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Policy PointsCultural racism—or the widespread values that privilege and protect Whiteness and White social and economic power—permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities.Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base.Considering the fundamental role of cultural racism is needed to advance health equity. Context: Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism. Methods: We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities. Findings: Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course. Conclusions: More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence‐based policy interventions to reduce cultural racism and promote health equity. [ABSTRACT FROM AUTHOR]

As evidence of the relationship between place and health mounts, more epidemiologists and clinical science researchers are becoming interested in incorporating place-based measures and analyses into their examination of population health and health inequities. Given the extensive literature on place and health, it can be challenging for researchers new to this area to develop neighborhood-effects research questions and apply the appropriate measures and methods. This paper provides a road map for guiding health researchers through the conceptual and methodological stages of incorporating various dimensions of place into their quantitative health research. Synthesizing across reviews, commentaries, and empirical investigations, the road map consists of 4 broad stages for considering place and health: 1) why? : articulating the motivation for assessing place and health and grounding the motivation in theory; 2) what? : identifying the relevant place-based characteristics and specifying their link to health to build a conceptual framework; 3) how? : determining how to operationalize the conceptual framework by defining, measuring, and assessing place-based characteristics and quantifying their effect on health; and 4) now what? : discussing the implications of neighborhood research findings for future research, policy, and practice. This road map supports efforts to develop conceptually and analytically rigorous neighborhood research projects. [ABSTRACT FROM AUTHOR]

Highlights • There was a non-linear association between discrimination and allostatic load. • The association between discrimination and allostatic load varied by education. • A U-shaped relationship emerged among those with lower education. • High discrimination had a buffering effect among those with higher education. • Associations were found for allostatic load and in system-specific analyses. Abstract Objective To examine the association between self-reported racial discrimination and allostatic load, and whether the association differs by socioeconomic position. Methods We recruited a purposive cross-section of midlife (ages 30–50) African American women residing in four San Francisco Bay area counties (n = 208). Racial discrimination was measured using the Experience of Discrimination scale. Allostatic load was measured as a composite of 15 biomarkers assessing cardiometabolic, neuroendocrine, and inflammatory activity. We calculated four composite measures of allostatic load and three system-specific measures of biological dysregulation. Multivariable regression was used to examine associations, while adjusting for relevant confounders. Results In the high education group, reporting low (b = −1.09, P =.02, 95% CI = −1.99, −0.18) and very high (b = −1.88, P =.003, 95% CI = −3.11, −0.65) discrimination was associated with lower allostatic load (reference=moderate). Among those with lower education, reporting low (b = 2.05, P =.008, 95% CI = 0.55,3.56) discrimination was associated with higher allostatic load. Similar but less consistent associations were found for poverty status. Associations were similar for cardiometabolic functioning, but not for neuroendocrine or inflammatory activity. Conclusions Racial discrimination may be an important predictor of cumulative physiologic dysregulation. Factors associated with educational attainment may mitigate this association for African American women and other groups experiencing chronic social stress. [ABSTRACT FROM AUTHOR]

Mounting evidence suggests that law enforcement organizational factors contribute to higher incidence and racial disparities in police killings. To determine whether agency policies contribute to race-specific civilian fatalities, this exploratory study compared fatality rates among agencies with and without selected policies expected to reduce killings. A cross-section of 1085 fatalities in the 2015–2016 The Counted public-use database were matched to 481 agencies in the 2013 Law Enforcement Management and Administrative Statistics (LEMAS) database. Negative binomial regression estimated incidence rate ratios (IRR) adjusted for agency type, number of officers, percent female personnel, median income, percent with a bachelor's degree, violent crime rate, and population size, with inference using robust standard errors. Agencies with greater proportions of full-time personnel (range 43–100%) had lower rates of all (IRR = 0.85; 95% confidence interval [CI] = 0.77–0.93) and non-White civilian killings (IRR = 0.85; CI = 0.73–0.99). Mission statements predicted lower rates of all (IRR = 0.70; CI = 0.58–0.84) and White killings (IRR = 0.60; CI = 0.40–0.90). Community evaluation and more types of personnel incentives predicted lower rates of White (IRR = 0.82; CI = 0.68–0.99) and non-White killings (IRR = 0.94; CI = 0.89–1.00), respectively. Increasing video use predicted higher rates of White killings (IRR = 1.13; CI = 1.01–1.28). No policies were significantly associated with Black civilian killings. Law enforcement policies that help reduce police killings may vary across racial groups with the least benefit for Black civilians. Impact evaluations and meta-analyses of initiatives aimed to mitigate fatalities should be explored, particularly policies to address anti-Black bias. A national registry tracking all police killings and agency policies is urgently needed to inform law enforcement policies aimed to mitigate civilian fatalities. [ABSTRACT FROM AUTHOR]