AJPH BOOK & MEDIA Racism, a Root Cause of Health Inequity, Must Be Tackled Head on Racism: Science & Tools for the Public Health Professional By Chandra L. Ford, PhD, Derek M. Griffith, PhD, Marino A. Bruce, PhD, and Keon L. Gilbert, DrPH Washington, DC: APHA Press; 2019 616 pages; $75.00 ISBN: 978-0-87553-303-2 1258 Book & Media Jones “Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call ‘race’) that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.”1(p3) Public health has a long-fraught relationship with racism through policies and practices such as attributing stigmatized disease to one’s nationality, ethnicity, or race. Fortunately, the American Public Health Association more recently has been raising the clarion call to address racism. One might ask whether we still have a need for a book explicitly titled Racism. Just as Camara Phyllis Jones, MD, PhD, MPH, president of American Public Health Association from 2015 to 2016 noted, for those who are privileged by a system (e.g., those who are successful in public health), “it is part of your privilege not to have to know.”1 But if we are to shift practice enough to ensure that a book like this becomes obsolete, know we must! Even more important, we must know from those who have the firsthand, lived experience of racism within public health. Critical race theory provides the reason that this book is so essential. Those who experience institutional racism within public health are the very ones who should challenge the traditional paradigms and theories.2 Thus, this book compiles the narratives from leaders within the public health profession to contextualize the praxis of racism within public health. Also compiled is a rich discussion of the key terms, such as ethnicity, race, and racism, which is central for enabling a meaningful discourse. Furthermore, the tactic taken goes beyond presenting the historical context and scientific underpinnings of the study of racism to structuring the earned assets and sources of strength as a toolkit to address racism. Segregation by race, poverty, education, and other social factors accounts for more than a third of total deaths in the United States in a year.3 Racism imposes a huge human, social, and economic burden, estimated as $1.24 trillion between 2003 and 2006 in health care or lost productivity and premature death.4 Racism affects health through racial stratification in social structures such as housing, the criminal justice system, and the educational system. Several examples of how racialization, the social process of “othering” those not of the dominant group, has health effects include mechanisms such as hypervigilance and high-stress coping (e.g., John Henryism). Racism is a public health issue, and practitioners have tools that can help achieve health equity such as social change, community organizing, policy advocacy, research, and scholarship. Public health practitioners are positioned with research tools and health system practices such that they can raise awareness, identify causal pathways, and organize cultural and institutional change. To address racism, research must start with explicitly naming racism and investigating it directly. This necessitates examining both implicit and explicit racial biases and assumptions in knowledge production, conceptualization and measurement, and action. Furthermore, public health has a rich history of partnering with communities, which can be used as an antiracism strategy when sharing of power and privilege in formal and informal ways is done with respect, recognition, and responsibility. Many innovations ABOUT THE AUTHOR Nancy L. Jones is with the National Institute on Minority Health and Health Disparities, Bethesda, MD. Correspondence should be sent to Nancy L. Jones, PhD, Health Scientist Administrator, National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Blvd, Suite 800, Bethesda, MD 20892 (e-mail: nancy.jones@nih.gov). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This book review was accepted June 3, 2020. doi: 10.2105/AJPH.2020.305823 Note. The final content is the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health or the US government. AJPH September 2020, Vol 110, No. 9 AJPH BOOK & MEDIA to address structural racism have come from public health, such as health literacy; cultural competence; and, more recently, cultural humility. Race is a social construct with racist underpinnings. Racial categorizations are reductive and racist, rooted in Colonial origins of the country when non-White and native institutions were dismantled to achieve manifest destiny of the United States. Thus, examining the categories can assist in measuring the real effects of racist consequences on nondominant groups. The racial/ethnic minority and religious minority populations share common themes, but each has a unique historical context that is needed to understand the key issues these populations confront today. Contemporary scientists often ask, “Why the history lesson? The past is already in the past.” Unfortunately, “racial hierarchy is not just a problem attributable to millions of individual Americans but is also deeply embedded in American systems, structures, and institutions.”5(p469) Historical trauma, a type of institutional racism, transfers through multiple generations via philosophies, institutions, organizations, and policies, with violence, depression, and substance use. Many common themes between groups include using historical and current laws and policies to illegitimize, criminalize, and dehumanize groups within the racial hierarchy of the United States. Another thread is who has the privilege of characterizing the group. Part of racism is that the dominant group assigns the value and meaning to nondominant groups. Those who self-identify as American Indian and Alaska Native are not minority populations; they are people from diverse nations with selfdetermination and sovereignty. Asian Americans come from September 2020, Vol 110, No. 9 AJPH many different nations but have been grouped together with other nations that experienced historical atrocities in times of war. Latina and Latino individuals are cast as perpetual foreigners, criminalized and dehumanized, with a low social rank within the racial hierarchy of the United States. Even explanations appealing to cultural differences can “easily devolve into victimblaming explanations instead of pointing to the inequities that place communities and individuals at increased risk.”6(p416) Most insidious are when threats to one’s cultural identity are internalized, and the person believes his or her group is truly inferior. Thus, community-based research, community partners, and community scientists need to be central in helping recast the realm of data and knowledge systems to serve their own groups. “Structural competency calls on health care providers and students to recognize how institutions, markets, or health care delivery systems shape symptom presentations and to mobilize for correction of health and wealth inequities in society.”7(p190) Racism, a root cause of health inequity, must be tackled head on. What better place to begin than learning from the wealth of seminar papers, narratives from key warriors, and the historical context of the fight against racism in public health. It behooves all of us who are privileged to work within public health to take the time to learn about racism from fellow practitioners who have generously shared their earned assets and sources of strength. CONFLICTS OF INTEREST The author has no conflicts of interest to disclose. REFERENCES 1. Jones C. Launching an APHA presidential initiative on racism and health. Nation’s Health. Am J Public Health. 2016; 45(10):3. 2. Flores A, Gaxiola Serrano T, Solrzano D. Critical race theory, racial stratification in education and public health. In: Ford CL, Griffith DM, Bruce MA, Gilbert KL, eds. Racism: Science & Tools for the Public Health Professional. Washington, DC: American Public Health Association; 2019:151. 3. Galea S, Tracy M, Hoggatt KJ, Dimaggio C, Karpati A. Estimated deaths attributable to social factors in the United States. Am J Public Health. 2011;101(8): 1456–1465. 4. LaVeist TA, Gaskin DJ, Richard P. The Economic Burden of Health Inequalities in the United States. Washington, DC: Joint Center for Political and Economic Studies; 2009. 5. Smedley B. Towards a comprehensive understanding of racism and health inequities: a multilevel approach. In: Ford CL, Griffith DM, Bruce MA, Gilbert KL, eds. Racism: Science & Tools for the Public Health Professional. Washington, DC: American Public Health Association; 2019:469. 6. LeBrón A, Viruell-Fuentes E. Racism and the health of Latina/Latino communities. In: Ford CL, Griffith DM, Bruce MA, Gilbert KL, eds. Racism: Science & Tools for the Public Health Professional. Washington, DC: American Public Health Association; 2019:416. 7. Metzl JM, Petty J, Olowojoba OV. Using a structural competency framework to teach structural racism in pre-health education. Soc Sci Med. 2018;199:189– 201. Nancy L. Jones, PhD ACKNOWLEDGMENTS I thank Nathaniel Stinson Jr, MD, PhD, MPH, National Institute on Minority Health and Health Disparities, for providing substantive review. Jones Book & Media 1259 Copyright of American Journal of Public Health is the property of American Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. 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