Racism and the Life Course: Taking Time Seriously

摘要

The adage “time is money” signifies that time itself is a major social resource, but the role of time as a determinant of health inequities remains underappreciated. Time is fundamental to health promotion and human agency, as in having time to exercise and maintain social relationships. Further, scarcity in time is related to stress and illness. Time is also racialized, such that racial/ethnic minorities often have less free time and suffer a time penalty in multiple facets of life. Such penalties manifest in problems such as greater time in prison or more time spent accessing services. We argue that time may be a social determinant of health that is shaped by racism across the life course. We focus on three aspects: time as age, time as exposure, and time as a resource and privilege. We distinguish between chronological age, biological age, and social age. We discuss issues of accelerated aging and potential interconnections with critical periods. We also examine racial inequities in time. By more deeply considering time, we may advance our understanding of racial inequities in health. The study of racism and its manifestations, such as racial discrimination, has become increasingly important in the study of health inequities. More often than not, reports of discrimination are associated with greater morbidity. 1,2 This body of work has expanded to consider new outcomes and social groups, not only within the United States but across the world. The greatest recent strides in research may include an elaboration as to the types of biomarkers, often connected to stress and allostatic load, that are related to self-reported discrimination. Nonetheless, as we take stock in the body of research, there is still much room to deepen our understanding. The perspective of intersectionality emphasizes that racism is connected to other systems of inequity. Borrowing from that perspective, we examine how time may be related to racism, aging and the life course, and health inequities. Racism is an organized and dynamic system in which the dominant racial group, based on a hierarchical ideology, develops and sustains structures and behaviors that privilege the dominant group, while simultaneously disempowering and removing resources from racial groups deemed inferior. 2 In the US context, Whites are the privileged group that benefits from racism. Racism operates on multiple levels, and manifests through differential societal policies and norms, unfair treatment by social institutions, and negative beliefs (stereotypes), attitudes (prejudice), and behaviors (discrimination) toward nondominant racial groups. Historically, in the United States, racism has been sustained through explicit policies and practices, such as slavery, the Indian Removal Act, the internment of Japanese Americans, and Jim Crow laws. In contemporary society, racism still persists in institutional policies (e.g., residential segregation, mass incarceration, immigration policies, voter suppression) and societal norms that are often unrecognized (e.g., using Whites as the reference group to which others are compared). 3 At the individual level, racial bias persists through both explicit and intentional discrimination, and also through implicit (unconscious) and automatic processes. 2 Although these multiple levels of racism are often studied separately, they are reciprocally interdependent and dynamically reinforce each other. 4 The net effect of racism is to constrain agency among people of color, and to foster racial inequity in opportunities and outcomes. Racism shapes the life course, a perspective for understanding how human experiences unfold over time. 5 At the interpersonal level, the life course perspective recognizes that development is not simply the addition of age to a person’s life, progression through predictable stages, or cellular aging and senescence. Rather, it emphasizes that human development is profoundly social: the ages of 18, 21, 65, and 100 years are more important for social, legal, and symbolic implications than for biological reasons. Progression through the life course means that individuals interact with a variety of new social institutions that all have the potential to discriminate. Studies are emerging that document how discrimination unfolds over the life course. Time is a critical component of the life course, which needs to be understood in all of its complexity. This includes time as age, time as exposure, and time as resource. (For space reasons, we will not discuss other dimensions of time such as historical period, cohorts, and cumulative disadvantage.) The box on page S46 summarizes these ideas, which are elaborated in this commentary. Recommendations for Studying Time and Racism Recommendation Rationale Disentangle chronological, biological, and social age. Chronological age may have a different relationship to health compared with biological age and social age. Some research suggests that racial minorities may