INTRODUCTION
Racism is deeply embedded in everyday discourse, social interactions, and institutional practices in the United States. Critical race theory holds that racism is the ordinary way in which society does business, and that one of its means of operation is through a system of images, attitudes, and scripts (Delgado and Stefancic, Reference Delgado and Stefancic2001). According to this theory, racism is not expressed only as racist acts, such as discrimination in the workplace or police harassment, but as a system of subordination that devalues Black people (Brooks Reference Brooks2009; Delgado and Stefancic, Reference Delgado and Stefancic2001). It is not surprising, then, that empirical research finds that racism negatively affects the health and well-being of Black people in the United States (Pascoe and Smart Richman, Reference Pascoe and Richman2009). We use Black and African American interchangeably, recognizing that factors such as nativity are important in any discussion of people of African descent. Still, as stereotypes continue to redraw and harden the twenty-first-century color line, skin categorized as “Black” in the West is a stigmatizing mark.
Stereotypes are some of the building blocks of the system of images and scripts that form racist subordination—they form commonsense understandings of race (Omi and Winant, Reference Omi and Winant1994). Stereotypes underlie social discourse about race and thus, affect how outgroups perceive Black people and even how Black people perceive themselves. Stereotyping links the meaning of race with social organization and, thus, is one of the most insidious forms of subordination (Brooks Reference Brooks2009). Despite the importance of stereotypes in understanding racism and its effects on Black people, little attention has been paid to stereotypes as a determinant of health. The prominent biopsychosocial model of racism as stress proposed by Clark et al. (Reference Clark, Anderson, Clark and Williams1999) focuses on perception and appraisal of racist events as the cause of pathogenic psychological and physiological stress responses. Although the authors recognize the structural sources of racism, their model focuses on stress related to perception of racism—where there is no perception and no appraisal of an experience as racism, there is no stress. Yet, for many reasons, processes of racism are not necessarily perceived by the individual or appraised as such (Meyer Reference Meyer2003).
We expand on the model presented by Clark et al. by considering stereotypes as more distal than stress; we claim that stereotypes affect health through pathways that are not coextensive with stress. As Williams and Williams-Morris (Reference Williams and Williams-Morris2000) noted: “The age-old proverb that ‘sticks and stones may break my bones but words can never hurt me’ does not ring true for the effect that believing hurtful words and negative cultural images can have on an individual's health” (p. 255). By health we refer to diseases and conditions—such as overweight/obesity, diabetes, heart disease, and cancer that result in disproportionate morbidity and mortality among Black people—and also to physical and mental health and well-being. In this brief paper, we introduce some of the ways in which stereotypes could harm health, operating through two pathways, psychological and structural.
THE PROCESS OF STEREOTYPING
Although stereotypes are common, we would not expect similar outcomes for all targets. Whites occupy a superordinate position in the United States' racialized social system (Bonilla-Silva, Reference Bonilla-Silva1996), dramatically lessening the impact of any associated stereotypes. For other targets, stereotypes become damaging in the context of stigma, wherein the person's entire social identity is devalued (Link and Phelan, Reference Link and Phelan2001). Stereotyping of Black people has a long history in the United States; an exhaustive discussion is beyond the scope of this paper. We shall focus on a few key examples. In the early twentieth century, Black lives were described as “care-free … full to the brim with excitement, interspersed with the smallest possible amount of work” (Bevis Reference Bevis1921, p. 70). Today, Black women are stereotyped as harboring characterological laziness and antipathy to work, particularly as “welfare queens” who reproduce prodigiously and enjoy material excess at American taxpayers' expense. Brought into the common lexicon during Ronald Regan's 1976 presidential campaign (The Washington Star, 1976), the image has remained indelibly imprinted in American minds as the apotheosis of Black undeservedness. Black people are stereotyped as hypersexual and sexually deviant: men as brutal bucks—subhuman, savage sexual predators who lust for and threaten White women (Bogle Reference Bogle2000); women as sexually cheap and antithetical to innocence or proper womanhood (hooks Reference hooks1992; Stephens and Phillips, Reference Stephens and Phillips2003). Although the content of the stereotypes may shift over time—Black persons have alternately been portrayed as simple and happy or brutish and requiring surveillance and repression (Delgado and Stefancic, Reference Delgado and Stefancic2001)—the negative connotations of racial stereotypes, and their stigmatizing properties, have been resistant to change.
