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Theme 1: Who am I?

I am a first generation hispanic/Latina woman. I am a student, friend, daughter, and much more. I am shy and outgoing depending on the people and setting I am in. I pretend to be a confident person, who has their life together. People think I am the basic white girl that has everything figured out and has no "real" problems in life due to my fair skin and parents still being married. I wish I could be someone who was confident and sure of their decisions. I want to be the best version of myself physically, emotionally, and mentally. I want to be proud of what I do for myself and others.

Theme 2: First Experience with Race

When I was about 7 years old, I went on a trip with my family to a very dominated white community. My family is dark skinned which is a contrast to my very light skin. During this trip, we went to the grocery store and received dirty looks and rude mannerisms. I was confused and scared because I grew up in a hispanic dominated city and never had a problem with skin color. I have talked about this experience because it was something I was unfamiliar with given that where I live and surrounding cities are all Latinos/Hispanics. This opened my eyes to how different it is outside of the bubble I lived in. It also made me realize how scared people live every single day facing things like this daily.

Theme 3: Positive Sense of Self Brainstorming

The connections between having a positive sense of self and experiences with identity and race can be beneficial. If you are comfortable in your skin and know who you are, no matter what someone says, you know your truth. I think someone who has a negative view of one's self can still have a positive ethnic identity. I think this because you can be proud of where you come from and your culture but still be self conscious.

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2.4 Ubuntu, Afrocentricity and Nguzo Saba

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2.4 Ubuntu, Afrocentricity and Nguzo Saba

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Theme 1: Ubuntu

1. I think it is well and alive in today's African American culture. Some of the principles of Ubuntu is community and justice. African American families and communities are very serious and passionate when it comes to these things. There many parades and other things to celebrate this.

2. One of the similarities between African American cultures and African culture is hip hop. Hip Hop has been passed down by generations as a from of oral communication. This was due to laws that permitted slaves from learning how to read and write. A difference is African American culture lost traditions during the socialization process. They were more socialized in this country making traditions lost along the way.

THEME 2: 7 Concepts of Afrocentric Psychology

1. The concept I have chosen that i see most in the African American community is Maafa. This is the word used to describe the enslavement of Africans by Europeans. The maafa was designed to oppress,

humiliate, and destroy African people. Critical to maafa is the denial of the humanity of Africans. I chose this concept because there has been multiple injustices done and parades fighting for the equality of African Americans.

2. When reading the 7 principles of Nguzo Saba, I was able to relate it to an example. Once i reached Inclusive metaphysical epistemology, I was unable to provide an example. I think this principle is least present in African American culture. This principle means the use of both affective and cognitive syntheses of information as a way of knowing. Reality is not limited to what is understood by the five senses, and rational logic is not the only way of obtaining knowledge.

THEME 3: 7 Principles of Nguzo Saba

1. Kujichagulia (self-determination): To define ourselves, name ourselves, create for ourselves, and speak for ourselves. I think this is very important to help yourself and every one around you. I think this is very common in African American community because they are constantly trying to better themselves and make a name for themselves. They are trying new things and creating businesses to "make it out".

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3.4 Three Self-Assessments, Racial Identity Development and Identity Resource.

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3.4 Three Self-Assessments, Racial Identity Development and Identity Resource.

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3.1: Within the category of Natal Measures I chose natural parents, grandparents, and birthplace of self. I chose these because I feel like these things really define and shape my ethnic self identity. My parents are who taught me my culture and taught me who and where I come from. My grandparents have stories and lives from living decades in their country. My birth place is important because settling down in my city I was able to see that everyone around me was like me.

Behavioral Measures I chose language use patterns, food preferences, and friendship. In my house we speak spanish and english, my grandparents only speak spanish so this is very important to my culture. Food preferences is a big part of my culture. The food I eat on a daily basis is mostly mexican food and it is my favorite food. It brings my family together and it all holds history. I chose friends because all of my friends were more or less raised the same as me being first generation and spanish speaking.

I chose self identification of preferred ethnic group for Subjective Measures because i never had a problem identifying as hispanic/latina.

For Situational Contextual Measures I chose community. I chose this because in the city i live in as well as surrounding cities it is very hispanic/ latino heavy. This made me feel welcomed and comfortable having a community around me that all shared the same history.

3.2: My multigroup ethnic identity measure score is 40. To me this means that I have very in touch and proud of who I am and where I come from. I think this means I have a strong bond because I really only had 2 number 2's. Nothing really surprised me about this analysis.

3.3: My score for the self esteem scale was 16. It stated that My score was average, I think I can work on it because there is always room for improvement. I think it is that score because there was some parts that I could be better at. for example being satisfied with myself. I am trying to be better and not 100% where i want to be.

3.4: I believe that I am in the internalization stage. I believe this because I am comfortable and proud of who I am. I am less defensive, I always felt like i was having to defend who I am and my culture but now I am happy and accepting.

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1. The most type of racism I have seen is Individual Racism. I see this a lot with white people think they are superior than any other race. They will immediately look down on you and act like you are so inferior. I have also seen a lot of symbolic racism. I believe this ties to individual racism because whites think they are superior. In thinking this they believe other groups are not reaching "their level" simply because it is impossible to. They believe that we just don't work hard enough, aren't smart enough, or just looking for hand outs.

2. I do not believe we live in a post racial society. Especially today with the government and president we have race is seen more than anything. People are getting deported if they are not white no matter if they are citizens or not. They are being targeted based off how they look and their background.

3. My definition of racism is hating on a person or group of people based off their cultural or ethnic/racial background. I think race is a social construct. I think society has the power to make it the first thing you see or the last. It is how you were raised and the environment you are surrounded with.

4. https://pmc.ncbi.nlm.nih.gov/articles/PMC10519151/

This is my resource.

5. Something that stood out to me in one of the videos that getting asked "Where are you from?" can be seen as microaggresion. This stood out to me because I myself ask this based off curiosity of background and never to come off as rude.

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In scientific studies, the social construct of race is often conceptualized as a biological variable, supported by the false historical narrative that there are inherent biological differences between racial groups. This scientific error has led to decades of flawed practices in the medical setting, contributed to ongoing health disparities, and reinforced racial biases in diagnosis and treatment rationale. The notion of race as a biological determinant in research has contributed to the perpetuation of negative stereotypes and further stigmatization of minoritized racial and ethnic groups. Due to the reciprocal interdependence of research and clinical practice, these false notions extend into the clinical realm, impacting patient outcomes. Additionally, results from these studies are frequently used to determine policies, practices, and resource allocations throughout medicine and society more broadly. We must therefore consider fully how misinterpretation of research findings contributes to the ongoing oppression of minoritized racial and ethnic groups and perpetuates racism by obscuring the underlying causes of racial disparities. Below, we focus on race as a biological factor and its contribution to misdiagnosis and health disparities in the area of mental health for Black individuals. We also discuss the appropriate use of race in mental health research and provide recommendations on how clinicians can aptly use race to inform practice.

The current concept of race, a social construct, stems from the 18th century when it flourished, in part, due to attempts to rationalize the enslavement of African people in Western societies. This construct has been used to delineate differences between humans, assigning "whiteness" as the standard, and promoting the narrative that Black and other marginalized people are inherently and genetically inferior. In mental health, as in biomedicine, race continues to be used inaccurately-a practice rooted in the historical racialized belief that race can act as a causal factor across the entire spectrum of disease-thereby influencing data interpretation, treatment decisions, and clinical practices. Despite evidence that the variable race is often not genetically discrete, reliably measured, nor biologically relevant, researchers and clinicians continue to use the basis of race to incorrectly explain differences in health outcomes as a consequence of biological properties presumed to be associated with race. This error not only contributes to the fallacy that a person's skin color determines risk profiles for specific mental health conditions but also negates the influence of factors that can contribute to wide variabilities in health and are differentially expressed across diverse global populations (e.g., environmental conditions, cultural practices). Hence, racial determinism obscures the effects of social determinants and contributes to misinterpretation.

Racial determinism also contributes to false diagnostic conclusions, whereby Black people experiencing mental health conditions can be misdiagnosed, even when measures of psychopathology are inconsistent with the given diagnosis. Such examples highlight the need for a greater examination of the ways in which bias influences our diagnostic practices. Similarly, there is a critical need for greater inclusion of Black and other minoritized racial and ethnic groups in research studies to better inform objective diagnostic measures.5 Research that relies on clinical measures that demonstrate disparate validity across racial and ethnic groups produces findings and promotes practices that have low ecological validity and effectiveness, further perpetuating racial and ethnic health inequities.

To adequately address the misuse of race in mental health research and practice, changes must be made on individual, institutional, and societal levels. As the US grapples with the extensive impacts of racism, it is essential that we dismantle the notion of race as a biological determinant in mental health and simultaneously enhance our understanding of how the social phenotype known as race functions in society to preferentially advantage and value White lives, cultural ideals, and norms over those of other racial and ethnic groups. Individually, it becomes the work of every researcher and clinician to acknowledge the existence of structural racism and its historical and current role in producing inequities that contribute to poor mental health outcomes among minoritized populations. This work also requires us to evaluate mental health measures, screening tools, and diagnostic practices to ensure racial and ethnic equity in the validity of these measures. Additionally, research that investigates social determinants (e.g., environmental racism, resource allocation inequities, social discrimination) and the mechanisms through which they confer risk will undoubtedly transform our understanding of mental health and disease. It may also lead to improvements in diagnosis, treatment, and clinician-patient rapport, as findings from this research will foster a more holistic and accurate understanding of pathogenesis. With this deeper appreciation of etiology, we will be better able to reduce the burden of mental health disorders among all members of our society.

