Research on racism as a fundamental cause of adverse health requires further theoretical guidance. The current article proposes a novel approach to address racial ethnic health disparities that incorporates theories of racism. Racism trauma health theory (RTHT) centers racism as a primary factor in health disparities among African Americans. It analyzes racism as a dynamic and multi-stage process and accounts for levels and domains of racism, types of exposure, specific racist treatment, and stress responses. RTHT addresses limitations of current explanations of racism predicting adverse health by exploring impact beyond economics, to include social, physical, legal, and emotional pathways. The multiplicative effect, at the core of RTHT, assesses compounded experiences of racism that intersect across levels and domains affecting health.
Plain Language Summary
Racism Trauma Health Theory: Moving Beyond a Single Factor to Explain How Racism Harms Health
Research on racism as a fundamental cause of adverse health requires further theoretical guidance. The current article proposes a novel approach to address racial ethnic health disparities that incorporates theories of racism. Racism trauma health theory (RTHT) centers racism as a primary factor in health disparities among African Americans. It analyzes racism as a dynamic and multi-stage process and accounts for levels and domains of racism, types of exposure, specific racist treatment, and stress responses. RTHT addresses limitations of current explanations of racism predicting adverse health by exploring impact beyond economics, to include social, physical, legal, and emotional pathways. The multiplicative effect, at the core of RTHT, assesses compounded experiences of racism that intersect across levels and domains affecting health.
AdlerR. H. (2009). Engel’s biopsychosocial model is still relevant today. Journal of Psychosomatic Research, 67(6), 607–611.
2.
AllenR. (2001). The concept of Self: A Study of Black Identity and self- esteem. Wayne State University Press.
3.
AlexanderM. (2010). The new Jim Crow: Mass incarceration in the age of colorblindness. The New Press.
4.
BaileyZ. D.KriegerN.AgénorM.GravesJ.LinosN.BassettM. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. Lancet, 389(10077), 1453–1463.
5.
BeechB. M.FordC.ThorpeR. J.JrBruceM. ANorrisK. C. (2021). Poverty, racism, and the public health crisis in America. Frontiers in Public Health, 9, 6990049.
6.
BennettG. G.MerrittM. M.Sollers IiiJ. J.EdwardsC. L.WhitfieldK. E.BrandonD. T.TuckerR. D. (2004). Stress, coping, and health outcomes among African-Americans: A review of the John Henryism hypothesis. Psychology and Health, 19(3), 369–383.
7.
Bonilla-SilvaE. (2003). Racial attitudes or racial ideology? An alternative paradigm for examining actors' racial views. Journal of Political Ideologies, 8(1), 63–82.
8.
BowenF. R.LewandowskiL. A.SrethanJ. A.ChildsG.OutlawF. (2022). A Schema of Toxic Stress Informed by Racism, Transgenerational Stress, and Disadvantage. Journal of Pediatric Health Care, 36(2), 79–89.
9.
BoykinA. W.AllenB.SingerR.HearstA.DucharmeR.SpilsburyJ.WoodhouseB. B. (2003). Rethinking Childhood. Rutgers University Press.
10.
BoykinA. W.TomsF. D. (1985). Black child socialization: A conceptual framework. In McAdooH. P.AdooJ. L. (Eds.), Black children’s social, educational, and Parental Environments (pp. 33–52). Sage Publishing, Inc.
11.
BravemanP.EgerterS.WilliamsD. R. (2011). The social determinants of health: Coming of age. Annual Review of Public Health, 32, 381–398.
12.
Bryant-DavisT.OcampoC. (2005). The trauma of racism: Implications for counseling, research, and education. Counseling Psychologist, 33(4), 574–578.
13.
CameH.GriffithD. (2018). Tackling racism as a “wicked” public health problem: Enabling allies in anti-racism praxis. Social Science & Medicine, 199, 181–188.
14.
CannonW. B. (1932). The wisdom of the body. W. W. Norton & Company.
15.
ClarkK. B.ClarkM. P. (1996). Racial Identification and preference in Negro Children. Bobbs-Merrill.
16.
ClarkR. (2004). Interethnic group and intraethnic group racism: Perceptions and coping in Black university students. Journal of Black Psychology, 30(4), 506–526.
17.
CrossW.E.Jr.StraussL.Fhayen-SmithP. (1999). African American identity development across the lifeSpan: Educational implications in racial and ethnic identity in school practices (pp. 39–58). Routledge.
18.
CrossW. E.Jr. (1991). Shades of black: Diversity in African American identity. Temple University Press.
19.
DovidioJ. F.GaertnerS. L. (1993). Stereotypes and evaluative intergroup bias. In MackieD. M.HamiltonD. L. (Eds.), Affect, cognition, and stereotyping: Interactive processes in group perception (pp. 167–193). Academic Press.
20.
Du BoisW. E. B. (1903[1968]). Of the training of Black men (pp. 67–81). In The souls of Black folk: Essays and sketches. Johnson Reprint Corp.
21.
