Over one hundred years ago, W. E. B. Du Bois (1899) documented large, pervasive, and persistent racial inequities in health. While the current demography of racial groups in the United States is radically different compared to the times when Du Bois first discussed issues of race and health, many of the significant developments in research on racial differences in health in the last century can be traced to his seminal work (Williams and Sternthal, 2010). Du Bois recognized that the limited access to economic resources and the social marginalization of some racial groups could have dire social, physical, and psychological consequences for them. Current research studies continue to document that racial groups with a long history characterized by economic exploitation and geographic marginalization—Blacks or African Americans, American Indians, and Native Hawaiians and other Pacific Islanders—have markedly poor health outcomes compared to the dominant White population. Immigrant Asians and Hispanics tend to have better health than the U.S. average, but their health tends to worsen over time and across subsequent generations. Despite Du Bois's prescience and the advances made by contemporary researchers, there are many substantive theoretical and methodological challenges confronting scholars who study the health of diverse racial and ethnic groups. This special issue of the Du Bois Review provides a state-of-the-art overview of some of these unanswered questions and critical research directions for the study of racial inequality in health.

Although there have been significant decreases in U.S. mortality rates, racial/ethnic disparities persist. The goals of this study are to: (1) elucidate a conceptual framework for the study of racial/ethnic differences in U.S. adult mortality, (2) estimate current racial/ethnic differences in adult mortality, (3) examine empirically the extent to which measures of socioeconomic status and other risk factors impact the mortality differences across groups, and (4) utilize findings to inform the policy community with regard to eliminating racial/ethnic disparities in mortality. Relative Black-White differences are modestly narrower when compared to a decade or so ago, but remain very wide. The majority of the Black-White adult mortality gap can be accounted for by measures of socioeconomic resources that reflect the historical and continuing significance of racial socioeconomic stratification. Further, when controlling for socioeconomic resources, Mexican Americans and Mexican immigrants exhibit significantly lower mortality risk than non-Hispanic Whites. Without aggressive efforts to create equality in socioeconomic and social resources, Black-White disparities in mortality will remain wide, and mortality among the Mexican-origin population will remain higher than what would be the case if that population achieved socioeconomic equality with Whites.

The assessment of multiracial status in U.S. health research is fraught with challenges that limit our ability to enumerate and study this population. This paper reconceptualizes the assessment of multiracial status through the development of a model with three dimensions: mixed ancestry multiracial status, self-identified multiracial status, and socially assigned multiracial status. We present challenges to studying multiracial populations and provide recommendations for improving the assessment of multiracial status in health research.

Explanations for immigrant and Latino health outcomes often invoke culture through the use of the concept of acculturation. The use of acculturation models in health research has been, however, the topic of growing debate. Critics of acculturation-based explanations point out that despite the growing psychometric sophistication in measuring acculturation, the concept and its underlying assumptions remain flawed. Specifically, questions regarding how Mexicans experience and make sense of the ethnoracial structure of the United States and how racialization processes impact health and well-being remain largely ignored within acculturation-based models. By examining the processes Mexican women engage in as they construct ethnic identities within a stigmatizing social environment in the United States, this paper contributes answers to these questions. Based on a qualitative analysis of forty in-depth interviews conducted with first-generation Mexican immigrant women and second-generation Mexican American women in Detroit, this paper describes how Mexican women work through the tensions and complexities embedded in the process of constructing a sense of ethnic belonging while, at the same time, confronting and resisting racial stereotypes of Mexicans in the United States. Women's narratives suggest that the stress involved in negotiating ethnic identities under stigmatizing environments might be one of the ways in which living in a racialized society affects health outcomes. The paper concludes with a discussion of the implications of these findings for Latino and immigrant health.

This research examines the impact of ethnic concentration and community socioeconomic status (SES) on elderly health in ethnically diverse communities in Xinjiang in northwest China. Effects of the concentration of two major ethnic populations are compared: the Han, which is the dominant ethnic group in China, and the Uyghur, the largest Muslim group in Xinjiang. Net of socioeconomic status, we find that population densities of the ethnic groups have a significant impact on our aggregate-level indicators of elderly health. Han density predicts good health, while Uyghur density predicts poor health. However, we do not find that SES indicators are independent predictors of community elder health. These findings suggest that rapidly developing economies, like those in China, do not necessarily provide the attention to health care that would result in improved quality of life and health status for the population.