On an institutional level, universities, federally funded health organizations, and private institutions should work to eliminate the misuse of race and other forms of racial bias in mental health research and practice. As an initial step, institutional leaders must not only reflect the populations being served but also promote practices that allow their organizational members to regularly incorporate antiracism principles into their work and develop systems that leverage resources to promote equity. Institutions have an ethical responsibility to go beyond antiracism, where the focus is not solely on the absence of discrimination and inequities but rather on the presence of deliberate systems and supports that achieve and sustain racial justice through proactive and preventive measures. Examples include ensuring that people from minoritized groups receive equitable compensation, promotion opportunities, and leadership opportunities; ensuring equity in health care access for all patients; and ensuring institutions regularly examine the impact of policies and practices on marginalized groups, applying corrections as needed to achieve equity. Institutions also have an ethical responsibility to commit to racial justice in action by educating all organizational members about the historical racial context that has contributed to inequities, poor access to care, and poor mental health outcomes in the US, as well as by providing instruction on how to create structures that can reallocate power to those most marginalized.

Societally, major structural reforms and systems that support racial justice must be enacted. We must invest in public health infrastructure, ensuring minoritized individuals have equitable access to critical resources, such as desegregated health care systems, well-funded educational systems, fair employment opportunities, safe and well-maintained housing, and technological advances (e.g., reliable high-speed Wi-Fi). In addition, we must examine and correct dysfunctional institutional practices, such as the utilization of police in responses to acute mental health crises and as a regulatory presence in schools. These are just some of the key societal interventions that could begin to address elements of structural racism and other social determinants of health to improve mental health outcomes for all communities.

Research supports what we know intuitively-racism is associated with grave individual, societal, and economic costs. It is imperative that we address all levels of racism in our society, as doing so will substantially improve the mental health of our citizens and our nation. Academia and those associated therein have the opportunity to hold research agencies, organizations, and individuals accountable to protect Black and other minoritized people from the perpetuation of structural racism (e.g., by requiring regular monitoring of equity metrics and outcomes and by linking these outcomes to institutional resource allocations). It is beyond time that these systems and practices transform into those that prioritize, reward, and promote equity.

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Race as a Social Construct in Psychiatry Research and Practice

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In scientific studies, the social construct of race is often conceptualized as a biological variable, supported by the false historical narrative that there are inherent biological differences between racial groups. This scientific error has led to decades of flawed practices in the medical setting, contributed to ongoing health disparities, and reinforced racial biases in diagnosis and treatment rationale.

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1. What I found most unique about the black family is fictive kin care. I found this the most fascinating because they took care of each other like they were their own. For example, family friends will love for the children like they share the same blood.

2. I think the strength would be solidarity and never giving up. They have family to lean on and continue to fight for each other. Some challenges it would be discrimination, racism, and raising kids in a world that has it out for them.

3. This can affect them in a good way. The parents will explain to them and build their self esteem before someone else can tell them differently. They will learn who they are and where they come from and be proud.

4. I think what has impacted them the most is discrimination and incarceration. Black families are denied from job opportunities and other things to stay stable because of the discrimination and racism. Also, a lot of black people get sent for crimes they did not commit leaving a bad stigma.

5. https://www.pewresearch.org/2022/04/14/black-americans-family-history-slavery-and-knowledge-of-black-history/

6. One thing i learned was jumping the broom. I had seen it in movies when a couple would get married, but never knew why or the significance.

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2. Family history, slavery and knowledge of Black history

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Learning about family history can be a challenge for Black Americans. Because of slavery, it is often difficult for them to trace their ancestry prior to

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Maya Banegas

May 14, 2025

Psych 110

Racial Autobiography Outline

I.         Introduction Paragraph: Definition of Race

1. Introduction Statement: Race is a social construct used to categorize people based off physical characteristics.

2. Is race biological or social? Race is formed by society making it a social construct rather than biological.

II.         Body Paragraph 1: Self-Assessments/Scores/Analysis

2. Main point 1: Multidimensions of Ethnic Self Identification

1. Supporting Detail: For Behavioral Measures one of the categories I chose was language. It is a big part of who I am and my culture.

3. Main point 2: Multi-Group Ethnic Identity Measure

1. Supporting Detail: My score for this self-assessment was 40.

III.         Body Paragraph 2: Summary of Stages of Racial Identity Development & Life Examples

3. Main point 1: Immersion/Emersion

1. Supporting Detail: I was always trying to prove that I was Hispanic/Latino but have now learned that I do not need to prove anything.

4. Main point 2: Internalization Stage

1. Supporting Detail: I am proud of who I am and comfortable in my skin.

IV.         Body Paragraph 3: Post Racial Society Critical Analysis

4. Main point 1: We are not in a post racial society.

1. Supporting Detail: There had to be a law implemented to keep discrimination happening at jobs.

5. Main point 2: Our President is attacking people based on race.

1. Supporting Detail: He is challenging birth right citizenship as well as deporting citizens.

V.         Conclusion Paragraph

5. Summary statement: Race can be a superpower if you are comfortable and confident with who you are. Do not let someone else use your superpower against you.

6. Closing Statement: Race is still used to determines someone’s worth and value today.

Resource: https://www.embracerace.org/resources/recording-and-resources-understanding-racial-ethnic-identity-development

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Theme 1.

1. I think biases and stereotypes is a huge factor in why there are low numbers. Some people are unknowingly bias and this can lead to who you think can and can't succeed in STEM.

2. Teachers play an important role. They should make the students feel confident and supported in school to help them reach their goals. Like the speaker had said, her geometry teacher made her feel trusted and smart.

3. It affects the negatively. Young students are the most vulnerable, because during this time they are trying to find out who they are and how to be comfortable in their own skin. They need a lot of reassurance from adults such as, parents, teachers, coaches, and whoever plays a major role in their lives. Teachers see them for a large part of their day so they need to feel valued, supported, and that they really are smart.

4. This contributes to imposter syndrome because they start to self doubt. In the article, the girl was stereotyped and believed to be testing for the special education simply by looking at her. She was in fact there to test for the ACT.

5. People need to feel represented and supportive. Stereotypes really are harmful whether joking or not. They need to feel as though they are enough and they can do it.

6. One thing that I learned is how much representation does matter. The speaker was extremely smart and proved it, but still felt she like she wasn't enough because she was all alone in Harvard.

Theme 2

1. Imposter syndrome is a psychological experience which makes you self doubt and believe that your achievements are deserved.

2. It affects them negatively. It makes them believe that will not do or say anything right. They start to question why they are even there and that they will not make it in life.

3. It brings down their self esteem and adds on to stress they are already facing. You start to believe you are not as capable as other people at your workplace.

4. Women are holding out on opportunities and reaching greater areas because of stereotypes.

5. People need to be more welcoming and let go of the stereotypes. They have worked hard and are working alongside you because they are capable and qualified. There also needs to be more representation in all fields for a more diverse workplace.

6. What stood out to me is that people will doubt and think they can not do the job when they were hired and promoted even because they do their job well. It baffles me how people just don't see the whole picture.

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6.6 Two Page Racial Autobiography Paper Feedback Discussion

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6.6 Two Page Racial Autobiography Paper Feedback Discussion

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7.6 Intersectionality, Bias and Microaggressions

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7.6 Intersectionality, Bias and Microaggressions

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1. When experiencing this, it can cause depression, anxiety, and loneliness. When this happens people may start to become anxious in social settings and feel out of place.

2. It can perpetrate harmful stereotypes. Microaggressions can spread false information increasing the list of stereotypes already made. In doing so, the endless cycle of stereotyping people will never end.

3. It brings not only race as an issue but also gender and class. Black women will get discriminated against for being black but now it will also include sexism as well. This can affect jobs, school, and everyday life.

4. It affects someones sense of self because people might start to believe what is said. It can degrade someone and lower their self esteem. If not confident with yourself and culture you can start to feel ashamed due to racial micro aggressions or bias.

5. https://www.nea.org/resource-library/implicit-bias-microaggressions-and-stereotypes-resources

This resource informs you of different micro aggressions as well as stereotypes. It is important to know these things to prevent ones self from doing it or to protect other people while they face it.

6. A strategy to address it can just be communication. If the person is not aware what they are doing, it is important to educate them on why it was wrong and how it made you feel. After learning what was said can be a microaggression, they will be more mindful of what and how they say things.

7. What stood out to me is how people seek comfort when facing a microaggression. For example, people of color looking at each other when something wrong was said.

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Asian Americans Advancing Justice Southern California

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Legal Center and Advocacy Group |Asian Americans Advancing Justice Southern California

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Asian Americans Asian Americans Advancing Justice Southern California provides legal services and advocating for change in local, state, and national policy.

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1. The strengths of being apart of a black community is the sense of belonging. You are surrounded with people who make you feel supported and are resilient. Over time they have manifested more psychological sense of community.

