The Construction of a Meaningless, yet Deadly System: How Race and Racism Get Under Our Skin.

written by Dr. Miranda Reiter and Dr. Abigail B. Reiter

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Introduction

Race is not a biological fact. It is a social construct - an idea created and maintained through social, political, and historical processes. Although race has no genetic basis, it has real and lasting effects on people’s lives, particularly for people of color. This paper examines how the social construction of race contributes to persistent racial health inequalities and harms the psychosocial well-being of people of color. By examining the ways racism and racialized experiences are embedded in healthcare systems, everyday interactions, and broader social structures, we can better understand the causes of health disparities and their impact on physical and psychosocial health.

Social Constructions

Much of our social world is socially constructed, and many aspects of our way of life are not natural or based on objective reality. Rather, they exist because they were created and maintained through shared beliefs, ideas, and practices. Our cultural ideas, social institutions, social structures, social categories, and many other aspects of our world that we consider normal or natural are shaped by the people andexperiences we share with one another. Of course, there are some objective realities in the world. For instance, sex is based on real biological and physical characteristics that classify people as male, female, or intersex. On the other hand, how we see gender is socially constructed. Society, not biology, shapes our ideas of what it means to be “masculine” or “feminine.” These roles and expectations are learned through culture and socialization, not fixed by nature. Many other social concepts that we consider “normal” or natural are constructed in a similar way. For instance, our conceptions of age, beauty, fashion, power, and so on, are all socially determined.

Race as a Social Construction

In many ways, the process of social construction benefits some groups to the detriment of others. A significant example of this is seen in how cultures use the concept of race to classify and rank people. Race is a social construction that was created specifically to allocate resources and privileges differentially to groups, based on where their society placed their “race” in the racial hierarchy. Societies can vary in the characteristics they use to determine an individual’s race. Some use social class, others use caste or religion, and others use skin color or nationality. This points to the arbitrary nature of race. It shows how the US created its idea of race and how this classification system has methodically and continually worked to privilege whites over others since it was created and imposed on all of us.

The concept of race has been used to make social distinctions, especially to exclude people of African origin (Telles and Paschel 2015). Throughout the seventeenth century, forced labor of people taken from Africa and forced to work as slaves on US soil and in US homes, made possible the foundation of this nation. By the Naturalization Act of 1790, these individuals were redefined as slaves and property, not as citizens, as this law set the first uniform rules for granting US citizenship by naturalization to, and therefore limiting it only to, “any …. free white person” (Chin 2024). Through a new and strategic racial classification system, the individuals forced from Africa to work as slaves in the US were redefined as subhuman, not as humans with normal human capacities. In short, the social construction of race, the way we see it in the US, was created to define the Africans outside of the human race, as a subspecies, with supposedly inherently different cognitive and physical capacities as compared to whites. This new system helped to justify their exploitation and maltreatment in slavery.

The Maintenance of Race in the US 

Even after slavery was officially outlawed in all fifty states on December 6, 1865 through the Thirteenth Amendment to the Constitution, our racial classification system remained intact. Whites remained, in theory and practice, a superior group to Blacks. This was reinforced by successive laws and policies that withheld resources and opportunities, as well as rights and protections, from Blacks. For example, even though slavery was ended by this amendment, by 1865, practically all white men were allowed to vote in presidential elections, but Black men were only allowed to vote in a handful of states. Blacks were not able to own property, yet it was unlawful to be unhoused, as reflected in the vagrancy laws. So, many Blacks went from slavery to prison.

And the subjugation of Blacks carried into the 1900s with Jim Crow laws, the Black Codes, and other policies implemented from the 1880s. It was not until the Civil Rights Movement and the landmark Civil Rights Act of 1964 forced the end of racial segregation of US South institutions and other resources, and the Loving vs Virginia case of 1967 that people of color were lawfully “allowed” to marry whites. This marked the end of the criminalization of interracial marriage, and in effect, prompted social discussions about how to classify interracial children, where mixed couples would live, and how they were to be treated.

Therefore the “color-line” in the U.S., as explained by WEB DuBois, has been, and continues to be a defining feature of the US. As other groups immigrated to the US, they have been blocked opportunities, exploited, segregated, forced to assimilate, and/or otherwise fell victim to the classification system that has maintained white privilege since the US was founded.

