underfunded schools.

According to the American Academy of Family Physicians, the U.S. healthcare system has historically discriminated against non-White populations. Many healthcare facilities throughout the country that predominately serve Black communities lack the funding, resources, and staff to deliver adequate healthcare. Often, poor healthcare services lead to adverse health outcomes.

In fact, in the United States, Black women are as much as four times more likely than White women to experience a pregnancy-related death. Research has found that, in addition to healthcare providers’ racial biases , inadequate access to prenatal healthcare raises the risk of maternal mortality.

Also, the COVID-19 pandemic highlighted inequities in the U.S. healthcare system . Lack of access to healthcare services, such as COVID-19 testing, led to a disproportionate number of infections and deaths among minority groups.

According to one study published in 2022 in  Health Affairs , poor COVID-19 outcomes among non-White populations directly result from racist U.S. healthcare policies.

Also, where a person lives and the conditions of their neighborhood greatly impact their health outcomes. When it comes to housing in the United States, institutional racism has profound effects on Black communities.

"The historical practice of 'redlining' is an example of a racist institutional policy still felt today," explained Beatriz. Redlining happened when banks refused to lend money for mortgages in communities with large proportions of people of color. The banks considered those communities to be "hazardous."

"Despite redlining being outlawed over 50 years ago, we continue to feel that impact today in so many ways." continued Beatriz. "In 2020, Black Americans were over 40% less likely to own their homes compared to White Americans. This greatly impacts how families accumulate wealth."

In 2017, the Urban Institute reported the homeownership rate for White households was 71.9%. In contrast, the rate for Black households was 41.8%.

That racial residential segregation is the cornerstone of Black and White disparities,  Marsha Parham-Green , the executive director of the Baltimore County Office of Housing, told  Health .

"The inequities built into low-income housing is a fundamental cause of health disparities between [Black and White people]," explained Parham-Green. 

"Concentrated poverty, safety, and segregation, as well as other social and community attributes, further contribute to stress and deterioration of health," continued Parham-Green. "Those who are most vulnerable, children and the elderly, are most adversely affected by unstable housing conditions."

Faced with high crime, dilapidated housing stock, and the stress and marginalization of poverty, residents of impoverished neighborhoods demonstrate a high risk of poor physical and  mental health  outcomes. Those outcomes include asthma, depression, diabetes, and heart ailments.

Law and Policing

Black people are roughly five times as likely as White people to report being unfairly stopped by the police. Black Americans are also more likely to suffer the ill effects of racial profiling. Racial profiling is stereotyping a person based on assumed characteristics of a racial or ethnic group rather than the individual.

Police brutality is an ongoing problem in the United States, disproportionally affecting Black communities. As a result of police brutality, Black people face an adverse risk of poor health outcomes, like:

• Death from injuries sustained by the police
• Health complications that increase the risk of death
• Unfair arrest and incarceration

Economically based discrimination goes hand-in-hand with interpersonal racism. For example, business loan officers may require Black applicants to have higher credit scores and income levels than White applicants. If that discrimination is widespread in finance, it may become an example of institutional racism.

Also, a 2018 investigation by the National Fair Housing Alliance, a Washington-based non-profit, found economic discrimination regarding car loans. According to the results, on average, non-White applicants who experienced discrimination would have paid an average of $2,662.56 more over the life of the loan than less-qualified White applicants. 

The investigators also found that 75% of the time, White applicants were offered more financing options than non-White applicants.

Some state elected officials denied early and mail-in voting. During the 2020 U.S. general election, in North Carolina, Black voters' ballots were rejected at more than three times the rate of White voters.

Also, in August 2020, the U.S. Postal Service removed hundreds of sorting machines, a form of institutional racism, Lauren Raysor, an attorney and founder of the Mount Vernon Coalition for Police Reform, told  Health .

"Mail delivery was slowed down, and residents over-indexing with a Black population couldn't get their mail," said Raysor.

Another form of institutional racism in politics is gerrymandering. Gerrymandering determines electoral districts, which decide the outcomes of state and federal elections. For example, there is one U.S. representative from each district. Census data, which the U.S. government collects every 10 years, influences redistricting. 

Racial gerrymandering happens when people in positions of power redraw district lines to suppress minority voices. Take, for example, a community largely made up of Black voters. However, if lawmakers gerrymander that community into several districts, the likelihood of Black voters being accurately represented decreases.  

How To Fight Institutional Racism

From creating fair hiring and recruitment guidelines to working with minority-owned businesses to changing government funds, finding ways to reimagine policies is key. Civil rights groups, such as the NAACP, and lawmakers nationwide have called for changes in police policies. The goal is that those policies don't target Black people more than White people.