EssedP. (1991). Understanding everyday racism: An interdisciplinary theory (Vol. 2). Sage.
22.
FeaginJ. (2013). Systemic racism: A theory of oppression. Routledge.
23.
FerraroK. F.Kelley-MooreJ. A. (2003). Cumulative disadvantage and health: Long-term consequences of obesity?American Sociological Review, 68(5), 707–729.
24.
FieldsB. J. (1990). Slavery, race, and ideology in the United States of America. New Left Review, I(181), May–June. https://doi.org/10.64590/cfe
25.
FordC. L.AirhihenbuwaC. O. (2010). Critical race theory, race equity, and public health: Toward antiracism praxis. American Journal of Public Health, 100, S30–S35. https://doi.org/10.2105/ajph.2009.171058
GarbarskiD. (2015). Racial/ethnic disparities in midlife depressive symptoms: The role of cumulative disadvantage across the life course. Advances in Life Course Research, 23, 67–85.
28.
GeeG. C.FordC. L. (2011). Structural racism and health inequities: Old issues, new directions1. Du Bois Review Social Science Research on Race, 8(1), 115–132.
29.
GeronimusA. T.HickenM.KeeneD.BoundJ. (2006). “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. American Journal of Public Health, 96(5), 826–833.
30.
GustafssonP. E.San SebastianM.JanlertU.TheorellT.WesterlundH.HammarströmA. (2014). Life-course accumulation of neighborhood disadvantage and allostatic load: empirical integration of three social determinants of health frameworks. American Journal of Public Health, 104(5), 904–910.
31.
HelmsJ. E. (1995). An update of Helm's White and people of color racial identity models. In Versions were presented at the Psychology and Societal Transformation Conference, U Western Cape, South Africa, Jan 1994, and at a workshop entitled" Helm's Racial Identity Theory," Annual Multicultural Winter Roundtable, Teachers College–Columbia U, New York, Sage Publications, Inc.
32.
HenningK. N. (2022). Policing as trauma: The harms of Hyper-surveillance and over-policing youth of color. Criminal Justice, 37(1), 42–45.
33.
HoodA. M.MoraisC. A.FieldsL. N.MerriwetherE. N.BrooksA. K.ClarkJ. F.McGillL. S.JanevicM. R.LetzenJ. E.CampbellL. C. (2023). Racism Exposure and trauma accumulation perpetuate pain inequities-advocating for change (RESTORATIVE): A conceptual model. American Psychologist, 78(2), 143–159.
34.
JamesS. A. (1994). John Henryism and the health of African-Americans. Culture, Medicine and Psychiatry, 18(2), 163–182. https://doi.org/10.1007/BF01379448
35.
JemalA.GardinerM.BloeserK. (2019). Perceived race as variable: Moderating relationship between perceived discrimination in the workplace and mentally unhealthy days. Journal of Racial and Ethnic Health Disparities, 6, 265–272.
36.
Johnson-AgbakwuC. E.AliN. S.OxfordC. M.WingoS.ManinE.CoonrodD. V. (2022). Racism, COVID-19, and health inequity in the USA: A call to action. Journal of Racial and Ethnic Health Disparities, 9, 52–58.
37.
KeyesL.BingR. L.KeyesV. D. (2021). America’s Anti-Drug Abuse Act: The disproportionality of drug laws on Blacks—A policy analysis. Justice Policy Journal, 18(2), 1–14.
38.
KriegerN. (2000). Epidemiology, racism, and health: The case of low birth weight. Epidemiology, 11(3), 237–239.
39.
KriegerN. (2014). Discrimination and health inequities. International Journal of Health Services, 44(4), 643–710.
40.
KriegerN. (2021). Ecosocial theory, embodied truths, and the people's health. Oxford University Press.
41.
LaVeistT. A. (1996). Why we should continue to study race . . . but do a better job: An essay on race, racism, and health. Ethnicity & Disease, 6(1/2), 21–29. http://www.jstor.org/stable/45409633
42.
LewisJ. A.GrzankaP. R. (2016). Applying intersectionality theory to research on perceived racism. In AlvarezA. N.HilaryC. T.NevilleH. A. (Eds.), The cost of racism for people of color: Contextualizing experiences of discrimination (pp. 31–54). American Psychological Association.
43.
MirzaF. R. (2001). Mandatory minimum prison sentencing and systemic racism. Osgoode Hall Law Journal, 39, 491–512.
44.
National Research Council. (2004). Measuring racial discrimination. The National Academies Press.
45.
NeedhamB. L.DokshinaD.AliT.AllgoodK. L.DouglasM.DulinA.FleischerN. L.JohnsonA. E.RoA.AgénorM. (2025). Exposure to structural racism-related state laws is associated with worse cardiovascular health among US adults, BRFSS 2011 and 2013. American Journal of Epidemiology, 194(1), 142–151.
46.
OmiM.WinantH. (2014). The theory of racial formation. In M. Omi & H. Winant (Eds.), Racial formation in the United States (3rd ed., pp. 105–136). Routledge. https://doi.org/10.4324/9780203076804
47.