2. One issue or weakness in black neighborhoods is the education systems. People do not provide the same tools necessary to help them succeed. A solution to this would be to start pushing for better education and equal treatment.

3. Three ways are, prioritizing community well being, investing in black owed businesses, and civic engagement.

4. Three ways is internal division, reinforcing inequalities, and gentrification.

5. https://pmc.ncbi.nlm.nih.gov/articles/PMC6927402/

6. One thing that stood out was that the psychological sense of community has increased over time rather than the physical sense.

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Cultural Values and Behavior Among African American and European American Children

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This study explores the relationships of individualistic (e.g., competition, material success) and collectivistic values (e.g., familism, respect) with risky and prosocial behavior among African-American and European-American youth. While previous…

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9.6 Thesis, Direction and Resources for Critical Analysis Project

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9.6 Thesis, Direction and Resources for Critical Analysis Project

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1. What surprised me most is the more successful the woman is, the less likely they are to be married. Black men are more likely to date outside their race while black women are more likely to date outside their education.

2. It affects the psyche negatively. It damages their self esteem and have to fight stereotypes due to these women getting portrayed as objects. Some might believe there is nothing more for them than to simply be property.

3. Some factors are that black women are less likely to marry out of their race and there are not many highly educated black men. Economic struggles are also a factor.

4. There is a stigma of LGBTQ+ because black communities are very strong on religion. They also have very traditional gender roles.

5. https://www.psychiatry.org/news-room/apa-blogs/barriers-for-lgbtq-people-of-color

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Understanding the Barriers to Coming Out for LGBTQ+ People of Color

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Even as societal attitudes and laws have shifted, many queer people from minority communities still stay in the closet. Understanding the reasons why can help health professionals better serve this group, and everyone to better understand the challenges this community faces.

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Theme one: Code Switching

1. Code switching is changing the way someone expresses themselves. This affects their success in life because they have to fit a certain image and talk a certain way in order to get beyond.

2. It threatens diversity because people will try to "fit in" and lose their culture and who they are. They will change themselves to fit the picture of others.

3. The need to be someone else and constantly change can lead to psychological strain. It can cause stress and anxiety.

4. https://www.talkspace.com/blog/code-switching-what-is/

This resource explains what it is and the types of code switching. It goes more into depth of how negative it can be.

5. There needs to be a deeper understanding of why it is done. People want to be accepted and feel as though they have to change themselves to achieve that.

Theme 2: The language of African American Vernacular English

1. The difference is AAVE is "broken english". It has grammatical and pronunciation features that make it different.

2. Traditionally it is seen as wrong. They believe it to be the wrong way to speak or write. The school in the video was welcoming it.

3. It was help them feel more comfortable and realize that they too can speak both. They will have the representation that they need.

4. https://www.hakimcrampton.com/post/a-fresh-look-at-ebonics-how-are-contemporary-educators-dealing-with-black-vernacular-english-in-tod

This resource goes more into depth about AAVE.

5. I think people should start to appreciate the language and learn where it came from and started. It is part of history and apart of their culture.

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The way you communicate with people intersects with your identity in many ways. In daily interactions within formal and social settings, you may find that you voluntarily or involuntarily alternate between two or more languages, dialects, or varieties of language, depending on the environment you find yourself in. Perhaps you also tone down or amplify your accent based on who you are talking to, or you use certain words only when you are around a specific group of people. This is known as "code-switching," a concept that plays a big role in communication, especially among minority groups.

What is Code-Switching?

Code-Switching was originally a term coined by linguists to explain the act of mixing languages while in conversation. However, a broader meaning of the term has now developed to include the idea of self-expression in cultural or, sometimes, racial contexts. It indicates a habit of changing the way you speak, dress or engage with others, in order to fit in with the predominant cultural group in a particular place.

Code-switching has become a way of life for so many people, who have come to terms with the fact that it is the only way to gain acceptance in certain environments. Stephanie Heath, a Career Coach at Soul Work and Six-Figures, described code-switching as something she had to incorporate into her experience in corporate America. "As a Jamaican-American woman who worked in a mostly non-diverse environment for a long time, it became a necessity," she said. "I've had to perform and code-switch my entire career."

Code-switching is a posture that many people have to keep up for their entire lives, and this can take a toll on their health and wellbeing. The immense toll it can take on one's mental health is worth discussing.

Code-Switching as a Bilingual

For many individuals who speak English as a second language, code-switching is a tool for communicating effectively in a monolinguist society. People who live in a predominantly English-speaking country like the United States and grew up speaking a different language may be quite familiar with this concept. Nick Galov, Business owner and Co-founder of Review 42, deals with the daily pressure of switching between two languages - English, which he uses to communicate with his clients, and Bulgarian, which he speaks at home.

"Having to quickly code-switch doesn't often go so fast," he said. "Sometimes I forget to change, and I might address my family in English, which we make jokes about." However, having code-switching "glitches" in the work environment gets frustrating for him. "Sometimes I can't switch instantly, or I could have words at the tip of my tongue but can't locate them at a moment's notice," he said.

Even though studies have shown that bilinguals have a communicative edge over monolinguals, bilingual who code-switch do not have it easy. At the workplace, it could involve ditching your foreign accent in the hope of more work opportunities. At school, it might mean trying to sound more "American" to fit in with peers and other students. Shihlin, a Software Engineer at a private tech startup, finds herself code-switching at work tobe taken more seriously among her coworkers.

"As an Asian-American woman working in a field where a majority of the leadership positions are held by men, I have to show more awareness in being grammatically correct and making the right word choices, to avoid miscommunication and misunderstanding between me and my colleagues," she said. This causes her a lot of anxiety while she prepares for meetings and other work activities.

No matter the situation, it is clear that a person who must present different versions of themselves in different environments will be faced with feelings of stress, confusion, frustration, or even inferiority. These feelings can affect that person's mental health.

Code-Switching as a Person of Color

Code-switching plays a big role in communication in American society, and the cost of this practice mostly affects people of color. Studies have shown that a lot of Black and Hispanic Americans feel the need to change the way they express themselves around people of other ethnicities, especially around white Americans. Not only is code-switching a way of life for most of these people, it has also become a means of survival.

Navigating an environment dominated by white friends or colleagues causes many people of color to code-switch, because their chances of thriving in such an environment is dependent on how well they are able to fit in. For example, the use of African American Vernacular English (AAVE) by Black Americans is, often wrongly, seen as unprofessional or inappropriate, limiting their opportunities in the areas of work and study. Because of this prejudicial treatment, there is an immense amount of pressure on Black people to adopt a more "acceptable" mode of speech in formal spaces, to help them gain employment or admission into reputable institutions. This can undoubtedly cause a lot of mental and emotional stress for people who feel inclined to conform, modify, or limit their speech in order to succeed.

Chandra Arthur, founder of the Friendish app, explained the impacts of code-switching in her TEDx talk. "The cost of code-switching is immense as it causes minorities to spend time worrying about cultural compatibility, rather than dwelling on things that do matter," she said. For people of color, this can often be frustrating, and it can have a negative effect on their mental health and wellbeing.

Code-Switching as it Relates to Behavior

Not only does code-switching mean modifying your speech to adapt to sociocultural norms, it now commonly means changing your behavior to suit the setting and circumstances. It could involve toning down a part of your personality or hiding an aspect of yourself to fit in. For people from minority groups, it could mean adopting an introverted personality in formal situations to keep from drawing too much attention to themselves. While this may not always be the same thing as code-switching, it can be seen as an offshoot of the code-switching process.

Kenny Screven, an LGBTQ+ advocate, code-switches to avoid being judged as not being "masculine" enough. As a gay black man who wears makeup, he has anxiety about doing ordinary things like going to the barbershop or even visiting his family during the holidays, where his lifestyle is not accepted. Changing his personality became a form of code-switching for him; a way to protect himself.

"My anxiety increases when I'm not in an area I'm familiar with," he said. Becausehe lives in a small town, where people who resemble him are rare, he has to constantly stay on guard. "More recently, I stopped going out to nightclubs as much because I'm afraid to get attacked or assaulted for being the guy who wears makeup," he said. "It's something I've struggled with my entire life, and it tends to make one feel a bit alienated from society."

Addressing the Problem

The act of code-switching is not necessarily a negative thing. However, a closer look at its complexities shows that, when people feel obligated to code-switch in order to thrive in a particular environment, it can have serious consequences. For Shihlin, an ideal working atmosphere is one where she is not affected by the fear of not being respected for her contributions and experience, because of her pattern of speech. "A normal environment is one where no one ever feels the need to tone down any particular part of their speech in order to perform their responsibilities to high standards," she said.

As the world becomes more inclusive, diverse, and accepting, it is also important to provide a conducive environment where people can exist as their true selves - regardless of race, culture, or ethnicity - and create safe spaces where people are respected for their personal abilities. No one should fear being judged based on the way they communicate.

Talkspace articles are written by experienced mental health-wellness contributors; they are grounded in scientific research and evidence-based practices. Articles are extensively reviewed by our team of clinical experts (therapists and psychiatrists of various specialties) to ensure content is accurate and on par with current industry standards.

Our goal at Talkspace is to provide the most up-to-date, valuable, and objective information on mental health-related topics in order to help readers make informed decisions.