Institutional racism hurts society, squashing innovation and creating an environment that breeds unhealthy stress and burnout. If institutional racism continues as the status quo, those affected will continue to be a part of a cycle of despair and disenfranchisement.

" Black Americans who call out institutional racism are often gaslighted,"  La Shawn Paul , mental health expert and diversity and inclusion strategist, told  Health . "But to address any problem, you must first acknowledge its existence. Silence is complacency."

According to Schick, in the United States, people can combat institutional racism by making the following changes:

• Don't stop with one Black friend and think you know enough about the Black experience. One person does not represent an entire group of people.
• Go to town halls, school board meetings, and other places people are discussing solutions. Protests and books are great for creating awareness. But then, it's time for solutions at every level.
• Speak up when you see changes that can be made. Sometimes, the change is in a policy. Other times, change is as small as an individual's behavior.

"It's getting harder for all of us to claim ignorance. It's time to make a change," added Schick. "And perhaps that is where it begins, with pure intention. Adding courage and action, big changes can occur. But we likely have to do some deep soul-searching first and accept that it will be uncomfortable. Nevertheless, this is where we must begin. Again."

A Quick Review

Institutional racism is pervasive and can affect every aspect of peoples' lives, from their finances to their education and physical and mental health.

Institutional racism is not as obvious as in previous generations, but it affects people of color profoundly. For example, institutional racism may be as subtle as a lack of spending on public schools in economically disadvantaged areas serving minorities.

The best way to fight institutional racism is to become aware and active in changing the policies and behaviors perpetuating it.

CROWN Act of 2020 , HR 5309, 116th Congress, 2020.

EdBuild. Nonwhite school districts get $23 billion less than white districts despite serving the same number of students .

American Academy of Family Physicians. Institutional racism in the health care system .

Howell EA. Reducing disparities in severe maternal morbidity and mortality .  Clin Obstet Gynecol . 2018;61(2):387-399. doi:10.1097/GRF.0000000000000349

Gadson A, Akpovi E, Mehta PK. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome .  Semin Perinatol . 2017;41(5):308-317. doi:10.1053/j.semperi.2017.04.008

Yearby R, Clark B, Figueroa JF. Structural racism In historical And modern US health care policy .  Health Aff (Millwood) . 2022;41(2):187-194. doi:10.1377/hlthaff.2021.01466

Urban Institute. Breaking down the Black-White home ownership gap .

Pew Research Center. 10 things we know about race and policing in the U.S. .

Alang S, McAlpine D, McCreedy E, et al. Police brutality and Black health: Setting the agenda for public health scholars .  Am J Public Health . 2017;107(5):662-665. doi:10.2105/AJPH.2017.303691

Board of Governors of The Federal Reserve System. Availability of credit to small businesses .

National Fair Housing Alliance. Discrimination when buying a car .

ProPublica. In North Carolina, Black voters mail-in ballots much more likely to be rejected than those from any other race .

NAACP Legal Defense Fund. How redistricting works — and how you can get involved .

Related Articles

• Open access
• Published: 07 June 2024

Evaluating the impact of an educational intervention on the history of racism in America for teaching structural competency to medical academicians

• Jason E. Glenn 1 ,
• Kristina M. Bridges 2 ,
• Kakra Boye-Doe 3 ,
• LesLee Taylor 4 ,
• Jill N. Peltzer 5 ,
• Shawn Leigh Alexander 6 ,
• Danielle Binion 7 ,
• Matthew Schuette 8 ,
• Carrie L. Francis 9 &
• Jerrihlyn L. McGee 5  

BMC Medical Education volume  24 , Article number:  638 ( 2024 ) Cite this article

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A challenge facing many Academic Health Centers (AHCs) attempting to revise health professions education to include the impact of racism as a social and structural determinant of health (SSDoH) is a lack of broad faculty expertise to reinforce and avoid undermining learning modules addressing this topic. To encourage an institutional culture that is in line with new anti-racism instruction, we developed a six-part educational series on the history of racism in America and its impact on contemporary health inequities for teaching structural competency to health professions academicians.

We developed a six-hour elective continuing education (CE) series for faculty and staff with the following objectives: (1) describe and discuss race as a social construct; (2) describe and discuss the decolonization of the health sciences and health care; (3) describe and discuss the history of systemic racism and structural violence from a socio-ecological perspective; and (4) describe and discuss reconciliation and repair in biomedicine. The series was spread over a six-month period and each monthly lecture was followed one week later by an open discussion debriefing session. Attendees were assessed on their understanding of each objective before and after each series segment.

We found significant increases in knowledge and understanding of each objective as the series progressed. Attendees reported that the series helped them grapple with their discomfort in a constructive manner. Self-selected attendees were overwhelmingly women (81.8%), indicating a greater willingness to engage with this material than men.

