Introduction

Racism has shaped the fabric of American society, and its impacts are felt across all systems and institutions. Nowhere is this more apparent than in the fields of research and medicine, where biases, stereotypes, and erroneous beliefs about Black bodies have influenced the health and health outcomes of people of color. From its beginning, race has been used as a construct to justify systemic inequities that have caused tremendous harm to communities of color in the United States.

Perspectives on Racism in Research and Medicine explores the intersection of race and health through a multifaceted lens. This book draws from historical documents, the work of scholars and clinicians, lived experiences, and advocacy to provide a comprehensive perspective on how racism operates in the fields of science and medicine, both past and present. By examining the implications of racism in research, medical practices, and health outcomes, this book seeks to shed light on the entrenched inequities that continue to affect communities of color and other marginalized groups in the United States.

This book seeks not only to document the presence and impact of racism in research and medicine but also to raise awareness and catalyze change. By highlighting how deeply entrenched racism is in society and examining its profound effects on research, medicine, and health outcomes, I hope this book will foster awareness and provoke difficult but necessary conversations that can pave the way for meaningful progress toward health equity. Through this lens, we invite scholars, students, and medical professionals to question, learn, and ultimately take part in a movement toward health equity for all.

Before we discuss how racism has become entrenched in society, let us first establish a common understanding of racism.

Racism

People of color often face racism in the form of intentional actions and unconscious biases. Racism can manifest in various ways, all of which negatively affect individuals and communities of color.

Types of Racism^[2]

Racism, unlike discrimination, is rooted in power structures and determines who is empowered and who is oppressed, placing some groups at a societal disadvantage. Power is simply the ability or capacity to do something. Within power is the ability to influence or control; however, power itself is not inherently good or evil.

Forms of Oppression

Oppression, like racism, takes many forms.

Racism and oppression can be explained through the concept of “targets” and “agents” of oppression. Targets and agents are defined by the roles that individuals or groups hold within systems of oppression^[4]. Each must be present for the other to exist and for oppression to persist.

Agents of Oppression

• Privileged by birth
• Members of the dominant social group
• Have the power to define societal norms, and by default are the “norm”
• Can knowingly or unknowingly exploit those in the target group while simultaneously reaping the benefits of being a target

Targets:

• Subject to having their choices limited or restricted
• Treated as expendable and replaceable
• Subjected to exploitation, marginalization, violence, and powerlessness
• Remain targets through systems enacted by agents of oppression

The Lens of Systemic Oppression assumes that^[5]:

• All negative forms of prejudice and/or bias are learned and therefore can be unlearned.

• Oppression and injustice are human creations and phenomena that can be undone.

• Systemic oppression exists at the level of institutions through harmful policies and practices and across structures (such as education, health, transportation, and the economy) that are interconnected and reinforcing over time.

• Oppression and systematic mistreatment (such as racism, classism, sexism, or homophobia) are more than just the sum of individual prejudices.

• Systemic oppression is deliberate and has historical antecedents. It is the intentional disadvantaging of groups of people based on their identity while advantaging members of the dominant group (gender, race, class, sexual orientation, language, etc.).

• Systemic oppression manifests in economic, social, political, and cultural systems.

• Systemic oppression and its effects can be undone through recognizing inequitable patterns and intentional action to interrupt inequity and create more democratic processes and systems supported by multi-ethnic, multi-cultural, multi-lingual alliances and partnerships.

• Discussing and addressing oppression and bias will often be accompanied by strong emotions.

Throughout the rest of this text, we will explore how people of color have been historically targeted by White individuals and the many ways the oppression of African Americans has been justified and perpetuated over centuries. We will also examine how racism and oppression have been ingrained in research and medicine, with detrimental effects on the health of African Americans. Finally, we will conclude with solutions that can help move this country closer to achieving health equity.