PaisJ. (2014). Cumulative structural disadvantage and racial health disparities: The pathways of childhood socioeconomic influence. Demography, 51, 1729–1753.
48.
PerezA. D.DufaultS. M.SpearsE. C.ChaeD. H.Woods-GiscombeC. L.AllenA. M. (2023). Superwoman schema and John Henryism among African American women: An intersectional perspective on coping with racism. Social Science & Medicine, 316, 115070.
49.
PhelanJ. C.LinkB. G. (2013). Fundamental cause theory. In CockerhamW. C. (Ed.), Medical sociology on the move: New directions in theory (pp. 105–125). Springer Netherlands.
50.
PhelanJ. C.LinkB. G. (2015). Is racism a fundamental cause of inequalities in health?Annual Review of Sociology, 41, 311–330.
51.
PieterseA. L.CarterR. T. (2010). The role of racial identity in perceived racism and psychological stress among black American adults: Exploring traditional and alternative approaches. Journal of Applied Social Psychology, 40(5), 1028–1053.
52.
PrinceD. M.RochaA.NuriusP. S. (2018). Multiple disadvantage and discrimination: Implications for adolescent health and education. Social Work Research, 42(3), 169–179.
53.
PuskaP. (2007). Health in all policies. European Journal of Public Health, 17(4), 328.
SabinJ. A.GreenwaldA. G. (2012a). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. 109(16), 6217–6222.
56.
SabinJ. A.GreenwaldA. G. (2012b). The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: Pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. American Journal of Public Health, 102(6), 988–995. https://doi.org/10.2105/AJPH.2011.300621
57.
SellersR. M.SmithM. A.SheltonJ. N.RowleyS. A.ChavousT. M. (1998). Multidimensional model of racial identity: A reconceptualization of African American racial identity. Personality and Social Psychology Review, 2(1), 18–39.
58.
SelyeH. (1946). The general adaptation syndrome and the diseases of adaptation. Journal of Clinical Endocrinology and Metabolism, 6(2), 117–196. https://doi.org/10.1210/jcem-6-2-117
59.
SelyeH. (1978). The stress of life, Rev. McGraw Hill.
60.
SelyeH. (1998). A syndrome produced by diverse nocuous agents. 1936. Journal of Neuropsychiatry and Clinical Neurosciences, 10(2), 230–231.
61.
SimonsR. L.LeiM. K.KlopackE.ZhangY.GibbonsF. X.BeachS. R. H. (2021). Racial discrimination, inflammation, and chronic illness among African American women at MidLife: Support for the weathering perspective. Journal of Racial and Ethnic Health Disparities, 8, 339–349.
62.
SmithW. A. (2008). Higher education: Racial battle fatigue. In SchaeferR. T. (Ed.), Encyclopedia of race, ethnicity, and society (pp. 615–618). Sage Publications.
63.
SpencerM. B.Markstrom-AdamsC. (1990). Identity processes among racial and ethnic minority children in America. Child Development, 61(2), 290–310.
64.
Staggers-HakimR. (Ed.). (2022). Profiled life: A systems approach to understanding the foundation and persistence of racism in America (1st ed.). Kendall Hunt Publishing.
65.
StopforthS.KapadiaD.NazrooJ.BécaresL. (2022). The enduring effects of racism on health: understanding direct and indirect effects over time. SSM - Population Health, 19, 1–11.
66.
TatumB. D. (2003, 1997). Why are all the black kids sitting together in the cafeteria: And other conversations about race. Basic Books.
67.
WadeD. T.HalliganP. W. (2017). The biopsychosocial model of illness: A model whose time has come. Clinical Rehabilitation, 31(8), 995–1004.
68.
WallaceS.NazrooJ.BécaresL. (2016). Cumulative effect of racial discrimination on the mental health of ethnic minorities in the United Kingdom. American Journal of Public Health, 106(7), 1294–1300.
69.
WienS.MillerA. L.KramerM. R. (2023). Structural racism theory, measurement, and methods: A scoping review. Frontiers in Public Health, 11, 1–15.
WilliamsD. R.ChungA. M. (1997). Racism and health. Sage Publications.
72.
WilliamsD. R.CollinsC. (1995). U.S. socioeconomic and racial differences in health patterns and explanations. Annual Review of Sociology, 21, 349–386.
73.
WilliamsD. R.MohammedS. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32, 20–47.
74.
WilliamsD. R.MohammedS. A. (2013). Racism and health I: Pathways and scientific evidence. American Behavioral Scientist, 57(8), 1152–1173. https://doi.org/10.1177/0002764213487340
75.
WillisH. A.SosooE. E.BernardD. L.NealA.NeblettE. W. (2021). The associations between internalized racism, racial identity, and psychological distress. Emerging Adulthood, 9(4), 384–400.
76.
WilliamsD. R.Williams-MorrisR. (2000). Racism and mental health: The African American experience. Ethnicity & Health, 5(3–4), 243–268. https://doi.org/10.1080/713667453