Although racial disparities in health have been documented both historically and in more contemporary contexts, the frameworks used to explain these patterns have varied, ranging from earlier theories regarding innate racial differences in biological vulnerability, to more recent theories focusing on the impact of social inequalities. However, despite increasing evidence for the lack of a genetic definition of race, biological explanations for the association between race and health continue in public health and medical discourse. Indeed, there is considerable debate between those adopting a “social determinants” perspective of race and health and those focusing on more individual-level psychological, behavioral, and biologic risk factors. While there are a number of scientifically plausible and evolving reasons for the association between race and health, ranging from broader social forces to factors at the cellular level, in this essay we argue for the need for more transdisciplinary approaches that specify determinants at multiple ecological levels of analysis. We posit that contrasting ways of examining race and health are not necessarily incompatible, and that more productive discussions should explicitly differentiate between determinants of individual health from those of population health; and between inquiries addressing racial patterns in health from those seeking to explain racial disparities in health. Specifically, we advance a socio-psychobiological framework, which is both historically grounded and evidence-based. This model asserts that psychological and biological factors, while playing a central role in determining individual risk for poor health, are relatively less consequential for understanding racial disparities in health at the population level. Such a framework emphasizes the etiologic role of social inequities in generating and perpetuating racial disparities in health and highlights their impact on psychological, behavioral, and biological disease processes.

In the United States, African Americans face stark inequalities in health. The life course perspective offers a unique viewpoint through which racial disparities in morbidity and mortality may be understood as the result of repeated exposures to risk factors during both childhood and adulthood. However, the utility of this approach is limited by its failure to investigate the degree to which racial/ethnic minorities are able to translate gains in socioeconomic status into favorable health outcomes, both for themselves and for their children. In order to adequately reflect the realities of marginalized groups, life course models must explore the interactive nature of linkages across lifecourse stages, pay particular attention to the unique processes that create and maintain health disparities over time, and consider the specific contexts in which these processes occur. To this end, I examine the ways in which exclusionary forces and discriminatory conditions are likely to prevent African American women and their children from reaping the health benefits typically associated with upward socioeconomic mobility.

Despite the widespread assumption that racial differences in stress exist and that stress is a key mediator linking racial status to poor health, relatively few studies have explicitly examined this premise. We examine the distribution of stress across racial groups and the role of stress vulnerability and exposure in explaining racial differences in health in a community sample of Black, Hispanic, and White adults, employing a modeling strategy that accounts for the correlation between types of stressors and the accumulation of stressors in the prediction of health outcomes. We find significant racial differences in overall and cumulative exposure to eight stress domains. Blacks exhibit a higher prevalence and greater clustering of high stress scores than Whites. American-born Hispanics show prevalence rates and patterns of accumulation of stressors comparable to Blacks, while foreign-born Hispanics have stress profiles similar to Whites. Multiple stressors correlate with poor physical and mental health, with financial and relationship stressors exhibiting the largest and most consistent effects. Though we find no support for the stress-vulnerability hypothesis, the stress-exposure hypothesis does account for some racial health disparities. We discuss implications for future research and policy.

Racial minorities bear a disproportionate burden of morbidity and mortality. These inequities might be explained by racism, given the fact that racism has restricted the lives of racial minorities and immigrants throughout history. Recent studies have documented that individuals who report experiencing racism have greater rates of illnesses. While this body of research has been invaluable in advancing knowledge on health inequities, it still locates the experiences of racism at the individual level. Yet, the health of social groups is likely most strongly affected by structural, rather than individual, phenomena. The structural forms of racism and their relationship to health inequities remain under-studied. This article reviews several ways of conceptualizing structural racism, with a focus on social segregation, immigration policy, and intergenerational effects. Studies of disparities should more seriously consider the multiple dimensions of structural racism as fundamental causes of health disparities.

This article reviews evidence linking incarceration and health, with a particular focus on African Americans, who are disproportionately affected by the incarceration system. Although inmates generally suffer from worse health than comparable, non-institutionalized adults, this comparison is not uniformly the case, and some of the strongest negative effects of incarceration emerge after release, suggesting that the struggles of reintegration into society are as important as the conditions of incarceration. We review evidence for the basic relationship between incarceration and health from individual-level and aggregate-level studies, as well as from evidence and speculation regarding potential mediating mechanisms. Many questions remain regarding these mechanisms and, by extension, which policies are most promising for reducing incarceration's impact on health. Among other issues, the incarceration-health connection also raises fundamental questions regarding the level of harm society is willing to accept as part of routine punishment for criminal behavior.

