How Racism Leads to Cancer Health Disparities

Racism is a system that assigns value and gives opportunity to people based on the way they look or the color of their skin. CDC brought issues of social justice and health equity to the forefront of the national discussion in April 2021, when CDC’s director declared racism a serious public health threat. Racism is a serious threat to the public’s health because it makes it harder to address other social determinants of health.

Racism works as a system on several connected levels and includes structural, institutional, interpersonal, and internalized racism.¹ It contributes to cancer health disparities by limiting the ability of people of racial and ethnic minority groups to prevent cancer, find cancer early, and get treatment. For example—

• Structural racism is the way key areas of society (education, employment, health care, housing, and law enforcement) are structured to benefit the group in power and hinder racial and ethnic minority groups. Because of structural racism, health care can be difficult to access, navigate, and pay for, especially for historically marginalized groups.
  For example, American Indian and Alaska Native people are more likely to get colorectal cancer than White people. One reason may be that many Native people live far away from clinics that provide colonoscopies.²
• Institutional racism is the way practices and policies of institutions block racial and ethnic minority groups from access to resources and opportunities.
  For example, Black women are less likely to live 5 years after being diagnosed with cervical cancer than White women. This disparity may be partly explained by a lack of proper clinical follow-up practices after screening.³
• Interpersonal racism can be seen during individual interactions, when a person’s conscious or unconscious racial prejudice results in discriminatory behavior or actions that block another person’s access to resources or opportunities.
  For example, a scheduler who only gives the most convenient follow-up appointments to patients who look like them, regardless of the patients’ health status, is showing interpersonal racism.
• Intrapersonal or internalized racism is when people of racial and ethnic minority groups accept stereotypes about themselves and those who share their identity and believe that members of other racial and ethnic groups are superior.

References

¹Race Forward: The Center for Racial Justice Innovation. Race Reporting Guide.[PDF-255KB] Race Forward; 2015.

²Melkonian SC, Jim MA, Haverkamp D, Wiggins CL, McCollum J, White MC, Kaur JS. Disparities in cancer incidence and trends among American Indians and Alaska Natives in the United States, 2010–2015. Cancer Epidemiology, Biomarkers and Prevention 2019;28(10):1604–1611.

³Perkins RB, Adcock R, Benard V, Cuzick J, Waxman A, Howe J, Melkonian S, Gonzales J, Wiggins C, Wheeler CM. Clinical follow-up practices after cervical cancer screening by co-testing: A population-based study of adherence to U.S. guideline recommendations. Preventive Medicine 2021;153:106770.