Conclusions

The series provides a model for AHCs looking to promote anti-racism and structural competency among their faculty and staff.

Peer Review reports

The primary cause of health inequity in the United States is structural racism [ 1 ]. Stark inequities in morbidity and mortality among minoritized populations have persisted for generations. In 1899, W.E.B. Du Bois was the first to note that social conditions determined by the experience of racism and discrimination, not genetics, were the primary determinants of ill health of Black residents in Philadelphia, leading to their higher mortality rates [ 2 ]. The COVID-19 pandemic amplified and exacerbated the health inequities that have plagued marginalized communities for over a century [ 3 , 4 , 5 ]. The Black Lives Matter movement, brought to a crescendo with the brutal public murder of George Floyd, prompted many Academic Health Centers (AHCs) in the U.S., including associated schools of medicine, nursing and health professions, to increase their anti-racism efforts in the face of one of the most glaring examples of structural violence in America: the systemic killing of unarmed Black persons by police. These included efforts to eliminate bias from teaching materials and clinical algorithms, and mandated training in unconscious bias and other forms of discrimination [ 6 ]. Other academic institutions issued anti-racism statements or held community conversations to process the traumatic effect of structural racism [ 7 ]. Academic organizations were closely scrutinized for compliance with accreditation standards regarding diversity and many were found lacking [ 8 ].

Like many campuses, The University of Kansas Medical Center (KUMC) held community conversations and town hall meetings to discuss the legacies of racism at AHCs. University leadership instructed all departments to audit their curricula and remove instances of outdated race-based medicine and review their anti-racism instruction (including racism as a major structural determinant of health in the US). Initial efforts across the institution were disjointed, using non-standardized criteria to review curricula, and relying upon faculty with varying levels of content expertise in this area. To coordinate our efforts and improve implementation across the institution, KUMC adopted The REPAIR Project. The REPAIR Project ( REPA iring I nstitutional R acism) is designed to address anti-Black racism and augment Black, Indigenous and People of Color (BIPOC) voices and presence in science and medicine. The project addresses racism in medicine and health professions as an educational problem by providing a theoretical framework for coordinating and implementing social justice and anti-racism curriculum throughout the medical center. The REPAIR framework began at the University of California at San Francisco [ 9 ] and is now being implemented at KUMC and Johns Hopkins School of Medicine as well.

The REPAIR framework is grounded in one question: How can academic health centers repair the harms caused by centuries of neglect, exploitation, and abuse in clinical encounters, and by biomedical systems of knowledge that have justified this mistreatment of persons of color by propagating and upholding theories of race, racial difference, and racial inferiority? The REPAIR framework explicitly recognizes that the European and American medical profession played a central role in giving race a veneer of biology, thus helping to naturalize the social hierarchies and health inequities that arose due to slavery and colonialism, by placing them in a discourse of biogenetic determinism.

We undertook the challenge of “repair” with the acknowledgement of social theory in Indigenous studies that troubles the concept of repair [ 10 ] in contexts where the material conditions for returning to a pre-harm status may no longer exist, especially in situations in which the harms committed led to losses of life. This acknowledgment includes insights from critical disability studies scholars who have long-critiqued distinct but interrelated concepts such as repair, rehabilitation, and cure [ 11 , 12 ] in biomedical contexts. Each activity, training, and learning module developed under the REPAIR framework is designed to meet one or more of four pillars within the theoretical framework. These pillars also guide the development of new research, inform institutional policies and practices, and enhance community engagement. They are:

The History of the role of biomedicine in perpetuating racism and reinforcing theories of racial difference and racial inferiority.

Decolonizing the health sciences from bench to bedside, including deconstructing the use of race as a proxy in medical decision-making.

Action : developing strategies to address structural racism and other isms from a socio-ecological perspective.

Accountability : Envisioning how the field of biomedicine can repair these harms.

REPAIR Project initiatives at KUMC fall into four categories, each linked to one of the above pillars of understanding: curriculum development; faculty/staff educational development and training; clinical interventions to eliminate local health inequities; and community accountability.

As we began developing and rolling out new evidence-based curricular content around racism as a major structural determinant of health as part of REPAIR, initial student feedback revealed that it was not uniformly implemented by all instructors. Students reported that some preceptors lacked the expertise in structural competency [ 13 ] to adequately facilitate class discussions around the new topics, some undermined the new instruction by re-iterating some of the non-evidenced-based racial folklore [ 14 ] that permeates Western medicine, and some eschewed discussing the new content altogether.

