You know the old saying, “It’s hard for a fish to see the water in which it swims?” That’s true! And in the United States, we are all swimming through a polluted ocean. More of us are starting to see the icebergs and reefs that structure our watery landscape, in part because we are starting to understand that the wreckage that they cause is not “natural.” But we have been slower to see the water. And we need to see both, because it is the very murkiness of this water in which we swim that makes it hard for us to see the structures that harm and divide us.

We swim in an ocean of racism. Racism is the system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call “race”), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.

There are a lot of pearls in that one-sentence definition. First, that racism is a system, not an individual character flaw, not a personal moral failing, not even a psychiatric illness, but a system of power. Second, that so-called “race,” the substrate on which racism operates, is not in our genes but is the social interpretation of how one looks in a “race”-conscious society. Third, that racism has three impacts: unfairly disadvantaging some while unfairly advantaging others, but also sapping the strength of the whole society through the waste of human resources. And finally, that racism operates in two ways: both by structuring opportunity and by assigning value.

Structuring opportunity: the icebergs and reefs and wreckage of our ocean.

Assigning value: the water in which we swim.

We already know many of the structural targets for anti-racism action: residential segregation by “race”; funding of public schools based on local property taxes; over-policing of communities of color; disproportionate incarceration of Black and Brown people; communities of color as environmental “sacrifice zones.”

But we may have neglected the values targets for anti-racism action. I would like to present seven candidates for our consideration:

• Narrow focus on the individual
• A-historical stance
• Myth of meritocracy
• Myth of a zero-sum game
• Limited future orientation
• Myth of American exceptionalism
• White supremacist ideology

I used to simply describe these as cultural or societal barriers to achieving health equity. I have since come to recognize that four of these seven—the narrow focus on the individual, a-historical stance, myth of meritocracy, and White supremacist ideology—directly contribute to the staunch racism denial so prevalent in our nation, and that all seven inhibit our ability to create a society in which all people can know and develop to their full potentials.

Narrow focus on the individual. In the United States, we are so narrowly focused on the individual that it makes systems and structures invisible or seemingly irrelevant. Our sense of self-interest is very narrowly defined, often including only our immediate households and not even extending to aunts, uncles, and cousins, much less to neighbors or to strangers across town. Many of us do not have a sense of interdependence, that “There but for the grace of God go I” or “We’re all in this together.” This narrow focus on the individual also constrains our effectiveness in trying to change things, because we ask ourselves “What can I do?” as rugged individuals, instead of understanding the power of collective action and asking, “What can WE do together?”

A-historical stance. In this country, we are a-historical, acting as if the present were disconnected from the past and as if the current distribution of advantage and disadvantage were just a happenstance. And being a-historical also constrains our understanding of how to make change happen. If things were a certain way when we were born, we assume that they have always been that way and will always be that way. If we do not fully understand how things came to be the way they are or learn from the history of past movements for change, our current view of what is possible and how to get to a better future will be limited.

Myth of meritocracy. Our national admonishment to “Pull yourself up by your bootstraps,” our celebration of the Horatio Alger story, our insistence that this is the land of equal opportunity—these are all vigorous endorsements of the myth of meritocracy, that “If you work hard, you will make it.” I give you that most people who have made it in this country have worked hard. (Mind you, not all people who have made it have worked hard, and we currently have prominent examples of some exceptions.) But even as we acknowledge that most people who have made it have worked hard, we must also recognize that there are many, many other people who are working just as hard—or harder—who will never make it because of an uneven playing field. And that uneven playing field has been structured and is being maintained by racism, sexism, heterosexism, capitalism, and other systems of structured inequity.

To the extent that we deny racism, we are endorsing the myth of meritocracy and blaming folks who do not make it, labeling them as lazy or stupid. There are many ways to deny racism. One way is to say, “Racism does not exist.” Another way is to never say the word “racism.” Because even if we are talking about “disparities” or “disproportionalities” or “diversity, equity, and inclusion” or “implicit or unconscious bias” or “cultural competence” or “structural competence” or even “race,” if we never say the word “racism” in our national context of widespread racism-denial, we are complicit with that denial.

Myth of a zero-sum game. This is the myth that “If you gain, I lose” which fosters competition over cooperation, masks the costs of inequity (the reality that racism is sapping the strength of the whole society through the waste of human resources), and hinders efforts to grow the pie. It is as if I don’t want you to come to my dinner table because I think that you will just come and eat up all of the food, without recognizing that you are bringing all kinds of cakes and pies and roasts and fruits and salads with you. It comes from two deeply held beliefs, that you have nothing of value to offer and that I have everything that I need at my table. Neither of those beliefs is ever true. Each of us has something to teach, and each of us has something to learn.

Limited future orientation. Two parts of the future that each of us can touch today are the children and the planet. In this country, we exhibit a disregard for the children. We do not have the “seven generations” perspective that many American Indian nations do when they consider the impacts of their actions. Nor do we have a “How are the children?” focus like many East African peoples do when they greet one another with the question “How are the children?” and hope to get the response “All the children are well.” We rarely inquire about the well-being of our nation’s children, and when we do, we certainly do not get the answer that “All the children are well.” The impact of our lack of future orientation with regard to the children is compounded by our usurious relationship with the planet.

Myth of American exceptionalism. This is the myth that the United States is so special, so different, so unique, so blessed that the rules for others may not apply to us. Endorsement of this myth gives us a false sense of entitlement and makes us disinterested in learning from the experiences of other nations. Oh, that we would drop our false pride and learn from how other countries are more successfully handling the COVID-19 pandemic. Tens of thousands of lives would have already been saved. Our families would not be so devastated, our communities would not be in such crisis, and we would still have access to the lost genius and leadership that could have helped the nation and the world navigate this global crisis.

White supremacist ideology. White supremacist ideology is the false belief that there exists a hierarchy of human valuation by “race” and that puts “White” people at the top of this fictional hierarchy as the ideal and the norm. This ideology has given people who are living as “White” a sense of entitlement, resulted in the dehumanization of people of color, and led to the fear by some at the “browning of America” that underlies much of our political divide today.

Approaches to addressing these seven values targets will involve all of us. We need to augment our curricula at all levels of education to name racism and prevent another generation from being lulled into the somnolence of racism denial. We need to teach our full histories. We need to change the media practices that make some of us at times invisible and at other times hyper-visible. Perhaps our religious institutions will need to get involved. We will need to burst through our bubbles of experience to realize that folks across town are just as kind, funny, generous, hard-working, and smart as we are, but are living in very different circumstances. We need to become interested in the stories of others, believe the stories of others, and then join in the stories of others.

This is my invitation to all of us to join in and become actively anti-racism. And my observation that to be effective, we need to both see the murky water and dismantle the treacherous structures that it hides. When we do, we can all swim free.

Camara Phyllis Jones, MD, MPH, PhD, is a family medicine physician, epidemiologist, and anti-racism activist. She is a Past President of the American Public Health Association and was the 2019-2020 Evelyn Green Davis Fellow at the Radcliffe Institute for Advanced Study at Harvard University. She has taught at the Harvard School of Public Health, Morehouse School of Medicine, and Rollins School of Public Health and has also served as a medical officer at the Centers for Disease Control and Prevention.

**Feature photo by Kelly Lacy from Pexels

Interested in contributing to the Harvard Primary Care Blog? Review our submission guidelines

Interested in other articles like this? Subscribe to our bi-weekly newsletter