This commentary discusses advances in the conceptual understanding of racism and selected research findings in the social neurosciences. The traditional stress and coping model holds that racism constitutes a source of aversive experiences that, when perceived by the individual, eventually lead to poor health outcomes. Current evidence points to additional psychophysiological pathways linking facets of racist environments with physiological reactions that contribute to disease. The alternative pathways emphasize prenatal experiences, subcortical emotional neural circuits, conscious and preconscious emotion regulation, perseverative cognitions, and negative affective states stemming from racist cognitive schemata. Recognition of these pathways challenges change agents to use an array of cognitive and self-controlling interventions in mitigating racism's impact. Additionally, it charges policy makers to develop strategies that eliminate deep-seated structural aspects of racism in society.

While it is clear that self-reported racial/ethnic discrimination is related to illness, there are challenges in measuring self-reported discrimination or unfair treatment. In the present study, we evaluate the psychometric properties of a self-reported instrument across racial/ethnic groups in a population-based sample, and we test and interpret findings from applying two different widely-used approaches to asking about discrimination and unfair treatment. Even though we found that the subset of items we tested tap into a single underlying concept, we also found that different groups are more likely to report on different aspects of discrimination. Whether race is mentioned in the survey question affects both frequency and mean scores of reports of racial/ethnic discrimination. Our findings suggest caution to researchers when comparing studies that have used different approaches to measure racial/ethnic discrimination and allow us to suggest practical empirical guidelines for measuring and analyzing racial/ethnic discrimination. No less important, we have developed a self-reported measure of recent racial/ethnic discrimination that functions well in a range of different racial/ethnic groups and makes it possible to compare how racial/ethnic discrimination is associated with health disparities among multiple racial/ethnic groups.

Increasingly, understanding how the role of historical events and context affect present-day health inequities has become a dominant narrative among Native American communities. Historical trauma, which consists of traumatic events targeting a community (e.g., forced relocation) that cause catastrophic upheaval, has been posited by Native communities and some researchers to have pernicious effects that persist across generations through a myriad of mechanisms from biological to behavioral. Consistent with contemporary societal determinants of health approaches, the impact of historical trauma calls upon researchers to explicitly examine theoretically and empirically how historical processes and contexts become embodied. Scholarship that theoretically engages how historically traumatic events become embodied and affect the magnitude and distribution of health inequities is clearly needed. However, the scholarship on historical trauma is limited. Some scholars have focused on these events as etiological agents to social and psychological distress; others have focused on events as an outcome (e.g., historical trauma response); others still have focused on these events as mechanisms or pathways by which historical trauma is transmitted; and others have focused on historical trauma-related factors (e.g., collective loss) that interact with proximal stressors. These varied conceptualizations of historical trauma have hindered the ability to cogently theorize it and its impact on Native health. The purpose of this article is to explicate the link between historical trauma and the concept of embodiment. After an interdisciplinary review of the “state of the discipline,” we utilize ecosocial theory and the indigenist stress-coping model to argue that contemporary physical health reflects, in part, the embodiment of historical trauma. Future research directions are discussed.

Deeply embedded in everyday discourse, social interactions, and institutional practices, racism negatively affects the health and well-being of Black people in the United States. Theory and empirical research on the impact of racism on health have focused on stressful events and individual perceptions of racism, although racism is not expressed only as racist acts. Racism subordinates people and diminishes their importance; stereotyping is one of the most insidious forms of such subordination. The stereotypes that underlie social discourse about race influence how others perceive Black people and, to some extent, how Black people perceive themselves. Thus stereotypes help maintain and promote racism. Despite the importance of stereotypes in understanding racism and its effects on Black people, little attention has been paid to the impact of stereotypes on health. This paper explores the adverse effects of stereotypes on African American health, focusing on the psychological and structural pathways through which stereotyping operates. Psychological pathways are salient for these reasons: stereotyping constitutes a form of racism that may be experienced vicariously; stereotypes induce vigilance and rumination as people caricatured by them anticipate their use and spend time trying to disconfirm them; stereotypes may be internalized. Structural pathways occur because stereotypes that portray Black people as deviant, undeserving, and ultimately less human negatively affect opportunity structures and physical environments.

Over the past two decades, thousands of studies have demonstrated that Blacks receive lower quality medical care than Whites, independent of disease status, setting, insurance, and other clinically relevant factors. Despite this, there has been little progress towards eradicating these inequities. Almost a decade ago we proposed a conceptual model identifying mechanisms through which clinicians' behavior, cognition, and decision making might be influenced by implicit racial biases and explicit racial stereotypes, and thereby contribute to racial inequities in care. Empirical evidence has supported many of these hypothesized mechanisms, demonstrating that White medical care clinicians: (1) hold negative implicit racial biases and explicit racial stereotypes, (2) have implicit racial biases that persist independently of and in contrast to their explicit (conscious) racial attitudes, and (3) can be influenced by racial bias in their clinical decision making and behavior during encounters with Black patients. This paper applies evidence from several disciplines to further specify our original model and elaborate on the ways racism can interact with cognitive biases to affect clinicians' behavior and decisions and in turn, patient behavior and decisions. We then highlight avenues for intervention and make specific recommendations to medical care and grant-making organizations.