To address these knowledge and attitudinal deficits in our faculty and staff, the KUMC Office for Diversity, Equity, and Inclusion (DEI) identified a team of content experts to develop an educational series designed to facilitate competency in understanding racism as the major social and structural determinant of health (SSDoH) in the United States. The series, open to all KUMC community members, explicated the roots of racism in Western thought and socio-political organization. It began by emphasizing the novelty of racialized human classification systems – a recent phenomenon in the 2.5 million years of human evolution that is barely 500 years old. Our series traced the colonial origins of racial thinking from its first emergence in the 16th century as a European religious cum natural philosophical system of classification demarcating civilized Christians from so-called barbarous pagans and infidels. From this emergence, the series followed the evolution of racial thinking as European and American intellectuals shrouded “race” in a veneer of biology in the 19th century, to lend racist prejudices, policies, and laws an air of scientific legitimacy. This biologization of racial human classificatory schemas transformed the idea of “race” into its current common understanding – the assumption that a few, specific phenotypic features (such as skin color, eye shape, hair texture, etc.) are good proxies for understanding innate morphological and/or genetic differences between groups of people so defined as “races.”

The series traced this development from the first Portuguese voyages into sub-Saharan Africa during the 1450s, then to the Indigenous-Columbian contact during the 1490s in the Caribbean which set in motion both the genocide of Native Americans and the importation of Africans as slaves. The series then mapped the evolution of race and racism during the transatlantic slave trade, the Civil War, Jim Crow era, and the Civil Rights Movement, culminating in a critical examination of how this legacy impacts health and wellbeing in contemporary contexts.

Though many academic institutions have implemented DEI programming and training over the past few years, published research looking at implementation and effectiveness is scarce [ 15 ]. This evaluative study of the series is meant to help fill the gap in implementation and effectiveness research pertaining to similar efforts. In this paper, we describe the educational program, explain the challenges to intervention and how they were overcome, report its outcomes, and offer suggestions for next steps in dismantling racism in academic health institutions.

The idea for the series originated with KUMC’s Vice Chancellor for DEI and Chief Diversity Officer, co-author JM. Her office appointed an interdisciplinary team of faculty, students, and staff (all co-authors on this manuscript) with expertise in assessment, the History of Medicine, African and African American Studies, and the social and structural determinants of health to develop the series objectives, scope, and topic areas. The goal of the series was to deconstruct and denaturalize the idea of race as a proxy for bio-genetic difference, and elevate the understanding of race as a social construct and racism as one of the most powerful structural determinants of health in the U.S.

The team came up with four series objectives:

Contextualize the historical and systemic nature of racism and bias in the United States.

Describe the relationship between race and health as an outcome of the intergenerational impact of historic structural racism.

Explain the mechanisms through which structural racism shapes health outcomes using the socio-ecological framework.

Integrate lessons learned within each participant’s scope of influence.

The objectives for the series were largely driven by the perceived lack of structural competency among KUMC faculty and staff. This lack was identified by students seeking better training in these areas while frustrated by faculty who still taught race-based medicine; and as revealed during campus discussions that followed the murder of George Floyd outlining racism as the major structural determinant of health in the U.S.

The team then determined the critical topics to cover in each installment of the series, anticipating that most members of our community had never been taught a comprehensive history of racism and how integral it was to the founding of the Americas. As a committee, each member submitted a list of topics that they deemed important to cover in the series. We then voted on the best six topics to give a comprehensive overview of how integral racism has been to the history of the United States and its lasting impact on the contemporary health landscape, for an audience that we assumed had zero prior training.

Our top-voted series topics were:

The Birth of Race: The Genocide of Indigenous Peoples & Colonization of the Americas (delivered by co-author Glenn).

The Atlantic Slave Trade and the Evolution of Racial Thinking (delivered by co-author Glenn).

The Civil War (delivered by David Roediger [ 16 ]).

The Jim Crow Era (delivered by co-authors Bridges and Alexander).

The Civil Rights Movement (delivered by co-authors Bridges and Glenn).

The Modern Day – Contemporary Impacts of Historical Racism (delivered by co-authors Boye-Doe and Peltzer).

There were some topics proposed but that did not make our top list (e.g., History of Mass Incarceration, History of Racism in Policing, A History of Health Inequities, A History of Racism in Human Subjects Research, etc.), not because our committee didn’t share a sense of their vital importance, but because we felt our faculty and staff needed training in “the basics” – represented in our finalized topic list – before progressing to more advanced discussions that would rely on a shared foundation of those basics.

Our committee then determined which members had the content expertise to deliver each session, or if we would need to recruit from outside of our committee. Each lecture was created by the designated presenters. Each session was preceded by a ten-minute introduction designed to contextualize the history presented as to how it related to contemporary health inequities.

The series took place during the 2021–2022 academic year, in the middle of the COVID-19 pandemic, so organizers determined that all sessions would be delivered virtually over Zoom. Virtual delivery allowed for greater participation, automated data collection, and facilitated administering and collecting assessments. The ease and zero cost of recording each session over Zoom also facilitated further participation from persons who could not attend the live delivery of the content.

