Title: Understanding how discrimination can affect health - Williams - 2019 - Health Services Research - Wiley Online Library
Headings: Understanding how discrimination can affect health
Understanding how discrimination can affect health
Correspondence
Abstract
Background
Methods
Results
Conclusions
1 INTRODUCTION
2 BACKGROUND AND THEORETICAL FRAMEWORK
3 METHODS
3.1 Search strategy
3.2 Inclusion criteria
4 RESULTS
4.1 Discrimination and mental health
4.2 Discrimination and physical health
4.3 Discrimination and health behaviors
4.4 Discrimination and health care
4.5 Discrimination in children and adolescents
4.6 Discrimination and disparities in health
4.7 Individual and collective protective and resilient responses
5 DISCUSSION
6 CONCLUSION
ACKNOWLEDGMENTS
Supporting Information
REFERENCES
Citing Literature
Figures
References
Related
Information

Content: There are three major pathways that link racism to inequities in society and health. The first pathway by which racism operates is cultural racism. 6 This refers to the embedding of the inferiority of blacks and other nonwhites into the belief systems, images, and norms of the larger culture that leads to widespread negative beliefs (stereotypes) and attitudes (prejudice) that devalue, marginalize, and subordinate nonwhite racial populations. Cultural racism creates a larger ideological environment within which the system of racism can flourish. It initiates and sustains racial prejudice and negative racial stereotypes that can lessen support for egalitarian policies, trigger health‐damaging psychological responses in stigmatized persons such as internalized racism and stereotype threat, and facilitate explicit and implicit biases that restrict access to desirable resources, including medical care. 6
Figure 1
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The House that Racism Built
The second pathway is institutional or structural racism. We use these terms interchangeably to refer to societal structures and policies that reduce access of the socially stigmatized to desirable opportunities and resources in society. 5 The system of racism develops and sustains policies and structures that empower the dominant group to differentially allocate desirable societal opportunities and resources to racial groups regarded as inferior. Residential segregation is one example of an institutional mechanism of racism that adversely affects health in multiple ways. 7, 8 The forced removal and relocation of American Indians to reservations is another example of institutionalized isolation of a marginalized racial population.