Racism is a deeply ingrained system of prejudicial patterns and behaviours that permeates every aspect of society. It exerts a multifaceted and generational influence on health that is difficult to eliminate. Over the past century, substantial empirical evidence has demonstrated how racism adversely affects the health and well-being of Black Americans. Interpersonal racism occurs when individuals treat members of specific racial groups unfairly. It is characterized by discrimination rooted in assumptions about others’ skills, intentions, and motives.
Structural racism refers to laws, procedures, and institutional policies that create discriminatory outcomes in American institutions. Despite the legal prohibition of overtly inequitable policies, covert implementation persists in various areas, including criminal justice, employment, housing, and healthcare. The ideology and set of shared views, along with material cultural expressions of beliefs in the form of artwork, traditions, and lifestyles, were considered the main subjects of cultural racism.
The study aims to validate a theory-informed measure of cultural racism using self-report and non-self-report variables. A reflective measurement model was employed to investigate the cultural racism factor (CRF) and its underlying latent structure. The basic model loaded all nine indicators into a single factor with no associated measurement errors. Mortality data were derived from the underlying cause of death reported on physician-certified death certificates.
For analysis, age-adjusted mortality rates per 100,000 people were standardized to the 2000 United States (U.S) population. Deaths were categorized using ICD-10 codes: C00–C97 for cancer, 100 to 199 cases for cardiovascular, and E10 to E14 for diabetes. The National Vital Statistics System website for Life Expectancy provided data for 2018-2020 on life expectancy at birth. A linear mixed-effects model was used to evaluate the variation in outcomes explained by each racism measure.
Only 34 states reported figures on Confederate public symbols per 100,000 population. Sample sizes were not predetermined using statistical techniques. The statistical computer software R was used for all data analysis. Model 3 was selected as the final model based on both theoretical coherence and statistical adequacy. In the completed CFA model, the average variance extracted (AVE) was 0.45 with a 90% confidence interval (CI).
Internal consistency, reflecting measurement of a single construct, was adequate: the CRF’s mean inter-item correlation was 0.31, which was within the acceptable range of 0.15 to 0.5. Correlations between the CRF and other measures were substantial but not identical, as indicated by the CRF’s substantial but not perfect correlations with 90% CI; r = 0.66; and P = 1.7 x 10⁻⁷.
The demographics-adjusted model showed a two-year decrease in life expectancy at birth for every one-unit increase in the CRF. These findings underscore the persistent and measurable effects of cultural racism on population health. Long-term and evidence-informed interventions are needed to eliminate racial health disparities and improve health outcomes.
Reference: Akinyemiju T, Osazuwa-Peters OL, Brown TH, et al. A latent measure of cultural racism and its association with US mortality and life expectancy. Nat Hum Behav. 2025. doi:10.1038/s41562-025-02290-7