Virtual attendance over Zoom also meant that most participant data was automatically stored with names and emails, which then had to be de-identified. Prior to de-identification, co-author Glenn used the name and user email data (where present) to match to HR data to compose demographic profiles for participants, including preferred gender, race/ethnicity, administrator/faculty/staff/student/ or outside community member status, and departmental affiliation where appropriate. The data were then de-identified by removing names and user emails and assigning each participant a unique ID number. The de-identified data were then shared with co-author Bridges to perform demographic analysis while co-author Schuette performed statistical analysis on the de-identified assessment data.

Each of the six sessions in the series was accompanied by a pre-assessment. The pre-assessment asked each participant to rate their level of agreement with four statements: (1) “I can describe and discuss: race as a social construct versus race as a genetic factor”; (2) “I can describe and discuss: Decolonization of health sciences and health care”; (3) “I can describe and discuss: The history of systemic racism and structural violence from a socio-ecological perspective”; and (4) “I can describe and discuss: Reconciliation and repair in biomedicine.” Each statement was accompanied by a Likert scale of Strongly Disagree, Disagree, Neutral, Agree, or Strongly Agree. During the sixth and final session pre-assessment, an error occurred, and no attendees were asked question 4.

All attendees who registered and attended at least one session were emailed a post assessment following the final session, which asked participants to rate each of those questions again, followed by a three-question free-form survey: (1) “Compared to your initial expectations, how did the training align or change from those expectations?”; (2) “In what ways do you plan on implementing what you have learned?”; and (3) “What questions or concerns do you have following the Six-Part Educational Series?”

Number of sessions attended

Race as a social construct versus race as a genetic factor

decolonization of the health sciences and health care

The history of systemic racism and structural violence

Reconciliation and repair in biomedicine

Most common session responses

Statistical analysis

Responses to the four primary assessment questions were summarized (Figs.  2 , 3 and 4 , and 5 ) for each of the six sessions and the post-series poll, by calculating the percentage of respondents (vertical axis) who selected either strongly disagree, disagree, neutral, agree, or strongly agree, and representing this longitudinally (horizontal axis) from the first session to the post-series poll. The mode of the responses is shown as a clustered bar chart (Fig.  6 ), with the mode (horizontal axis) grouped by question and session date.

Participants

The series enjoyed 273 unique participants who attended one or more sessions as they were delivered live, averaging 92 persons per session. A further 134 participants watched recorded versions of one or more sessions online. Of the persons who attended the live streaming, 160 people attended only one session, 50 people attended only two sessions, 16 people attended only three sessions, 19 people attended only four sessions, 11 people attended only five sessions, and 17 people attended all six sessions (Fig.  1 ). The average number of sessions attended was 2 out of 6. We are unable to determine the amount of overlap between persons who attended the sessions live and those who watched recorded versions.

Overwhelmingly, participants identified as female. Self-identified gender data was available for 258 participants, and of those, 211 (81.8%) identified as female, 46 (17.8%) identified as male, 1 (0.4%) identified as “other,” and there were 15 (5.8%) persons for whom no data was available (see Table  1 ).

There were 213 participants for whom racial/ethnic data could be collected. Of those, 133 (62.4%) identified as White; 38 (17.8%) identified as Black/African American; 20 (9.4%) identified as Asian [including 9 (4.2%) who identified as Indian, 6 (2.8%) Middle Eastern, and 5 (2.3%) Southeast Asians or Pacific Islanders]; 19 (8.9%) identified as Latinx/Hispanic; and 1 (0.5%) who identified as American Indian/Alaskan/Hawaiian Native). The gender gap skewing heavily toward women was present for every racial and ethnic group save for persons who identified as Middle Eastern, who were evenly split between males and females (Table  1 ).

The series drew attendees from across the health center and the surrounding community. Affiliation data was available for 210 (76.9%) participants. Of those, 59 (28%) were university administration/staff (including 2 members of executive leadership); 47 (22.4%) were clinical faculty; 37 (17.6%) were community members not affiliated with KUMC or any other AHC; 26 (12.4%) were research faculty; 14 (6.7%) were nurses; 27 (5.5%) were students (including 12 medical students, 6 (2.9%) post-docs, 6 (2.9%) graduate students; and 3 (1.4%) undergraduates) (Table  1 ).