Articles contain trusted third-party sources that are either directly linked to in the text or listed at the bottom to take readers directly to the source.

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The Mental Health Costs of Code-Switching - Talkspace

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The way you communicate with people intersects with your identity in many ways. In daily interactions within formal and social settings, you may find that you voluntarily or involuntarily alternate between two or more languages, dialects, or varieties of language, depending on the environment you find yourself in.

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Theme one: Current Research on Religion in the African American Community

1. African Americans are more likely than any other group to believe in God. They are more likely to go to services weekly as well. They state religion is very important and pray regularly.

2. They state that religion is very important to them and pray regularly. Millennials feel a deep spiritual peace. They are also more likely to read scriptures outside of the service.

3. It promotes overall good mental health. It helps deal with depression and things of that matter.

4. https://www.pewresearch.org/religion/2021/02/16/faith-among-black-americans/

This shows the correlation of African Americans and religion.

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Pew Research Center's Religion & Public Life Project

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This study is Pew Research Center's most comprehensive, in-depth attempt to explore religion among Black Americans. Its centerpiece is a nationally representative survey of 8,660 Black adults (ages 18 and older), featuring questions designed to examine Black religious experiences. The sample consists of a wide range of adults who identify as Black or African American, including some who identify as both Black and Hispanic or Black and another race (such as Black and White, or Black and Asian).

The Center recruited such a large sample in order to examine the diversity of the U.S. Black population. For example, this study is able to compare the views and experiences of U.S.-born Black Americans with those of Black immigrants from Africa or the Caribbean. It can compare Black adults born before 1946 (the Silent Generation and a very small number of those in the Greatest Generation) with Black adults born after 1996 (Generation Z). Because the study focuses on faith among Black Americans, it also examines Protestants who attend Black churches, Protestants who attend churches where the majority is White or another race, Protestants who attend multiracial churches, Black Catholics, Black members of non-Christian faiths and Black Americans who are religiously unaffiliated (identifying as atheist, agnostic or nothing in particular).

The survey was complemented by guided, small-group discussions with Black adults of various ages and religious leanings, as well as in-depth interviews with Black clergy. These gave Black religious leaders, lay believers and nonbelievers an opportunity to describe their religious experiences in their own words.

Survey respondents were recruited from four nationally representative sources: Pew Research Center's American Trends Panel (conducted online), NORC's AmeriSpeak panel (conducted online or by phone), Ipsos' KnowledgePanel (conducted online) and a national cross-sectional survey by Pew Research Center (conducted online and by mail). Responses were collected from Nov. 19, 2019, to June 3, 2020, but most respondents completed the survey between Jan. 21 and Feb. 10, 2020. For more information, see the Methodology for this report. The exact wording of the questions used in this analysis can be found here.

Throughout this report, Black churches and congregations are defined as those where the respondent said that all or most attendees are Black and the senior religious leaders are Black. White or other race churches and congregations are those where the respondent said that either most attendees are White; most attendees are Asian; most attendees are Hispanic; or most attendees are of a different (non-Black) race, and the same is true of the senior religious leaders. Multiracial churches and congregations are primarily those where the respondent said that no single race comprises a majority of attendees - regardless of the race of the religious leaders. This category also includes smaller numbers of congregations where the majority of the congregation is not Black, but senior religious leaders are Black; congregations where all or most attendees are Black but the senior religious leaders are not; and congregations where the senior religious leadership is multiracial - regardless of the race of the congregation.

In tables and text that analyze survey findings on Black Protestants and Catholics, the category " other Christians" refers to a group composed mostly of Jehovah's Witnesses, but also Orthodox Christians, members of the Church of Jesus Christ of Latter-day Saints (also known as Mormons) and other groups. In the category " non-Christian faiths " the largest single group is Muslims, but this category also includes people who describe themselves as "spiritual but not religious," as well as Buddhists, Jews and adherents of traditional African or Afro-Caribbean religions.

In tables and text that analyze survey findings by generation, members of Generation Z are respondents who were born from 1997 to 2002, Millennials from 1981 to 1996, members of Generation X from 1965 to 1980, Baby Boomers from 1946 to 1964, and members of the Silent Generation prior to 1946 (in this report, the Silent Generation category includes a very small number of those in the Greatest Generation, who were born before 1928).

" Black, non-Hispanic" respondents are those who identify as single-race Black and say they have no Hispanic background. " Black Hispanic" respondents are those who are Black and also say they do have Hispanic background. " Multiracial " respondents are those who indicate two or more racial backgrounds (one of which is Black) and say they have no Hispanic background.

" African-born" respondents were born in sub-Saharan Africa, while " Caribbean-born" respondents were born in the West Indies. In this report, " immigrant " refers to people who were not U.S. citizens at birth - in other words, those born outside the U.S., Puerto Rico or other U.S. territories to parents who were not U.S. citizens.

Religion has long figured prominently in the lives of Black Americans. When segregation was the law of the land, Black churches - and later, mosques - served as important spaces for racial solidarity and civic activity, and faith more broadly was a source of hope and inspiration.

Today, most Black adults say they rely on prayer to help make major decisions, and view opposing racism as essential to their religious faith. Also, predominantly Black places of worship continue to have a considerable presence in the lives of Black Americans: Fully 60% of Black adults who go to religious services - whether every week or just a few times a year - say they attend religious services at places where most or all of the other attendees, as well as the senior clergy, are also Black, according to a major new Pew Research Center survey. Far fewer attend houses of worship with multiracial congregations or clergy (25%) or congregations that are predominantly White or another race or ethnicity, such as Hispanic or Asian (13%).

But these patterns appear to be changing. The survey of more than 8,600 Black adults (ages 18 and older) across the United States finds that young Black adults are less religious and less engaged in Black churches than older generations. Black Millennials and members of Generation Z are less likely to rely on prayer, less likely to have grown up in Black churches and less likely to say religion is an important part of their lives. Fewer attend religious services, and those who do attend are less likely to go to a predominantly Black congregation.

For example, roughly half of Black Gen Zers (born after 1996) who go to a church or other house of worship say their congregation and clergy are mostly Black, compared with two-thirds of Black Baby Boomers and members of the Silent Generation who say this.

Protestantism has long dominated the Black American religious landscape, and still does. The survey shows that two-thirds of Black Americans (66%) are Protestant, 6% are Catholic and 3% identify with other Christian faiths - mostly Jehovah's Witnesses. Another 3% belong to non-Christian faiths, the most common of which is Islam.

But about one-in-five Black Americans (21%) are not affiliated with any religion and instead identify as atheist, agnostic or "nothing in particular," and this phenomenon is increasing by generation: Roughly three-in-ten Black Gen Zers (28%) and Millennials (33%) in the survey are religiously unaffiliated, compared with just 11% of Baby Boomers and 5% of those in the Silent Generation.

Defining Black congregations

To help analyze survey data, this report splits Black Protestants' places of worship into three categories - (1) Black congregations, (2) White or other race congregations, (3) and multiracial congregations - based on the respondent's description of their congregation and clergy.

Black churches/congregations are those where the respondent said that all or most attendees are Black and the senior religious leaders are Black.

White or other race churches/
congregations are those where the respondent said that most attendees are White, most are Asian, most are Hispanic, or most are of a different (non-Black) race, AND most or all of the senior religious leaders are of the same non-Black race as one another.

Multiracial churches/congregations are primarily those where the respondent said that no single race makes up a majority of attendees. This category also includes smaller numbers of congregations where the majority of the congregation is not Black, but senior religious leader(s) are Black; congregations where all or most attendees are Black, but the senior religious leaders are not; and congregations where the senior religious leadership is multiracial, regardless of the race of the congregation.

Black Protestants are particularly likely to worship in congregations where most of the laypeople, as well as the senior clergy, are Black. Two-thirds of Black Protestant churchgoers say they attend this type of congregation. By contrast, majorities of Black Catholics and Black adults of other faiths say their congregations and religious leaders are multiracial, mostly White, or mostly some other race.

Nonetheless, there is a broad consensus among Black Americans of all faiths that predominantly Black churches have played a valuable role in the struggle for racial equality in U.S. society. Roughly three-quarters of Black adults surveyed say that Black churches have played at least "some" role in helping Black people move toward equality - including three-in-ten who say Black churches have done "a great deal" - while roughly half say Black Muslim organizations such as the Nation of Islam have contributed at least some in this regard. (See Chapter 10 for more on the history of religion among Black Americans.)

That so many Black Americans worship in Black congregations - and value their role in seeking equal rights - suggests that preserving them as institutions might be a high priority. Yet just a third (33%) of Black Americans say historically Black congregations should preserve their traditional racial character. Most (61%) say these congregations should become more racially and ethnically diverse. This is the majority view among those who attend Black congregations as well as those who do not.

Furthermore, while 34% of Black Americans say that if they were looking for a new congregation, it would be "very important" or "somewhat important" for them to find a congregation where most other attendees shared their race, most (63%) say this would be either "not too important" or "not at all important." Higher priorities include finding a congregation that is welcoming and that offers inspiring sermons. Again, this pattern holds regardless of whether respondents currently attend a predominantly Black congregation.