Loury (Reference Loury2002) notes that some conditions “appear anomalous, disquieting, worthy of further investigation, inconsistent with the natural order of things,” while others “appear normal, about right, consistent with the social world as we know it” (p. 71). Black subordination is perceived as “about right” through the workings of stereotypes. Empirical research bears out the salience of negative connotations around Blackness in the American psyche. In a series of experiments, Blair et al. (Reference Blair, Judd and Fallman2004) showed the automaticity of stereotyping: not only were African Americans readily stereotyped, but even explicit instructions to refrain from stereotyping were ineffective in stopping the practice. The authors argue that stereotyping operates before participants can engage in deliberate decision making: “a target simply looks like an aggressive basketball player and not a star pre-med student” (Blair et al., Reference Blair, Judd and Fallman2004, p. 744). Implicit attitude research investigates the kinds of attitudes individuals may hold that may operate without their awareness or beyond their control—often in contradiction to the individual's espoused values. This research shows that the overwhelming majority of respondents associate Black with “bad” and other negative constructions, such as “weapons” (Nosek et al., Reference Nosek, Smyth, Hansen, Devos, Lindner, Ratliff, Smith, Olson, Chugh, Greenwald and Banaji2007) and “apes” (Goff et al., Reference Goff, Eberhardt, Williams and Jackson2008).
HOW STEREOTYPES AFFECT HEALTH
Stereotypes about Black people weigh on Black minds, thereby affecting interpersonal and intrapersonal processes that have direct psychological consequences. Stereotypes about Black people also weigh on White minds, shaping public perceptions of—and producing polices and social contexts that affect—Black lives (structural consequences).
Psychological Consequences of Stereotyping
Literature on racism and health postulates that racism acts as a chronic stressor that dysregulates physiologic systems that respond to stress. Drawing on McEwen's formulation of allostatic load, racism is thought to represent a chronic biological challenge to bodily systems; chronic and excessive demands eventually result in wear and tear culminating in disease pathology (Mays et al., Reference Mays, Cochran and Barnes2007). We argue that not only direct encounters with racism act as chronic stressors. By inducing social pain and hyperalert states, stereotypes also affect health.
Vicariously Experienced Stereotypes
People vicariously feel the pain of racism experienced by others. Richard Wright's (Reference Wright1966) account is instructive: “The things that influenced my conduct as a Negro did not have to happen to me directly; I needed but to hear of them to feel their full effects in the deepest layers of my consciousness” (pp. 150–151). Experimental research shows that viewing others experiencing racist events negatively affects the observer's physiological processes (Harrell et al., Reference Harrell, Hall and Taliaferro2003). Indeed, people are capable of activating stress response not only from actual events but also from ideas (Massey Reference Massey2004). Frequent and highly visible stereotypical portrayals of Black people in the mass media, for example, are likely to produce feelings of humiliation, anger, and distress. Contestations around portrayals of Black people on television (Means Coleman Reference Means Coleman1998) suggest that stereotypical depictions may raise blood pressure as much as individual experiences of racism.
Vigilance and Rumination
Allport's (Reference Allport1954) concept of vigilance illuminates how stereotypes can be stressful even in the absence of an event. The stereotyped person must prepare for a potential threat that may come from the activation of the stereotype. This vigilance is damaging because one must monitor oneself and the environment to ward off potential harm related to discrimination, including violence. Stereotypes also threaten people's social identities, challenging how they are valued and whether an individual is accepted (Branscombe et al., Reference Branscombe, Ellemers, Spears, Doosje, Ellemers, Spears and Doosje1999). Goffman (Reference Goffman1963) discussed the anxiety with which stigmatized individuals approach interactions in society: such an individual “may perceive, usually quite correctly, that whatever others profess, they do not really ‘accept’ him and are not ready to make contact with him on ‘equal grounds’” (p. 7).
