The Racism-Race Reification Process: A Mesolevel Political Economic Framework for Understanding Racial Health Disparities (Sewell 2016)

INTRODUCTION

  • Upstream Approaches to Race

    • Racism produces racial inequality by embedding racial ideologies in societal institutions (Bonilla-Silva 1997; Carmichael and Hamilton 1967; Feagin 2000; Stewart 2008; Zuberi 2001).

    • Theories of upstream racism link institutional policies, processes, and practices to health disparities (Darity 2003; LaVeist 1993).

    • Institutional racism leads to racial residential segregation, which contributes to health disparities (Charles 2003; Feagin and McKinney 2003; Massey and Denton 1993).

Key Argument

  • The paper suggests that racial disparities in health are deeply rooted in political economic processes that drive racial residential segregation at the mesolevel—specifically, at the neighborhood level.

  • The dual mortgage market is highlighted as a crucial context where racially marginalized people are funneled into poor ecological environments, leading to health inequalities.

  • A conceptual framework titled racism-race reification process (R3p) is introduced to explain how institutional conditions influence the health of marginalized individuals by reinforcing the concept of race.

THE RACISM-RACE REIFICATION PROCESS (R3P)

Conceptual Overview

  • Reification of Race

    • The concept refers to the process of institutionalizing racial categories to the point where they are perceived as natural and unchangeable (Desmond and Emirbayer, 2009).

    • Racial bias is operationalized through institutional gatekeepers who act on their understandings of racial categories, which can worsen health outcomes for marginalized groups.

  • Ghettoization

    • Describes the segregation of racial groups across different residential areas, which can negatively impact health.

    • Examines how these power dynamics perpetuate disease burden through social relations existing within a racist framework, rather than attributing disparities to the race itself.

Mesolevel Race Reification

  • It identifies intermediate social contexts between individuals and larger societal structures, where power dynamics play a significant role in shaping health outcomes.

  • Understanding the distribution of resources, like mortgage loans and other opportunities, is essential to appreciating the health consequences tied to these race-based decisions.

ANALYSIS FRAMEWORK

Theoretical Roots

  • The theory incorporates insights from influential scholars such as W.E.B. Du Bois, who noted the interplay of economic exploitation and racial subjugation, whose relevance continues to persist.

  • Formulating different sociopolitical contexts highlights how structural dynamics inform health disparities.

Pathways to Health Disparities

  1. Racist Relational Structures

    • Institutionalized interactions that reflect and perpetuate racial inequalities.

    • Institutional actions and inactions create conditions that foster stratified outcomes in health.

  2. Harmful Ecological Environments

    • Physical and social environments characterized by poor organizational, social, and material resources impacting health negatively.

  3. Isolating Social Structures

    • Social contexts that separate marginalized groups from dominant ones, further exacerbating health inequalities.

EMPIRICAL ANALYSIS

Methodology

  • Utilized a mixed-method multilevel research design to analyze the relationships and test hypotheses concerning the dual mortgage market's impact on health outcomes.

  • The data sourced from projects studying human development in urban neighborhoods was triangulated with mortgage disclosure act data and census data.

Results and Findings

  1. Political Economy and Health

    • Various complex relationships show how political economic mechanisms in the dual mortgage market are linked to levels of ethnoracial residential segregation and health disparities.

    • Racialized credit refusals demonstrated elements of institutional discrimination directly affecting health outcomes.

  2. Health Disparities by Race

    • Significant differences in perceived health, particularly highlighting Black and Latino children having worse health outcomes compared to Whites.

    • Whether adjustments for socioeconomic factors were made, disparities persisted.

FRAMEWORK HYPOTHESES

  1. Upstream political economic mechanisms drive increases in ethnoracial residential segregation.

  2. These mechanisms are directly detrimental to health outcomes.

  3. Effects of political economy on health disparities are complex and multifaceted, often mediated through neighborhood quality.

  4. Neighborhoods with harmful ecological environments worsen health outcomes connected to racial inequality.

CONCLUSION

  • R3p framework correlates institutional behaviors with health outcomes, advancing an understanding of how entrenched racism structures influence health.

  • Recommends focusing on institutional solutions to reduce racial health disparities, emphasizing systemic changes over individual-level interventions.

  • Future research directions should encompass a wider scope of institutional influences outside of the mortgage market to paint a more comprehensive picture of health disparities in marginalized populations.