The response rates for each of the six pre-assessments were 53.5%, 51.1%, 57.1%, 60.9%, 52.2%, and 51.3% respectively, with an average response rate of 54.4%. Out of the 273 attendees who were emailed and asked to complete a post-assessment, 80 did so, for a response rate of 29.3%. Our assessments revealed that attendees of this series demonstrated appreciable increased understanding of all four series objectives over the course of the series. Out of the four objectives, the first (“I can describe and discuss race as a social construct”) had the highest pre-series understanding, with 68.5% of respondents indicating that they either agreed or strongly agreed at session 1 and only 10.9% reporting that they disagreed or strongly disagreed (see Fig.  2 ). By contrast, the fourth objective for the series, (“I can describe and discuss: reconciliation and repair in biomedicine”) had the lowest pre-series understanding, with 62% of respondents reporting that they either disagreed or strongly disagreed at session 1 while only 13% reported that they agreed or strongly agreed (see Fig.  5 ).

Overall, objectives two (“I can describe and discuss: Decolonization of the Health Sciences and health care”) and four (“I can describe and discuss: reconciliation and repair in biomedicine”) had more participants who were unfamiliar with the concepts pre-series than who were familiar (see Figs.  3 and 5 , and 6 ). For objective two, 47.8% of respondents indicated that they either disagreed or strongly disagreed at session one. This percentage was reduced to just 6.5% at the post-series poll following session six. We saw a similar degree of reduction in disagreement with objective four, from 62% at session 1 down to only 11.5% at the post-series poll following session six.

For objective three, “I can describe and discuss: The history of systemic racism and structural violence from a socio-ecological perspective,” most respondents (65.3%) polled before session one expressed either neutral or slight agreement, while only 6.5% of respondents expressed strong agreement. However, by the end of session six, strong agreement responses rose to 45.5% (see Fig.  4 ).

Participants responded to three optional open-ended questions during the post-series poll (Table  2 ). Many participants commented on the depth of the content delivered and the unexpected value of learning history to inform healthcare. Many other attendees commented on how the series helped them grapple with their discomfort around the topic of racism in a constructive manner. For some participants, the series sparked a plan to share what they learned with others and to change their behavior. Still, some patients had questions about how they could directly take action against racism.

Our pre- and post-polling data suggest that attendees found the series to be a powerful and rich learning experience. Complex concepts – such as race as a social construct, structural violence, decolonization, reconciliation and repair in biomedicine – all saw major advancements in participant understanding by the end of the series. A series of humanities and social science lectures were delivered to an audience trained largely in the biomedical sciences in a way that kept their attention and sustained their engagement over the course of six months.

Generally, female employees of KUMC outnumber males by a ratio of 3:2. However, female series attendees outnumbered males by a ratio of almost 5:1. Employees of the health center are also approximately 72% White. This means that both women and Black, Indigenous and People of Color (BIPOC) individuals ( n  = 80 or 37.6%) were over-represented as series attendees, though women were much more so. This is consistent with a 2022 Women in the Workplace Report which found that women are leading the charge for a more inclusive workplace and are two times as likely to invest time and energy in DEI activities, compared to their male counterparts [ 17 ]. White men accounted for only 9% of total attendees. Compared to their numbers on campus, they were the most underrepresented of any gender/racial group. Given that attendance was voluntary, this may indicate a general disinterest among White males in DEI educational programming, and a need to conduct greater targeted outreach for that population.

This also suggests that part of our success with this series likely benefits from some selection bias based on who chose to attend. While the marked improvement on all knowledge objectives among attendees over the course of the series was promising, these results may be boosted by the general amenableness to DEI concepts and activities by a predominantly female audience. Further research is needed to test whether persons who are more skeptical or hostile to DEI concepts and activities would progress as much in their learning if attendance to such a series was mandatory.

Though the series was primarily targeted to clinical and research faculty, administrative staff were our largest group of participants at 28%. This may be a function of the time that each installment of the series was delivered – over lunch – given that administrators and staff may be more likely to consistently have unstructured time during the noon hour. We do not necessarily see this as a shortcoming – all employees have a role to play in creating an anti-racist environment within an AHC – but it does suggest the need for special targeted programming when we specifically want to reach clinical faculty, researchers, or students.

The number of participants who were pleasantly surprised at the historical nature of the series is an indication of how integral history of medicine scholarship is to the development of an anti-racist and structurally competent biomedical workforce (when it doesn’t neglect the central role that racism and the concept of race played in the production of biomedical knowledge). It also demonstrates that there is an appetite for more of this type of learning on a medical campus. Unfortunately, it is also a commentary on how often teaching the history of medicine to students and faculty gets neglected in many AHCs [ 18 ].

All of our survey responses were collected anonymously, which limited our ability to measure any correlations between competency and the number of sessions attended, or demographic profile. We felt that collecting the assessment data anonymously was important for responders to feel safe in answering each question honestly and candidly. However, one institutional goal of this educational intervention is to assess whether or not direct care staff who participate and have improved competency in the series objectives will demonstrate more equitable treatment of the patients with whom they interact. Collecting the survey data anonymously makes this goal unobtainable. To correct this limitation in future educational interventions, we hope to devise an improved data collection system that deidentifies survey data while preserving its linkages to other participant data.