If most Black Americans say these congregations should diversify and the race of other attendees isn't a top priority to them, what leads so many Black Americans to attend predominantly Black congregations? The survey indicates that Black congregations are distinctive in numerous ways beyond just their racial makeup. Sermons are a prime example: Black Americans who attend Black Protestant churches are more likely to say they hear messages from the pulpit about certain topics - such as race relations and criminal justice reform - than are Black Protestant churchgoers who attend multiracial, White or other race churches. And Protestants who go to Black congregations are somewhat less likely than others to have recently heard a sermon, lecture or group discussion about abortion.

Black churches also have a distinctive atmosphere for worship. Protestants who worship in predominantly Black churches are more likely than other Black Americans to say their congregations feature worshippers calling out "amen" or other expressions of approval (known as call and response). They also are more likely to feature expressive forms of worship that include spontaneous dancing, jumping or shouting. And 54% of Protestants in Black congregations say the services they attend feature speaking or praying in tongues, a practice associated with Pentecostalism.

Taken as a whole, about half of congregants who attend Black Protestant churches report that the services they attend feature all three of these practices at least some of the time, compared with roughly a quarter of Black Protestants in White or other race churches and 18% of Black Catholics.

These are among the key findings of a survey of 8,660 Black Americans, conducted from Nov. 19, 2019, to June 3, 2020. While previous surveys on religion have included small or medium-sized samples of Black respondents, and other surveys with larger samples have asked questions about religion as one of multiple topics, this is Pew Research Center's first large-scale, nationally representative survey designed primarily to help understand distinctive aspects of Black Americans' religious lives. For more information on how the survey was conducted, see the Methodology.

This report is the first in a series of Pew Research Center studies focused on describing the rich diversity of Black people in the United States. The survey included not only single-race, U.S.-born African Americans but also Americans who identify as both Black and some other race or Black and Hispanic, as well as Black people who live in the U.S. but were born outside of the country.

Many findings in this survey highlight the distinctiveness and vibrancy of Black congregations, demonstrating that the collective entity some observers and participants have called "the Black Church" is alive and well in America today. But there also are some signs of decline, such as the gap between the shares of young adults and those in older generations who attend predominantly Black houses of worship. This gap is a result of two distinct pressures.

First, younger Black Americans, like younger Americans more generally, are less religious than their elders. Black Millennials (49%) and members of Generation Z (46%) are about twice as likely as Black members of the Silent Generation (26%) to say they seldom or never attend religious services at any congregation. Second, among Black adults who do attend religious services, the youngest adults are less apt to attend Black congregations than the oldest adults. Among Black Gen Zers who attend religious services at least yearly, about half (just 29% of all Black Gen Zers) say they go to a Black congregation. By contrast, among Black Americans in the Silent Generation who attend religious services at least yearly, fully two-thirds (which is 49% of all Black Americans in the Silent Generation cohort) attend Black congregations.

Additional findings suggest that, over the long term, fewer Black families with children have been going to Black congregations. While nearly nine-in-ten members of the Silent Generation (87%) say they grew up attending religious services at a congregation where most or all other attendees were Black, a smaller majority (64%) of Generation Zers say this about their more recent childhoods.

When asked to assess the influence of predominantly Black churches in their communities, nearly half of Black adults (47%) say that Black churches are less influential today than they were 50 years ago. Three-in-ten say they are more influential, and about one-in-five say they hold the same amount of sway.

Black Americans more religious than the U.S. public overall

In conjunction with this study, researchers also asked some of the same questions of 4,574 Americans who do not identify as Black or African American. The findings show that Black Americans are more religious than the American public as a whole on a range of measures of religious commitment. For example, they are more likely to say they believe in God or a higher power, and to report that they attend religious services regularly. They also are more likely to say religion is "very important" in their lives and to be affiliated with a religion, and to believe prayers to ancestors have protective power and that evil spirits can cause problems in a person's life.

In addition to being more religious by these measures, Black Americans' views on other topics involving religion or religious groups differ from those of the general population. For example, Black Americans are more likely than Americans overall to view opposition to racism as essential to what it means to be a religiously faithful or moral person. And they are more likely to credit predominantly Black Muslim organizations, such as the Nation of Islam, with a role in helping Black people move toward equality in the U.S.

Black Protestants stand out from Protestant churchgoers of other races. Black Protestants are far more likely to go to a church that has highly expressive worship that includes shouts of "amen," spontaneous dancing, jumping or shouting, and speaking in tongues. And they are less likely than U.S. Protestants overall to report hearing sermons on abortion, but more likely to say they have heard sermons about race relations or criminal justice reform. (While most respondents participated in this survey in early 2020 - prior to May 2020, when a Minneapolis police officer killed George Floyd, sparking nationwide protests - more recent polling from July 2020 supports this pattern, showing Black Protestants to be far more likely than Protestants of other races to have recently heard sermons supporting the Black Lives Matter movement.)

Religiously unaffiliated Black Americans

As is true within the general U.S. population, the share of people who do not identify with any religion is increasing among Black Americans. This religiously unaffiliated category (sometimes called religious "nones") includes those who describe themselves as atheist, agnostic or "nothing in particular" when asked about their religion. Most Black religious "nones" (18% of all Black Americans) identify as "nothing in particular," while far fewer describe themselves as agnostic (2%) or atheist (1%). The survey finds, furthermore, that many Black religious "nones" hold favorable views about Black churches and show numerous signs of religious or spiritual engagement.

For example, most religiously unaffiliated Black Americans credit Black churches with helping Black Americans move toward equality. This is true whether they identify as "nothing in particular" (66%) or as atheist or agnostic (also 66%). (Because so few Black Americans identify as atheist or agnostic, the two groups are analyzed together throughout this report.) In addition, most Black religious "nones" say that predominantly Black churches today have either "too little" influence in Black communities (35%) or "about the right amount of influence" (43%). Just one-in-five (19%) say predominantly Black churches have "too much influence."

Several religious beliefs and practices are common among Black "nones." Nine-in-ten say they believe in God or a higher power. Just over half report praying at least a few times a month. Similar shares say they rely, at least a little, on prayer and personal religious reflection when making major life decisions, and that they believe evil spirits can cause problems in a person's life. About half of Black religious "nones" say they believe in reincarnation, and a little more than a third believe that prayers to ancestors can protect them from harm.

By these measures, religiously unaffiliated Black adults are a lot more religious than unaffiliated adults in the U.S. general population. For example, they are more likely to believe in God or a higher power (90% vs. 72%) and to pray at least a few times a month (54% vs. 28%).

Religion and gender

Women make up a small minority of religious leaders at Black Protestant churches, according to the National Congregations Study, and media accounts suggest it is uncommon for women to be named to lead large Black congregations. Yet the survey shows that the vast majority of Black Americans - women (87%) and men (84%) alike - say women should be allowed to serve as senior religious leaders of congregations.

Black Americans also typically express egalitarian views on other issues relating to gender norms. For example, among men and women and across religious groups, most say they believe that mothers and fathers who live in the same household should share parenting and financial responsibilities equally.

In addition, Black Americans are almost as likely to say opposing sexism is essential to what it means to be a faithful or moral person as they are to say the same about opposing racism - and, again, men and women are equally likely to report this view.

However, other survey findings suggest that the culture at many Black congregations emphasizes men's experiences and leadership more than women's. Black Americans are much less likely to have heard sermons, lectures or group discussions about discrimination against women or sexism than about racial discrimination. In addition, Black Americans are much more likely to say their congregations strongly emphasize that men should financially support their families and be role models in Black communities than to say that they emphasize these same things for women. In fact, of the four roles asked about in the survey, the only one that congregants say is emphasized equally for men and women is being an involved parent.

Though gender is a key focus throughout the report, Chapter 7 looks specifically at the intersection of gender, sexuality and religion in more detail.

African and Caribbean immigrants

One advantage of surveying a large sample of Black Americans is that it is possible to analyze the views of the growing share of Black Americans who are immigrants to the U.S.

Immigrants from sub-Saharan Africa make up 5% of the Black adult population, and they stand out in the survey findings in numerous ways for more active religious behavior and more conservative social views.

Only 6% of all African immigrants are religiously unaffiliated, far fewer than the share of U.S.-born Black adults who are unaffiliated. African immigrants are less likely to identify as Protestant than are U.S.-born Black Americans, and more likely to identify as Catholic or with non-Christian faiths. African immigrants also are more likely than other Black Americans to say religion is very important in their lives, to report that they attend religious services regularly, and to believe that people of faith have a religious duty to convert nonbelievers.

African immigrants also tend to be more supportive of traditional gender norms than U.S.-born Black adults. For example, they are more likely to say that mothers should be most responsible for taking care of children and that fathers should be most responsible for providing for the family financially - though the prevailing opinion is still that both parents should be equally responsible for both functions. In addition, African immigrants are much less likely to say that homosexuality should be accepted by society.

A slightly larger share of Black adults were born in the Caribbean (6%). Like African immigrants, Black Americans from the Caribbean are more likely than U.S.-born Black adults to be Catholic, though they are about equally likely to be religiously unaffiliated. Caribbean-born immigrants are no more likely than U.S.-born Black Americans to say religion is very important in their lives or that they have a religious duty to convert nonbelievers.

Political partisanship

Most Black Americans (84%) are Democrats or lean toward the Democratic Party. Just 10% say they are Republicans or lean Republican.