Stereotype activation can also increase rumination. Rumination refers to “the process of thinking perseveratively about one's feelings and problems” and is related to adverse outcomes, such as depression (Nolen-Hoeksema et al., Reference Nolen-Hoeksema, Wisco and Lyubomirsky2008, p. 400). Sue et al. (Reference Sue, Capodilupo, Torino, Bucceri, Holder, Nadal and Esquilin2007) describe the process of reacting to racial microaggressions, highlighting processes of both identity threat and rumination. In reflecting on an incident, the individual may engage in self-questioning about whether the incident has actually occurred, whether or not it was deliberate, and how the individual should have responded. In anticipation of an incident, Black males may worry, “Do I look too threatening? Like, maybe I shouldn't wear this, maybe I shouldn't wear that” (Torres and Charles, Reference Torres and Charles2004, p. 124). “Am I walking so slowly that the cop is going to think I'm loitering? Or, am I walking so fast that he or she will think that I'm running away from the scene of a crime?” (Levins Reference Levins2000, p. 28). Black women may attempt to deflect activated stereotypes of being perceived as “angry” (Nuru-Jeter et al., Reference Nuru-Jeter, Dominguez, Hammond, Leu, Skaff, Egerter, Jones and Braveman2008). Taken together, the vigilance, rumination, and self-monitoring produced by stereotypes is psychologically and physiologically taxing, leading to racial battle fatigue (Smith et al., Reference Smith, Allen and Danley2007).
The concept of stereotype threat directly addresses the vigilance required to cope with stereotypes (Steele Reference Steele2010). Research shows that when a stereotype is activated, such as by telling a Black person that a task is a measure of aptitude, that person performs poorly on the test. This is because stereotype activation leads to vigilance and rumination that induce stress and distraction, ultimately diminishing the individual's mental capacity for the task at hand. Stereotype threat has consequences beyond test performance, broadly impairing human functioning. Steele (Reference Steele2010) describes research on women who, in a stereotype activation manipulation, watched a commercial with stereotypical images of women. As a result, they chose fewer math problems to solve, performed poorly when they did, and said they were less interested in math-related careers. If such an “incidental, passing cue” (Steele Reference Steele2010, p. 144) can foreshorten the aspirations of women in a single bound, what might be the effects of exposure to pervasive and deeply denigrating stereotypes on Black aspirations and self-worth?
Internalized Stereotypes
Black respondents are not immune to implicit biases that are self-denigrating (Nosek et al., Reference Nosek, Smyth, Hansen, Devos, Lindner, Ratliff, Smith, Olson, Chugh, Greenwald and Banaji2007). Internalized stereotypes refer to the application of racist stereotypes toward the individual and collective self. Individuals who internalize negative representations do not believe in people who look like them, do not believe in themselves, and ultimately “accept limitations to [their] own full humanity” (Jones Reference Jones2002, p. 1213).
Giscombe and Lobel (Reference Giscombe and Lobel2005) suggest that stress related to racism contributes to adverse birth outcomes in Black women. We argue that stress-induced negative birth outcomes may result from internalizing narratives about Black pregnancies as degenerate and deviant. Stereotypes about Black women's sexuality can also act as sexual scripts that are learned and acted out. These representations freeze young women into stereotypical identities with lowered sexual self-concepts and ideas about how to negotiate sexual behaviors (Stephens and Phillips, Reference Stephens and Phillips2003).
Internalized stereotypes can also act as health risks because without critical analysis of the dominant messages in American society, Black people may internalize meritocratic ideology—the notion that rewards are equitably bestowed based on merit—and in so doing, come to apply negative stereotypes toward themselves to explain their disadvantage (McCoy and Major, Reference McCoy and Major2007). Meritocratic ideology potentiates already salient stereotypes that interpret Black social disadvantage as innate deficiency (Kwate and Meyer, Reference Kwate and Meyer2010). Such beliefs diminish self-esteem and well-being.
Structural Consequences of Stereotyping
Social factors such as socioeconomic position strongly determine morbidity and mortality (Commission on Social Determinants of Health, 2008). Access to resources (including money, power, and prestige) and inequalities in public policies ostensibly not related to health (e.g., labor, transportation) are critical in shaping life chances (Link and Phelan, Reference Link and Phelan1995; Williams and Jackson, Reference Williams and Jackson2005). Stereotypes have structural consequences for health because they create and perpetuate social and physical environments inimical to health, and allow White-dominated institutions to devalue Black lives. In turn, health and social inequalities are rationalized as the logical outgrowth of deficiencies in capabilities, culture, and lifestyle (Geronimus and Thompson, Reference Geronimus and Thompson2004; James Reference James2003).