To capitalize off of the success of the intervention, we organized a follow-up series on six additional topics during the 2022–2023 academic year. For this follow-up series, we revisited many of the topics that were proposed for the first series but were ultimately set aside in favor first establishing a shared foundation of the basics. The topics covered in the second series were:

From Slavery to Mass Incarceration.

Race Throughout the Americas: Contrasting the Racial Cosmogonies of the U.S. and Latin America.

The Eugenics Movement, Genetic Determinism, and Blaming Victims: Understanding the American Desire to Attribute Health Inequities to Genetics.

Black Business Ownership, Communities, and Health.

Life as an African American student at the University of Kansas.

Discrimination, Stress and Allostatic Load: Understanding the Health Impacts of the Lived Experience of Racism.

The impact of this follow-up series is still being analyzed and will be discussed in a future publication. Our office of DEI is also partnering with the REACH Healthcare Foundation to develop updated and enhanced versions of each session in the series to offer it as continuing education and training to the foundation’s community partners and funding recipients. The two seasons from the series have been made available on open-source platforms for perpetual viewing to ensure accessibility and longevity.

In addition to increasing the overall institutional competency around our learning objectives, we were most interested in what plans participants have for implementing what they learned during the series. An obvious next step for us in future iterations of this curriculum is to target more clinicians and nurses, then track whether participation in this curriculum leads to improvements in satisfaction and health outcomes for their patients. The clinical intervention arm of KUMC’s REPAIR Project aims to do just that with the creation of health equity accountability dashboards for all clinical departments within the health system. Leveraging the past five years of EHR data, we are currently establishing health equity baseline dashboard scores for clinical departments and providers. We will then use future EMR data to track improvements, compared to the baseline score, for any clinician who has attended any DEI programming or training.

The series provides a model for AHCs looking to promote anti-racism and structural competency among their faculty and staff, even in a conservative and politically contentious environment. Through interdisciplinary cross-campus collaborations and the use of a virtual platform, the series was developed, delivered, and assessed without needing to fundraise and without incurring any additional costs to the institution.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Academic Health Center

Black, Indigenous and People of Color

Continuing Education

Diversity, Equity, and Inclusion

Electronic Medical Record

Identification

University of Kansas Medical Center

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Acknowledgements

The authors would like to acknowledge Ms. Antoinette Redmond for her efforts in organizing the launch of this series during the pandemic when online meetings were still relatively new. The authors would also like to thank Professor David Roediger for his contribution to the series.

The article processing charges related to the publication of this article were supported by The University of Kansas (KU) One University Open Access Author Fund sponsored jointly by the KU Provost, KU Vice Chancellor for Research, and KUMC Vice Chancellor for Research and managed jointly by the Libraries at the Medical Center and KU - Lawrence.

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Department of History and Philosophy of Medicine, University of Kansas Medical Center, Kansas City, KS, USA

Jason E. Glenn

Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA

Kristina M. Bridges

Department of Psychiatry, Northwestern University School of Medicine, Chicago, IL, USA

Kakra Boye-Doe

Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA

LesLee Taylor

School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA

Jill N. Peltzer & Jerrihlyn L. McGee

Department of African and African American Studies, University of Kansas, Lawrence, KS, USA

Shawn Leigh Alexander

Office for Diversity, Equity and Inclusion, University of Kansas Medical Center, Kansas City, KS, USA

Danielle Binion

Director of Institutional Research and Academic Analytics, University of Kansas Medical Center, Kansas City, KS, USA

Matthew Schuette

Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA

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Contributions

Authors JM, JG, JP, KB, SA, DB, and KBD designed the educational series, its objectives, and the content delivered. Author CF designed and facilitated one-hour discussion sessions after each lecture in the series. Authors LT and DB designed and implemented the pre- and post- evaluation rubrics. Author MS performed statistical analysis on the data from the evaluation rubrics. Author JG analyzed the attendee demographic data then deidentified the demographic data for further analysis with KB. Authors JG and KB drafted the manuscript, and author MS drafted the Statistical Analysis section of the Methods. All co-authors reviewed and edited drafts of the manuscript.

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Correspondence to Jason E. Glenn .

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The authors declare no competing interests.

Ethical approval

Ethical approval for this study was granted by KUMC’s Institutional Review Board on 2/3/2022, study number 00148039. Informed consent to participate was granted by all individuals who completed the assessments.