In several ways, the religious lives of Black Democrats and Republicans are similar. They are about equally likely to identify with a religion, to say religion is very important in their lives and to attend religious services at least once a week. The lack of a partisan divide on these measures of religious commitment contrasts with patterns seen among White Americans; White Republicans tend to be more religious than White Democrats.

Though they have similar rates of attendance, there are some differences between Black Democrats and Black Republicans when it comes to the types of congregations they attend. Fewer than half of Black Republicans who attend religious services go to a Black congregation (43%), compared with 64% of Black Democrats. And Black Republicans are more likely than Black Democrats to go to congregations where most attendees are White (22% vs. 11%).

In addition, as in the larger public, Black Democrats are more likely than Republicans to say that abortion should be legal and that homosexuality should be accepted by society. And among Black Christians, Democrats are more likely than Republicans to say that opposing racism and racial discrimination, as well as opposing sexism or discrimination against women, are essential to what being a Christian means to them - though more than half of all Black Christians in both parties say these are essential.

Roadmap to the report

The remainder of this report explores these and other findings in more detail. Chapter 1 describes six focus group discussions and highlights some of the reasons Black Americans value Black congregations. Chapter 2 examines the religious affiliations of Black Americans in more detail. Chapter 3 explores some common Christian beliefs as well as other forms of spirituality among Black Americans. Chapter 4 reports how frequently Black Americans engage in a range of religious and spiritual practices. Chapter 5 examines the impact that religion and church have on the everyday lives of Black Americans. Chapter 6 looks more closely at the role race plays in the religious experience of Black Americans. Chapter 7 analyzes views on gender and sexuality and how they are related to religion. Chapter 8 describes how political preferences, engagement and views on social and political topics vary across different types of congregations. Chapter 9 summarizes interviews with 30 Black Protestant clergy from around the country about issues affecting their churches. And Chapter 10 offers a brief overview of Black religious history in the United States, with an emphasis on efforts by religious groups to deal with racism and its effects.

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This study is Pew Research Center's most comprehensive, in-depth attempt to explore religion among Black Americans. Its centerpiece is a nationally representative survey of 8,660 Black adults (ages 18 and older), featuring questions designed to examine Black religious experiences.

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1. There are differences between and African American women and white women getting different pain meds because of the long hold belief that black people "feel less pain". They are not taking seriously.

2. African American mothers and children are more at risk in childbirth than white women because they do not get the same healthcare. They are ignored and not taken seriously. They have to fight to be heard.

3. Something that can be implemented is believing when they say something is wrong or something hurts. They need to be treated the same as the white mothers giving birth.

4. https://pmc.ncbi.nlm.nih.gov/articles/PMC4698019/

This resource explains the negative effects of the discrimination black women receive.

5. One thing I learned is how dangerous stereotypes and racism really is. They are playing with peoples lives simply because of the color of their skin.

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Black-White Differences in Severe Maternal Morbidity and Site of Care

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For every maternal death, over 100 women experience severe maternal morbidity, a life threatening diagnosis or undergo a life-saving procedure, during their delivery hospitalization. Similar to racial/ethnic disparities in maternal mortality, black…

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13.5 Film Analysis Outline Template (Insert Name Here)

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Theme One

1. African American men are live 7 years less than other racial groups. African American adults are 50% more likely to die prematurely from heart disease or a stroke.

2. Health care is either too expensive or just not as good. They eat what they know, even if it is unhealthy because they do not know anything better. They are uneducated on what is good for them and what isn't. This leads to families having diabetes or heart disease.

3. Everyone has to get involved to solve these problems. People need to share the knowledge to help each other out. Healthcare should be affordable to everyone. People should be able to know what foods are good and which cause a higher chance of disease or diabetes.

4. https://tcf.org/content/report/racism-inequality-health-care-african-americans/

5. One thing i found interesting is that some people have to choose between eating or buying their medicine. People should not have to starve in order to have the medicine needed to keep them alive.

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What You Should Know

Of the more than 20 million people who have gained coverage under the ACA, 2.8 million of them are African-American-and yet, this population is still more likely to be uninsured than white Americans.

The average American family spends around 11 percent of household income on health care premiums and out-of-pocket costs, but that amount approaches 20 percent for African American households.

Because African Americans tend to be poorer than other demographic groups on average, public health insurance programs such as Medicaid are vital to ensure affordable health care and healthier outcomes-yet fourteen states have resisted Medicaid expansion, mostly in the South.

Even with improved access to medical care under the ACA, the disparities in health outcomes between African Americans and whites are stark. African-American women are three times more likely to die of pregnancy-related causes than white women, for example, and the African-American infant mortality rate is twice the rate for white infants.

Certain social determinants of health, such as poverty, income inequality, wealth inequality, food insecurity, and the lack of safe, affordable housing have important implications for health risk and the ability to attain health insurance coverage for African Americans.

Another important social factor leading to poor health outcomes and economic disadvantage among African Americans is racism, because not only is it a stressor, leading to wear and tear on the body, but it also impacts who gets what in America, particularly health care.

The nation is at a moment when more progressive health care reform might be possible; any health care reform needs to take these inequities into account in recreating a health care system that will serve all Americans.

The American health care system is beset with inequalities that have a disproportionate impact on people of color and other marginalized groups. These inequalities contribute to gaps in health insurance coverage, uneven access to services, and poorer health outcomes among certain populations. African Americans bear the brunt of these health care challenges.

African Americans comprise 13.4 percent of the U.S. population. Over the span of several decades, namely since the Civil Rights Acts of 1964 and 1968, they have been able to make notable strides in American society. According to the Economic Policy Institute, educational attainment has greatly increased, with more than 90 percent of African Americans aged 25-29 having graduated from high school. College graduation rates have also improved among African Americans. When it comes to income, gains have been made as well, but African Americans are still paid less than white Americans for the same jobs and lag significantly behind when it comes to accumulating wealth. And as for home ownership, just over 40 percent of African Americans own a home-a rate virtually unchanged since 1968.

African Americans are also living longer, and the majority of them have some form of health insurance coverage. However, African Americans still experience illness and infirmity at extremely high rates and have lower life expectancy than other racial and ethnic groups. They are also one of the most economically disadvantaged demographics in this country.

This report will examine the state of health care coverage for African Americans and shed a light on important social factors that uniquely impact their health outcomes. In an effort to draw implications from leading health care reform plans, recommendations are made for the way forward in ensuring that the physiological and social impacts of racism are not omitted in efforts to secure truly universal health care coverage in America. African Americans are one of the most politically engaged demographics in this country. Addressing their unique challenges and perspectives, including the pervasive impacts of racism, must be included in health reform efforts.

Coverage Gains-and Obstacles-for African Americans Under the ACA

The Affordable Care Act (ACA) has helped to ensure health care coverage for millions of Americans. The uninsured rate among African Americans declined after the law was implemented: of the more than 20 million people who have gained coverage under the ACA, 2.8 million of them are African-American. Yet, this population is still more likely to be uninsured than white Americans: as of 2018, the uninsured rate among African Americans was 9.7 percent, while it was just 5.4 percent among whites. African Americans were more likely to be covered through employer-sponsored or private health insurance: 55 percent of African Americans used private health insurance in 2018, while 41.2 percent were enrolled in Medicaid or some other type of public health insurance.

While coverage expansions under the ACA have hastened the progress toward universal coverage, the continued high cost of many coverage options means that access to affordable health care is still a challenge for many Americans-particularly African Americans.

The average family spends $8,200 (or 11 percent of family income) per year on health care premiums, and out-of-pocket costs for things such as office visit copays, prescription drugs, and surprise or out of plan medical bills continue to wreak havoc on the financial security of families. For African Americans, the average annual cost for health care premiums is almost 20 percent of the average household income-a major cost to bear, when taking into account income inequality and other economic challenges for this demographic.

The high cost of coverage has kept the number of uninsured and underinsured unacceptably high: of the 27.5 million people that still lack health insurance coverage, 45 percent cite cost as the reason for being uninsured. Furthermore, the Commonwealth Fund estimates that an additional 87 million people (adults aged 19 to 64) are underinsured; that is, they have coverage, but their plan leads to unusually high out-of-pocket costs relative to income that can lead to a strain on personal finances or even debt. Of these underinsured adults, 18 percent are African-American.

Systemic Health Care Challenges That Reform Must Address

Despite coverage gains, remaining health care challenges exist that have a disproportionate impact on African Americans. The lack of Medicaid expansion in key states, health disparities, and health care provider shortages make it incredibly hard to address America's health care needs in a comprehensive way. And while these challenges are factors that touch many Americans in various parts of the country, the gravity of them is uniquely seen in the South, and among the African-American population.

The South's Stubborn Approach to Medicaid Expansion

The Medicaid program has been a lifeline for low-income Americans, pregnant people, the elderly, and people with disabilities. It is jointly funded by states and the federal government, and has been operating for fifty-four years. As of August 2019, the program covered 68 million people, with African Americans making up about 20 percent of Medicaid enrollees. Because African Americans tend to be poorer than other demographic groups on average, public health insurance programs such as Medicaid are vital to ensure affordable health care and healthier outcomes. In states that have not expanded Medicaid under the Affordable Care Act (ACA), African Americans and other people of color are most likely to fall within a coverage gap -meaning they earn too much to qualify for the traditional Medicaid program, yet not enough to be eligible for premium tax credits under marketplace plans.