Further race categories never have firm boundaries, nor do they remain consistent over time, even in the same society. For example, until 1930, if you were Mexican, you would be considered white by the US Census. But the following year, the US Census decided you would then be part of the “Mexican” race. In 1930, the US Census created a new race, “Mexican,” and began classifying individuals from Mexico as Mexican. During this time, the US Mexican population was rapidly growing in the US. Because they were classified as whites, whites’ rights and resources were losing their exclusivity. To maintain the relative exclusivity of white resources and privileges and to avoid extending whites’ privileges to this growing group, which of course meant limiting the resources and rights of people from Mexico, the US began classifying this large group of immigrants as Mexican. This, in effect, kept the white race smaller and its resources more exclusive. But in 1940, Mexican immigrants lobbied to have their race classified as white, and they won. They were then afforded the rights and privileges of whiteness due to this arbitrary label (Parker, Horowitz, Morin, and Lopez 2015). In this example, we can see how power affects how we view and label race, as well as how racial classification can impact our resources and opportunities.

Race is not a real, natural category, but instead a political decision made within a particular political, social, and cultural context, to continue to afford power to whites. Even so, we treat this category system as if it is real and natural, and it has very real, significant, long-lasting, and devastating consequences for those classified outside of the so-called white race.

Racial Health Inequalities

In the United States, people of color tend to suffer more chronic and infectious diseases, worse mental health, and shorter, less healthy lives than their white counterparts. For instance, in general, people of color are more likely to suffer serious complications during pregnancy and pregnancy-related deaths, and they are more likely to die from treatable and preventable conditions (Radley et al. 2024). They are also at higher risk for most chronic conditions, including hypertension, and diabetes, as compared to whites (Fei, Rodriguez-Lopez, Ramos, Islam, Trinh-Shrevin, Yi, Chernov, Perlman, and Thorpe 2017). In addition, Black Americans are more likely than whites to be diagnosed later and to die from colon and breast cancer (Baumgartner, Aboulafia, Getachew, Radley, Collins, and Zephyrin 2021). 

Sadly, racial health disparities also extend to differential treatment and outcomes of mental health. For example, compared to whites, Blacks and Hispanics are more likely to experience chronic, prolonged, and higher rates of severe and debilitating depressive symptoms (Bailey, Mokonongho, and Kumar 2019), and Blacks are more likely to experience post-traumatic stress disorder (PTSD) (Valentine, Marques, Wang, Ahles, de Silva, and Alegría 2019). And although they suffer more mental health conditions, people of color are less likely than whites to receive mental health services.

In all, whites tend to live healthier lives, both mentally and physically, and to receive better overall health care as compared to people of color. Not only are people of color more likely to live less healthy lives, but their lives also tend to be shorter. In fact, the 2022 life expectancy of whites was 77.5 years, as compared to 67.9 years for American Indian/Alaska Natives and 72.8 years for Black Americans (Ndugga, Hill, and Artiga 2024).

Because race is not a biological category, we know that these racial differences in health and longevity are not related to genetic or biological factors that place people with darker skin at greater risk of serious health conditions. So, what is causing these differences? The US has a long, sordid history of racist policies and events, some described above, that resulted in obvious differences in access to power, resources, and life chances that contribute to persisting racial disparities in health. Dating back to colonization and slavery, US people of color have been abused, mistreated, experimented on, and exploited by the US medical industry.

The effects of racial segregation and other historical discriminatory policies, such as redlining and unequal access to good housing and education, are everlasting, resulting in modern-day residential segregation (Vargas, Scherer, Fiske, and Barabino 2023). Urban Blacks and Hispanics live in neighborhoods characterized by limited health resources, higher crime rates, increased health risks, inadequate healthcare, and environmental racism (Cromartie 2018). Racist immigration policies and hateful political rhetoric have excluded certain groups and perpetuated “othering and xenophobia, especially among Mexican and Asian immigrants. Racism in the criminal justice system has also contributed to racial health inequalities, with increased incarceration rates of people of color based on racist policing and sentencing practices, as well as systemic disadvantages that contribute to cycles of poverty and violence, illicit drugs, and crime (Pew Research Center 2023).

And in the healthcare system, false beliefs about biological and meaningful differences across racial categories have contributed to racist decision-making and treatment practices. This is evident in providers’ attitudes and implicit biases, race-based disease stereotyping and diagnostic practices, and its use in clinical algorithms, instruments, and treatment principles.

Historical injustices like these have made it extremely difficult for minoritized racial groups to advance economically and socially, making it almost impossible for them to live as long and healthy as whites. In fact, discriminatory practices still occur in hiring, wages, and access to capital and financial resources that could potentially help racially minoritized groups overcome financial barriers to advance in society (Quillian, Pager, Hexel, and Midtbøen 2017).

