WWhen I go to a health care provider and check “Black” for my race or ethnicity, that means my provider—before even seeing me—knows that I have dark skin and “different” hair. But biases or stereotypes stemming from my answer may include assumptions that I don’t have a husband, have limited education, or earn little or no income.
What would be far more useful than the “race” checkbox is an index of racial privilege.
Such an index would be a score derived from a set of validated questions. This result would be consistent with two drivers of health disparities: race and socioeconomic status. The assessment would be an indication of how individuals experience their race in America and how their (or their caregiver’s) socioeconomic status contributed to or limited their lives.
A racial privilege score would be the sum of an individual’s lived social experiences, treatment based on race, socioeconomic status, and other factors, similar to how various factors or behaviors produce a credit score.
In Western civilization, race is largely determined by skin color. Along with society’s approach of making everything about race, it contributes to racism. This leads to improper data collection, especially in the US health care and public health system.
Roberta Oiler’s family in Ohio they may “look white” to some, but they identify as black. I identify as Black, but I have attributes that are often misplaced synonymous with being white. I believe that these attributes – wrong or right – can affect my health care.
As a black woman, I sometimes wonder what the “race” check box signals, not just in my provider’s office, but on a larger scale of data collection that describes racial disparities or poor health outcomes. The checkbox to identify my race may just be another way to stigmatize my beautiful brown skin.
“Racial inequalities are not the result of black skin, but the result of treatment BECAUSE with black skin”, I constantly tell myself and the students I teach.
In the United States, there is 55.3 deaths per 100,000 live births among non-Hispanic blacks compared with 19.1 per 100,000 live births among non-Hispanic whites. Which makes me think: Are maternal mortality rates higher for people of color because their skin is black, or do they have worse maternal mortality rates because of their lived social experiences due to black skin?
Some black mothers live in lower socioeconomic status, which can contribute to a number of conditions that can affect pregnancy and childbirth, such as purchasing and consuming lower quality foods, not participating in regular exercise because of costs and time, working long hours or inflexible jobs. unusual hours, or hard work such as working as a waitress or maid. They may experience stress from raising black children in a society filled with historical and current racial violence against them. These stressful circumstances, in addition to life and childbirth, can contribute to poor health outcomes such as preeclampsia in mothers of color.
Racism it makes people sicksomething both American Medical Association AND American Public Health Association agree Both cite racism as a threat to public health. It’s time to dismantle race — the foundation and cornerstone for racism — and develop a tool to measure racial privilege, the social and health privileges a person experiences because of their lived experiences based on their racial identity.
Over the years, I have explored the concept of racial privilege in several ways. I developed one COURSE on the social determinants of health. My colleague Brandi White and I described how students examine the privilege as a social determinant of health. I have developed a peer education program that pairs students with lower racial privilege scores with those with higher scores to discuss racial privilege as it affects their lives. I talked about the similarities between them Covid-19 and racism in the United States: how insidious racism is for all Americans, regardless of race and color. I also submitted a grant proposal to the National Institutes of Health to develop a valid tool to measure racial privilege, although it was not funded.
Despite some success in trying to establish the concept of racial privilege, it has been an uphill battle pointing out the flawed way of collecting and reporting data on race to discuss health disparities in the US.
What I envision is a reliable set of questions related to one’s lived experiences—rather than the color of their skin—focused on their physical and social communities that can determine the effect of racial privilege on health outcomes, in instead of just using someone’s skin color. Educator and activist Paul Kivel developed a questionnaire to examine class and race. Developing a valid racial privilege questionnaire that examines the relationship between people’s racial privilege scores and their health outcomes is the best way forward. The results may show how black people, especially black women, are treated because of the color of their skin. I imagine the results will apply to everyone, regardless of skin color.
Without developing and using a valid measure of racial privilege, health care providers and researchers will continue to measure race as a limiting check box that mischaracterizes people and ignores the intersectionality and interconnectedness of race, treatment because of skin color (an attitude poor for race ), socioeconomic status and lived experiences and their effects on primary care and public health. All public health stakeholders, including patients and people accessing various health services, deserve a validated approach to measuring racial privilege. It’s time to dismantle race as we know it.
Elizabeth A. Brown is an assistant professor and director of the bachelor of science program in public health at Old Dominion University and a public voices member of the OpEd Project.
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