The states that have not expanded Medicaid are largely concentrated in the southern region of the United States.

Under the ACA, Medicaid eligibility was expanded for adults with incomes up to 138 percent of the federal poverty level (FPL). This expansion was originally written into the ACA as a requirement for all states, but due to a 2012 Supreme Court ruling in National Federation of Independent Business v. Sebelius, it is now just an option for states. To date, thirty-seven states (including the District of Columbia) have expanded Medicaid, either through traditional means or the Section 1115 waiver process. The states that have not expanded Medicaid are largely concentrated in the southern region of the United States. (See Map 1.)

Map 1

In the South, African Americans are disproportionately represented. According to the U.S. Department of Health and Human Services Office of Minority Health, 58 percent of the African-American population lived in the South as of 2017. They are also more likely to be uninsured, with Texas, Florida, and Georgia being home to the largest shares of uninsured African Americans. Some states have also proposed draconian work requirements as a condition for the participation in the Medicaid program. These requirements can only serve to stigmatize enrollees, deny coverage, and discourage low-income people from the support they desperately need. In Arkansas-one of nine states to date with 1115 waivers approved by the Trump administration allowing fully implemented work requirements- 18,000 low-income people lost health care coverage as a result. This coverage loss comes as no surprise, because the use of work requirements for other safety-net programs, including Temporary Assistance for Needy Families (TANF), has proven them to be ineffective in their stated goal-promoting employment-yet highly effective in reducing program eligibility. Medicaid work requirements for three states have been struck down by the courts. Due to the failure to expand Medicaid, the South is now home to the nation's sickest people, and is where health disparities between whites and people of color are the most pronounced.

Disparities in Health Outcomes

Increases in health insurance coverage under the ACA have improved access to medical care and have been linked to better outcomes for African Americans, such as earlier diagnosis and treatment of certain cancers. However, disparities still exist across health conditions when comparing African Americans and whites, including maternal mortality, infant mortality, heart disease, diabetes, cancer, and other health issues. Social factors, including economic disadvantage, inequities in education, and lack of access to health care, impact a person's ability to lead a healthy and productive life. For people in American society that experience racism and inequality in their daily lives, and throughout the lifespan, the impact of social factors on health are the most grave.

Even with improved access to medical care under the ACA, the disparities in health outcomes between African Americans and whites are stark. African-American women are three times more likely to die of pregnancy-related causes than white women (see Figure 1). The African-American infant mortality rate is twice the rate for white infants (see Figure 2). African Americans are more likely to die from cancer and heart disease than whites, and are at greater risk for the onset of diabetes. However, death rates for African Americans with cancer and heart disease did drop over a fifteen year period. Across many chronic illnesses, however, African Americans are still more likely to die compared to other racial and ethnic groups. Homicides are also a leading cause of death for African Americans. In fact, African American children are ten times more likely to die by gun violence than white children (see Figure 3).

Figure 1

Figure 2

Figure 3

Health Care Provider Shortages

Due to residential segregation, majority African-American and Hispanic areas are more likely to lack hospitals and other health care providers. Therefore, place matters. When health care providers are located within majority African-American and Hispanic neighborhoods, they tend to offer lower-quality care. Often, people of color find themselves relying heavily on community health centers, emergency rooms or outpatient care, and community-based providers due to the lack of available primary care and mental health providers in a given geographic area. Traveling outside of the immediate geographic area to access health care may be an option for some people, yet this can be a challenge due to lack of access to transportation for those with limited incomes or for those living in rural areas.

It is not difficult to locate where-and for whom-provider shortages are a serious concern. The Health Resources and Services Administration (HRSA) defines Health Professional Shortage Areas (HPSAs) as geographic, population, or facility-based designations that are indicative of health care provider shortages. Designations are made by the following health disciplines: primary care, dental health, and mental health. Federal regulations dictate the threshold for shortages by calculating the ratio of population to provider in order to identify high need areas. In 2018, there were 17,657 geographic areas, populations, and facilities identified by HRSA as not having enough health care providers. Mental health and primary care were the disciplines in the shortest supply.

Medically Underserved Areas and Populations (MUA/Ps) are another designation by HRSA. They are geographic areas and populations that lack adequate access to primary care providers. MUA/Ps identify specific populations that are likely to experience barriers to health care including the homeless, low-income people, people eligible for Medicaid, Native Americans, and migrant farmworkers. Designations are made by calculating the population-to-provider ratio, percent of population below the federal poverty level, percent of population over the age of 65, and the infant mortality rate.

Important Considerations for Health Care Specific to African Americans

Certain social factors, also referred to as social determinants of health, have important implications for health risk and the ability to attain health insurance coverage. Poverty, income inequality, wealth inequality, food insecurity, and the lack of safe, affordable housing are just a few. Another important social factor leading to poor health outcomes and economic disadvantage among African Americans is racism, because not only is it a stressor, but it impacts who gets what in America, particularly health care.

Racism's Wear and Tear on African Americans

African Americans have endured racism within American society for hundreds of years. Studies conducted over time have been consistent in proving that racism not only impacts social stratification, but also the ability of African Americans to be healthy-both mentally and physically. This burden-a burden that is indeed inescapable for black and brown people in this country-causes African Americans to die prematurely and experience chronic illnesses and mental health challenges at higher rates than white Americans.

According to a study published in the journal of Psychoneuroendocrinology, racist experiences bring on an increase in inflammation in African Americans. This increase in inflammation raises the risk of becoming chronically ill. The researchers of the study assert that, because the body's response to stressors-such as the adversity of racism-results in compromising systems that are critical in fending off disease, exposure to racism over long periods of time caused the health of African Americans to suffer greatly with chronic illness as the body's defenses were down due to inflammation. Chronic illnesses associated with experiencing racism include heart attack, neurodegenerative disease, and metastatic cancer. The study participants had similar socioeconomic backgrounds, which eliminated poverty as a stressor-a social factor that has also been linked to the onset of illness.

Similar findings were yielded in some of the earliest studies looking at the impact of racism on the health of African Americans by University of Michigan public health researcher Arline Geronimous. After looking at biological factors associated with exposure to stressors, Geronimous hypothesized, in what is also referred to as the weathering hypothesis, that African Americans experienced health deterioration because of those stressors. Geronimous examined the allostatic load scores-that is, the cumulative wear and tear on the body's system brought on by the repeated adaptation to stressors-for adults aged 18-64. African Americans were found to have higher scores than white Americans. Once again, poverty was ruled out as a factor, due to the fact that the higher allostatic loads existed among African Americans of various socioeconomic backgrounds. Geronimous concluded that racism, and the burden of coping with it across the lifespan, leads to differences in health among African Americans and white Americans-including the onset of chronic illness and premature death.

In addition to instigating poor health outcomes among African Americans, racism also creates barriers to economic opportunity and uneven access to health care. Even the health care system itself perpetuates racism and bias toward African Americans. This has been well documented with examples, including differences in pain management and treatment of African Americans when compared to whites experiencing the same health conditions, use of African Americans' bodies in medical experimentation, and racial bias in health algorithms for the purpose of guiding health decisions and assessing health care costs. Actions like these have led to a general distrust of the health care system within the African American community. Racism cannot be divorced from the other social factors outlined in this report, which give reason to the fact that African Americans are disproportionately affected by them.

Poverty

Across economic indicators, vast disparities exist between African Americans and whites that mirror the proportions seen in health disparities. Due to structural barriers, African Americans are more likely to be poor than white Americans and are less likely to have a full-time worker in the household. The poverty rate among African Americans was 20.8 percent in 2018, higher than for any other racial or ethnic group in the United States, and more than twice the poverty rate of white Americans. Growing up in poverty is also associated with toxic stress, of which the impact can reach crisis levels when a person is also grappling with the toxic stress brought on by racism. When African Americans are able to attain work, they are more likely to work in low-paying jobs that lack important benefits, including health insurance and paid leave. The African-American poverty rate also shows how critical public programs such as Medicaid are to helping ensure access to health care for this population. Because of these factors, Medicaid expansion helps more African Americans gain coverage than any other group.

Household Income Inequality

African-American households have significantly lower household income than white households. The average household income for African Americans in 2018 was $41,361, while it was $70,642 for white households. (See Figure 4.) African Americans tend to make less than whites for the same jobs, pointing to unequal pay as a contributing factor in the gap in household income. Even when taking into account similar education levels, workers of color are consistently paid less than white workers.

Income is a major factor in a family's ability to access health care, which can make up a significant share of household spending in terms of insurance premium costs and out-of-pocket costs.

Figure 4

The Wealth Gap

When it comes to accumulating wealth, the numbers are even more grim-white families now have approximately ten times the wealth of African-American families, on average. (See Figure 5.) Research shows that the wealth gap impacts African Americans across the income and education spectrum, making it harder for them to own homes or build retirement savings. And while African Americans on average have less total debt than whites, the wealth gap means they are more likely to have costly, high-interest debt obligations. High health care costs and surprise medical bills can negatively affect an African-American family's ability to reduce or eliminate debt, and ultimately the ability to create wealth-which could impact a family for generations.