Furthermore, mainstream social attitudes about people of different racial groups are continuously shaped by stereotypes, false information, and implicit biases and prejudices, many of which come from the media, political agendas, and other social influences (Melson-Silimon, Spivey, Skinner-Dorkenoo 2023). And race-based attitudes affect decisions in law enforcement, workplace hiring, healthcare, and education, among other important resources and adequate access to critical social institutions. Even though they are often unrecognized and subconscious, these biases enhance racial health disparities by increasing the odds that people of color will live, work, and learn in unhealthy places, and that they will be perceived negatively and face limited opportunities to advance socially, economically, and politically (Melson-Silimon, Spivey, Skinner-Dorkenoo 2023).

Racism’s Psychosocial Effects

Racism also has profound psychosocial effects on its victims, and these effects can impact health long term. According to minority stress theory, individuals from marginalized groups, such as people of color in the U.S., experience unique and persistent stress due to prejudice and discrimination, which can have deleterious effects on their mental and physical health (Kelleher 2009; Lick et al. 2013; Meyer 1995). In fact, even perceived racism and potential racist attacks can lead to physical and mental health problems. For instance, both experienced and observed racism can trigger an automatic physiological response commonly known as the fight-or-flight response (Thames, Irwin, Breen, and Cole 2019). In this, when someone feels as if they are the target of racism, their sympathetic nervous system responds as it would to any other perceived threat or stress, triggering a series of physiological events. Their heart rate increases, their breathing becomes more rapid, their adrenal glands release hormones, such as adrenaline, and their digestion is suppressed. All of these physiological responses are the body’s effort to prepare itself for action to combat the stressor or the racist attack.

This bodily response is an adaptive evolutionary process that is actually protective, as it helps us to escape harmful situations. But when this system is constantly activated, it can be dangerous, as it is for people who live in societies in which racism is endemic and structures interactions, institutions, and behaviors. In such societies, people of color are under constant stress related to real or perceived acts of racism, and this often leads to dangerous, even deadly, cumulative physiological and psychological stress (Geronimus, Hicken, Keene, and Bound 2006; Hoggard, Hill, Gray, and Sellers 2015). That is, when the fight-or-flight response is chronically activated, as it is for people of color in societies in which racism is prevalent, the body does not return to homeostasis, or the normal state, and their risk of suffering from a host of serious health problems, such as those chronic condition mentioned, increases (Mayo Clinic Staff 2023).

In sum, centuries of racist practices, policies, and ideologies that began with the totally meaningless socially constructed idea of different “races,” in which humans are categorized by skin color, have led to the stark and devastating racial health inequalities we see in the U.S. (and worldwide) today. And because these practices and beliefs impact most aspects of a person’s life and life chances, addressing racial health inequalities would entail systemic transformations, policy reforms, ideological shifts, and a united and universal effort to dismantle the structures that perpetuate race-based prejudice, bias, discrimination, and social exclusion.

References

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Author Biographies

Dr. Miranda Reiter is an Associate Professor and Department Chair in the Department of Sociology and Criminal Justice at the University of North Carolina at Pembroke. She is the coordinator of the medical sociology minor, and she teaches a variety of courses, including social statistics, social research, health and society, and health inequalities. She earned her PhD from Utah State University and worked as a postdoctoral research assistant at Sam Houston State University. As a social epidemiologist, she studies how social processes and factors impact the health of groups and individuals and contribute to health inequalities. Most of her research focuses on health disparities related to race and other social categories. She is devoted to social justice and is involved with inclusion and diversity efforts at her university. Miranda is a past President and current chair of the Advisory Committee for the North Carolina Sociological Association.

Dr. Abby Reiter is an Associate Professor of Sociology at the University of North Carolina at Pembroke, where she teaches a variety of courses, including introduction to sociology, sociological writing and rhetoric, exploring masculinities, and sociological theory. She co-created a course on race and racism, and is working towards developing one on feminist theories. She earned her PhD from George Mason University. Her research typically uses qualitative or mixed methodology to examine experiences with, and manifestations of, various types of interpersonal and institutional oppression, such as racism, heteronormativity, and sexism, and the maintenance of power associated with these systems. She is involved with social justice and inclusion initiatives at the university. She is a member of multiple boards and committees devoted to advancing sociological knowledge, and she is the current President of the North Carolina Sociological Association.