Dimension of racism	Definition	Relationship with cultural racism	Examples	Pathways to health
Cultural	Values and belief systems—operating at the level of our shared social consciousness—that privilege and protect White people and power, and are expressed in the language, symbols, and media representations of dominant society	—–	See Appendix 1	Shapes health via structural, institutionalized, personally mediated, and internalized racism Exerts direct effects on health: stereotypical media representations, environmental reminders of White supremacy, and generalized awareness of stigmatized social status cause psychological distress and vigilance, leading to physiological dysregulation and multiple adverse health outcomes.
Structural	Cooperation of multiple social institutions—including housing, health care, education, carceral, banking, among others—to concentrate wealth, power, and ultimately health among White people relative to minoritized racial groups. 5 , 6 , 7 , 76	Cultural racism upholds structural racism Cultural racism reflects structural racism Cultural racism obscures structural racism	Cultural values undergird racialized rules and cross‐institutional policy development Structural arrangements signal who's lives are worth investing in and protecting The color‐blind racial frame (part of cultural racism) attributes social and health disparities to natural and biological differences rather than structural arrangements and inequities	Shape distribution of societal risk and protective factors by race Direct stress caused by major lifetime experiences of discrimination “Chronic contextual stress” 60 associated with the awareness of inequality in society and structural oppression
Institutional	Racism occurring within specific institutional settings, such as schools, the workplace, the judicial system, and medical system 19 , 33	Cultural racism shapes bias and prejudice among agents of institutions (e.g., teachers, doctors, bankers, law enforcement officers) who discriminate based on race	Teachers who disproportionately discipline Black and other racially marginalized students, based on culturally rooted biases that these students are inherently more deviant and dangerous	Same as structural, but focus is on single‐institution pathways (e.g., school‐based discrimination leading to disparate educational trajectories and subsequent health impacts)
		Cultural racism shapes the creation and enactment of racially discriminatory policies within institutions	White racial frame undergirds the creation of algorithms used to make medical diagnoses and treatments, which drives racial inequities in medical screening, diagnosis, and treatment
Personally mediated	Prejudice and discrimination enacted between individuals in day‐to‐day life 19	Cultural racism shapes racial prejudice among individuals operating in society, which in turn drives discriminatory behavior in day‐to‐day life. Cultural racism creates an environment that is more permissive of racial discrimination.	Stereotypical media representations and rhetoric lead to a prejudice that Asian Americans are “perpetual foreigners,” which contributes to stressful microaggressions such as “where are you really from?” Teachers turning a blind eye to race‐based bullying in schools, police officers ignoring or minimizing racial discrimination or hate crimes, or politicians ignoring calls for antidiscrimination policies to promote racial justice	Racial discrimination acts as psychosocial stressor, triggering the body's stress adaptation processes Threat appraisal and dispositions moderate the effects of racism‐related stress on health Adoption of unhealthy behaviors as coping response
Internalized	“The individual inculcation of the racist stereotypes, values, images, and ideologies perpetuated by the White dominant society about one's racial group, leading to feelings of self‐doubt, disgust, and disrespect for one's race and/or oneself” 39	Ideologies and values of White supremacy, as expressed in the language, symbols, and mass media of dominant society become internalized to shape individuals’ self‐views, self‐worth, and behavior.	White beauty standards Colorism Defensive othering	White beauty standards erode self‐esteem and can lead to harmful behaviors such as skin whitening Colorism and defensive othering can lead to cognitive dissonance, psychological distress, harmful compensatory behaviors, and heightened tension and decreased social cohesion