Figure 5

Food Insecurity

Food insecurity is also an issue affecting many African Americans and has important implications for health outcomes and economic well-being. Food insecurity occurs when a household or family lacks access to adequate nutritious food. This happens due to the lack of financial means to purchase healthy food or by living in impoverished geographic areas void of grocery stores with whole, fresh foods. Neighborhoods that lack access to nutritious foods are also referred to as food deserts. The ten U.S. counties with the highest food insecurity rates are all at least 60 percent African-American. African Americans experience hunger at twice the rate of white Americans, including one in four African-American children. Hunger can also lead to chronic illness and has been associated with low-birth weight, diabetes, cancer, pregnancy complications, and mental distress.

The Lack of Safe and Affordable Housing

Housing and neighborhood safety are also important economic indicators that can impact health. Unfortunately, far too many African Americans have to grapple with neighborhood violence and environmental factors (such as a lack of clean water, exposure to lead paint, and pollution) that can negatively impact both their mental and physical health. Additionally, a relative lack of affordable housing options and home ownership continues to plague the African-American community, largely due to longstanding racist practices such as redlining and subprime mortgages. The lack of affordable housing puts a financial strain on families and can pull resources away from necessities like food and medical care. For homeless and transient communities, it can be almost impossible to access health care or maintain adequate health regimens. Despite comprising just 13.4 percent of the total U.S. population, African Americans make up 40 percent of the homeless population, and are an overrepresented part of this group in every state.

Overview of Health Care Reform Plans

Several health care reform proposals have been introduced by members of U.S. Congress and by 2020 presidential candidates. In this section, the most widely known and promising plans that have gained traction and media coverage in recent months are highlighted.

Medicare for All

Medicare for All is a signature single-payer plan originally authored by Senator Bernie Sanders, setting forth a vision for major structural change of the health insurance system. It has since been endorsed and supported by Representative Pramila Jayapal (who introduced the House version of the legislation), Representative Alexandria Ocasio-Cortez, Senator Elizabeth Warren, Senator Kamala Harris, Senator Cory Booker, and a host of other progressive policymakers. It calls for a single federal program with comprehensive benefits for all U.S. residents that would replace all private insurance, Medicaid, Medicare, and the Children's Health Insurance Program (CHIP). The plan would be financed by taxes and eliminate premiums and cost-sharing or out-of-pocket costs, leading to major cost-savings for consumers in the long run. Taking into account the vast economic challenges for African Americans, savings in health care costs could help lead to better economic outcomes. In turn, health outcomes could also improve due to more comprehensive coverage available to all.

Comprehensive health benefits under Medicare for All include medically necessary services in thirteen benefit categories, including home and community-based long-term care, dental care, hearing, vision care, comprehensive reproductive health care (including abortion services), and transportation to health care appointments for people with disabilities and low-income people. Drug prices would be negotiated annually and a formulary would be established. Medicare for All would also prohibit balance billing, also known as surprise billing, which happens when health providers bill patients for the difference in the total cost of a health care service and the amount paid by an insurer.

Public Insurance Option

Public option plans call for a federal insurance option. These plans essentially build upon the ACA by adding a new option available to those seeking coverage. Former vice president Joe Biden has been an advocate for this plan and has included it in his platform as a 2020 presidential candidate. There are several versions of the public option-some that would leave the marketplace subsidy structure unchanged, and others that would enhance it for all plan participants. Some public option proposals even go so far as to eliminate individual heath insurance plans created by the ACA. A key difference in the Biden plan, when compared with Medicare for All, is that it retains current public and private insurance sources. For people who like or prefer their private insurance, they can maintain it under the Biden plan.

The Biden plan would retain major components of the ACA including protections for people with pre-existing conditions, premium subsidies, and Medicaid expansion, along with offering public insurance as an option to anyone who wants it. A public insurance option was initially part of the ACA as introduced in Congress but was taken out of the legislation later in the negotiations process. Biden's public option plan also aims to reduce the cost of prescription drugs by allowing importation of them from other countries, empowering Medicare to negotiate drug prices, and supporting the development of generic drugs. It would also offer tax credits to middle class families to help lower the cost of health insurance and eliminate the 400 percent federal poverty level income cap. The plan would eliminate balanced billing and be financed through capital gains taxes on rich individuals. Biden's plan also includes protecting access to contraception and abortion rights, as well as the promise to adopt California's strategy of public-private partnerships nationwide in addressing the U.S. maternal mortality crisis as major steps in building upon the ACA. Various versions of public insurance option legislation have also been introduced in Congress by Senator Ben Cardin, Representative Cedric Richmond, Senator Tim Kaine, Representative Jan Schakowsky, and others.

Sixty-one percent of white respondents in a November 2019 Gallup poll prefer the private health insurance system, whereas 57 percent of nonwhite respondents prefer government-run insurance. The cost of health care is still of major concern for those people with private health insurance, more so than for those with public insurance sources.

Ensuring Health Care Access and Affordable Coverage for African Americans

The single payer and public option insurance plans outlined in this report were developed in a way to help fill coverage gaps and get as many people insured as possible. The plans aim to do this by emphasizing affordability-addressing the high cost of insurance premiums and limiting out-of-pocket costs, including surprise medical bills, prescription drugs, and fees for direct health care services. Unfortunately, current health reform plans fall short in adequately addressing racism in the health care system. This stands in the way of ensuring health equity, namely full insurance coverage and quality health care access for African Americans.

Cost to the individual is certainly an important factor in the conversation about health coverage and ensuring that people can access the health care services they need. However, in order for African Americans to attain meaningful insurance coverage and access to quality health care, the health care system must be transformed to better address the unique social factors that cause African Americans to remain in the coverage gap and how racism plays a role in their health outcomes. Furthermore, the economic challenges African Americans face serve as barriers to sustaining comprehensive coverage which can lead to poor health outcomes. It is simply not enough for insurance coverage to be affordable or even "free"-it must also serve as a tool in progress toward systemic change and equity that will help African Americans get ahead.

To do this, getting to universal health care coverage will require that the following steps be taken:

Promote health equity by adequately addressing racism, bias, discrimination, and other systemic barriers within the health care system. To do this, policymakers must acknowledge the historical foundations of racism and ensure that health care providers, personnel and staff are substantively trained to recognize and eliminate all forms of bias in the health care system. Accountability measures at both the individual and systems levels should be in place, including measures that link payment, professional certification, and licensure to quality of care.

Incorporate evidence-based tools to adequately address health disparities that focus on quality of care that extend beyond health insurance coverage, including the impact of racism on the health of African Americans throughout the life course. In health reform efforts, policymakers must take into account the social determinants and address how they impact health by working across sectors, including social support agencies and community-based providers with patient-centered approaches to care. Racist practices, such as those in the treatment and pain management of African Americans, should be eliminated.

Protect and expanding access to insurance coverage and comprehensive benefits and bolstering the ACA benefit provisions and nondiscrimination guarantees. These efforts should include preserving coverage for people with pre-existing conditions by further codifying protections that ensure benefit inclusion and design decisions that do not result in limiting access to care. Policymakers should also build on the essential health benefits package to include important health care services currently omitted, such as long-term care and dental care.

Protect the integrity of Medicaid, an important health insurance source for African Americans, by denying state efforts to impose draconian stipulations on coverage for enrollees such as work requirements. In order to close the coverage gap among African Americans, policymakers must also implement targeted strategies to incentivize and ensure Medicaid expansion in all southern states.

Ensure access to quality providers and addressing provider shortages and hospital closures by anticipating increases in demand and working with HRSA to implement concrete strategies to close gaps in health care access for medically underserved areas/populations and health professional shortage areas. Strategies should include plans to not only increase the health care workforce, but also diversify it and offer technical support and training to minority-serving hospitals.

Support the development of a robust, diverse, and culturally competent health care workforce by encouraging and facilitating diversity throughout the health care system and care teams, and adequately training all staff to be culturally sensitive. Payment rates and coverage guidelines for health care coverage should be developed in a way that supports fair, living wages and pay equity in the health care professions and jobs.

Limit the cost of premiums and out-of-pocket costs, helping to make health insurance more affordable for individuals and families across the income spectrum. This should include limiting deductibles, prescription drug costs and other point-of-service charges, and completely eliminating surprise medical bills. All of these costs are major barriers to health care access, particularly for individuals and families with limited incomes.

Strengthen access to trusted community-based providers currently available through safety-net programs, such as Medicaid, Medicare, and the Children's Health Insurance Program (CHIP). These programs are often lifelines for marginalized communities and they disproportionately serve people of color. Policymakers should develop health reform plans that are intentional in ensuring continued access to these vital sources of care, as well as seamless coordination with health insurance payers for people with coverage seeking care from community-based providers.

African Americans stand to make significant gains if health reform is done right. The statistics outlined in this report paint a grim picture. Regardless of the progress made in recent decades, far too many African Americans still struggle to lead healthy and economically secure lives. This is due to the long-standing effects of racism, which touches all African Americans, regardless of socioeconomic status. These effects can be reversed, but it will take real commitment and systemic change. Health care reform must be part of the effort.

Tags: health care, income inequality, wealth inequality, racism, racial inequality, African americans

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Racism, Inequality, and Health Care for African Americans

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16.3 Final Recording of Film Analysis Presentation