From “reefer madness” to “crack babies,” American drug scares demonstrate that race shapes the construction of epidemics and diagnoses. This research brief reexamines the racial construction of drug scares in light of the recent methamphetamine (meth) scare, a drug “epidemic” constructed as White and accompanied by a new diagnosis: “meth mouth.” Through examination of survey data and dental research, I challenge the evidence for both the “epidemic” upsurge in meth use and the “meth mouth” diagnosis. Given the weak evidentiary basis for epidemic and diagnosis, I offer a preliminary interpretation that the meth epidemic is constructed as symptom and cause of White status decline, with dental decay the vehicle for anxieties about descent into “White trash” status.

This article posits that the response to the AIDS epidemic among Blacks in the United States must acknowledge structural and institutional realities that render poor Black urban neighborhoods particularly vulnerable to high HIV infection rates. The controversial film Precious: Based on the Novel Push by Sapphire, inspires our analysis, revealing the spatial context of HIV risk and suggesting new potential avenues through which to address the epidemic at the neighborhood level. In the film, we find opportunities for institutions to serve as intermediaries among neighborhoods, families, and individuals, not only to reduce the transmission of HIV, but also to improve health management for HIV-positive inner-city residents. The film points to three potential location-based sites of intervention: (1) mental health services that treat childhood sexual trauma; (2) HIV-related health messaging and services within urban street-level bureaucracies; and (3) neighborhood access to food and dietary resources that mitigate HIV disease progression.

The Siphithemba Choir, an HIV/AIDS support group at the McCord Mission Hospital in Durban, South Africa, uses songs that conflate “Africa” and “Black Race” (abantu abamnyama) or “Black Nation” (Umnyama yezwe) to perform their experience of HIV/AIDS, thus signaling global ethnic/racial consciousness in the context of the HIV/AIDS discourse. This paper argues that the musical referencing of race and ethnicity by this group of HIV-positive South Africans could be explained as a function of related factors: the nature of the AIDS virus, the history and lingering effects of apartheid, the continuing interracial acrimony in the post-apartheid environment, and the global politics of AIDS. A combination of these factors has inevitably impacted how HIV/AIDS is perceived and interpreted through the lens of race. Hence the Siphithemba Choir's musical performance is analyzed in this paper as an expressive articulation of an African and Black experience of AIDS, and a performance of Black identity in the context of the global AIDS pandemic.

Although thriving in many respects, racial health disparities research suffers from a lack of historical analysis and may be in danger of reaching a saturation point. This article examines how renewed attention to history can enhance the explanatory power of such research. First, it surveys a body of writing on what history can contribute to contemporary social science and policy debates. Next, it compares current racial health disparities research to the analytical impasse encountered by urban poverty researchers of the late 1980s and early 1990s. It contrasts that work with two classic post-Second World War urban histories, and identifies qualities of the latter lacking in conventional social science. The essay then surveys historically oriented works on race and health, pointing out their usefulness to racial health disparities research while discussing promising future research directions. It concludes with a brief reflection on changes in the academic institutional context necessary for fruitful synergy between public health researchers and historians.

One of the most controversial figures in Black intellectual history is psychologist Kenneth B. Clark. Prominently identified as the main proponent of the idea that racial segregation led to psychological damage in Black children, Clark's work heavily influenced the U.S. Supreme Court in its 1954Brown v. Board of Education school desegregation decision. Almost immediately afterwards, his research methods and conclusions were challenged as incomplete and biased. Scholars now argue that Clark and other racial liberals became solely wedded to the idea of racial psychological damage in order to secure victory in Brown. Yet a closer analysis of his thought reveals a more complex picture. During the early 1940s, he developed a new psychological concept which he called the “zoot effect.” He defined the zoot effect as the attempt by a person to gain psychological security in a society which mandated that individual's inferiority. The zoot effect or zoot personality reflected the larger society's pathology, which manifested itself internally in individuals. This concept was heavily shaped by ideas about race, class, and in particular the work of Alfred Adler, which he first learned as a student at Howard University. Using archival and secondary sources, I argue for a reconceptualization of Clark within the broader context of his social thought, suggesting that the zoot-effect concept grounded his research on Black children and set the stage for his later views on desegregation, civil rights, and American society.