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Glenn, J.E., Bridges, K.M., Boye-Doe, K. et al. Evaluating the impact of an educational intervention on the history of racism in America for teaching structural competency to medical academicians. BMC Med Educ 24 , 638 (2024). https://doi.org/10.1186/s12909-024-05626-5

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How is ongoing, severe stress and adversity in early childhood connected to chronic disease in adults? And, what can we do about it? In this animated video, learn what the latest science tells us about how early experiences affect not only early learning and school readiness, but also lifelong health.

InBrief: Connecting the Brain to the Rest of the Body

The environments we create and the experiences we provide for young children and their families affect not just the developing brain, but also many other physiological systems, including cardiovascular function, immune responsiveness, and metabolic regulation.

Health and Learning Are Deeply Interconnected in the Body: An Action Guide for Policymakers

Three key messages from the science of early childhood development, adversity, and resilience can help guide our thinking in a time when innovation has never been more needed in public systems to improve both health and learning.

Moving Upstream: Confronting Racism to Open Up Children’s Potential

The scientific evidence is clear and growing: racism imposes unique and substantial stressors on the daily lives of families raising young children of color.

How Racism Can Affect Child Development

Research suggests that constant coping with systemic racism and everyday discrimination is a potent activator of the stress response. This may help us understand the early origins of racial disparities in chronic illness across the lifespan.

5 Facts About Health That Are Often Misunderstood

Did you know that interactions among genes, experiences, age, and environments influence every biological system in the body, with especially powerful effects in the earliest years? Learn five quick facts about health that are frequently misunderstood.

Podcast Episodes

The brain architects podcast: connecting health & learning part i: the science.

How do our biological systems work together to respond to chronic stress? What do these responses mean for early learning and lifelong health? And when we say that early experiences matter, what do we mean by early?

The Brain Architects Podcast: Connecting Health & Learning Part II: The Implications

How do we use the science of early childhood development to implement practical strategies and overcome longstanding barriers in the early childhood field? How can we ensure that families’ voices are heard when we create policies or programs?

The Brain Architects Podcast: COVID-19 Special Edition: How Do We Rebuild and Re-Envision Early Childhood Services?

This episode explores what COVID-19 revealed about the needs of caregivers with young children or during pregnancy, what we learned about the importance of science over the course of the pandemic, and how we can make changes going forward.

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GOP Senator Grills Judicial Nominee Over Past Comments on Institutional Racism

“You’re a political activist, aren’t you, Judge?” Sen. John Kennedy, R-Louisiana, asked district judge nominee Meredith Vacca.

June 05, 2024 at 06:55 PM

3 minute read

Sulaiman Abdur-Rahman

Share with email, thank you for sharing, what you need to know.

• Sen. John Kennedy of Louisiana grilled the U.S. District Court judge nominee for the Western District of New York.
• Other U.S. District Court judge nominees at the same hearing fielded less intense questioning.

Meredith A. Vacca, a New York state judge nominated by President Biden to serve on a federal district court, faced intense questions Wednesday during her first Senate Judiciary Committee hearing.

“You’re a political activist, aren’t you, Judge?” Sen. John Kennedy, R-Louisiana, asked Vacca after questioning her about past comments she made concerning institutional racism and the criminal justice system.

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Harvard Says It Will No Longer Take Positions on Matters Outside of the University

The policy could ease pressure on the school to issue statements on current events. Officials were criticized for their handling of the Oct. 7 Hamas attacks.

By Vimal Patel and Anemona Hartocollis

Harvard said on Tuesday that it would now avoid taking positions on matters that are not “relevant to the core function of the university,” accepting the recommendations of a faculty committee that urged the university to dramatically reduce its messages on issues of the day.

If put into practice, Harvard would no longer issue official statements of empathy, which it did for Ukraine, after the Russian invasion, and for the victims of the Oct. 7 Hamas attacks in Israel, for example.

“In issuing official statements of empathy, the university runs the risk of appearing to care more about some places and events than others,” the report said. “And because few, if any, world events can be entirely isolated from conflicting viewpoints, issuing official empathy statements runs the risk of alienating some members of the community by expressing implicit solidarity with others.”

The university’s Institutional Voice Working Group, made up of eight faculty members, issued the report, with a set of principles and a recommended path forward, which the administration and governing board accepted.

“Harvard isn’t a government,” Noah Feldman, a Harvard law professor and a co-chair of the committee that developed the recommendations, said in an interview with The Harvard Gazette , released Tuesday as part of the university’s announcement. “It shouldn’t have a foreign policy or a domestic policy.”

The report, however, did not fully embrace “institutional neutrality” — a principle promoted by the University of Chicago, in which universities commit to staying out of political and social matters. Some universities, including Stanford University and Northwestern, announced shortly after the Hamas attack that they would adopt the policy.

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June 10, 2024

INSTITUTIONAL RACISM: Revealed: the Majority Black Committee that Excluded Caitlin Clark for U.S. Olympic Basketball Team.

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