Stereotype-based constructions of Black people can alter socioeconomic trajectories, which matter for health. For example, stereotypes about intellectual deficits may lead teachers to steer students away from academics: “I was pushed into sport and drama at school, when I was good at math and science, because of all these ideas that all black people can do is, you know, dance and run” (Howarth Reference Howarth2006, p. 447). Academic displacement occurs through microlevel interpersonal encounters such as these and macrolevel policies that underfund academic programs in Black neighborhoods. When stereotypes undergird the development of public attitudes and policies, they lead to constricted Black opportunity and adverse health outcomes.
Stereotypes also affect the interpretation of policy. The disproportionate numbers of Black men who are subjects of the criminal justice system is a telling point in fact (Alexander Reference Alexander2009; Loury Reference Loury2002). Stereotypes of Black men as criminal date back to slavery, making it easy for the public to accept dominant narratives about why grossly disproportionate incarceration rates exist for Black men, and about what is fair and appropriate in criminal justice policy (Alexander Reference Alexander2009). Stereotypes about Black women's sexual excess have led to opprobrium about their childbearing. White childbearing is thought of as a personal joy that allows the nation to flourish, but Black reproduction is seen as a form of degeneracy (Geronimus Reference Geronimus2003; Roberts Reference Roberts1997). Perceptions of uncontrolled reproduction by the “unfit,” once finding remediation in negative eugenics, drew the attention of policymakers in the 1990s as they attempted to make Norplant mandatory for women receiving welfare (Roberts Reference Roberts1997). Dorothy Height, former president of the National Council of Negro Women, contended that Black people are seen as problem people, rather than fellow citizens with problems (West Reference West1993). In that light, coercive reproductive policies seem reasonable.
In addition to opportunity structures, stereotypes shape physical environments and infrastructure in Black communities. Much scholarship has shown that neighborhoods bear on health behaviors and outcomes (Kawachi and Berkman, Reference Kawachi and Berkman2003). Thus, to the extent that stereotypes find outlet in Black neighborhoods, they play an important role in health chances. For instance, stereotypes about criminal activity and physical threat are “writ” on the built environment, evincing a heightened sense of defense through excessive security measures and stalwartness in building structure (Vergara Reference Vergara1997). This downgrading of the aesthetics of the physical environment may negatively affect health by creating an aesthetically demoralizing environment that increases distress (Steptoe and Feldman, Reference Steptoe and Feldman2001). Cannuscio et al. (Reference Cannuscio, Weiss and Asch2010) argued that bulletproof glass and other symbols of a “siege-ready environment” are demeaning signs that though their dollars are accepted, the community is feared. One study respondent stated, “It's like going into a prison or something … you shove your money in there and then they shove the food out to you” (p. 559).
Additionally, stereotypes mark Black communities as devoid of spending potential and cultural capital, perpetuating community disinvestment by private actors. For the often health-destabilizing industries that do locate in Black neighborhoods, stereotypes are important market drivers. Fast food is disproportionately located in Black neighborhoods (Kwate et al., Reference Kwate, Yau, Loh and Williams2009) in part because of stereotypes: “Chicken and fish fast food operations usually capture high sales in black neighborhoods, especially if the units are located in proximity to a major health service, drugstore, supermarket, or liquor store” (Melaniphy Reference Melaniphy1992, p. 83).
CONCLUSION
Stereotypes of African Americans fuel a moral economy that not only takes an intrapsychic toll on Black minds, but also subtly interweaves policies and practices that subordinate Black people. In this brief article, we noted the varied inflections that permeate characterizations of Black women and men, but research is needed to help us understand the myriad of ways in which stereotypes affect health in direct and indirect ways. One area that needs development is how the gendering of stereotypes about Black people potentially create different exposures to processes that harm health. Intersectionality theory, as it is conceptualized in Black feminist scholarship (Collins Reference Collins1990), highlights multiple identities and social locations.
Our call to attend to stereotyping fits well with the need for broader assessments of racism as a health exposure. Research evidence based solely on interpersonally mediated discrimination is a partial and conservative assessment of how racism affects health (Schulz et al., Reference Schulz, Gravlee, Williams, Israel, Mentz and Rowe2006). Stereotyping ought to be a part of this assessment. Krieger (Reference Krieger1999) argues that because humans literally incorporate the world around them, bodies tell stories that people are unwilling or unable to tell. By studying stereotyping as a manifestation of racism, we can take an important step towards the uncovering of heretofore unheard stories that African American bodies may be trying to tell.
