Chapter 13 surveys and assesses the different ways in which election laws and practices impact racial equality in the political process and the distribution of resources and power that stems from those elections. Topics include voter ID laws, felon disenfranchisement, and racial redistricting, as well as immigrant political incorporation and language access. Themed boxes include recent court cases on voter ID, specific voting rights cases, and noncitizen voting.

This chapter describes the role of individuals’ race-related thoughts and feelings in racial disparities in healthcare. Racial treatment disparities exist across a wide variety of medical settings and problems. Race-related thoughts and feelings – both implicit and explicit – play an important role in Black people receiving poorer healthcare. They affect the quality of communication between non-Black physicians and Black patients. Good physician–patient communication is critical to effective treatments; however, on average, communication is poorer in racially discordant (i.e., cross-race) medical interactions than racially concordant (i.e., same race) ones. Specific race-related thoughts and feelings, such as racial bias and medical mistrust also affect the quality of healthcare. Most physicians claim to be color blind when treating their patients but, in fact, physicians’ explicit and implicit racial bias negatively affect their perceptions of Black patients and how they act toward them. The behaviors of high implicit bias physicians can often have a negative impact on their Black patients. Black patients’ experiences with racial discrimination also affect race-related thoughts and feelings relevant to their medical care. Experiences with discrimination can result in greater medical mistrust, which makes people less likely to (1) experience positive outcomes from their healthcare and (2) engage in health-promoting behaviors.

This chapter is about the origins of anti-Black racism in the United States. It describes two separate but related processes. The first process involves historical events, of which slavery is the most important. In addition to systemic exploitation and degradation of enslaved people, slavery produced beliefs that enslaved people were inferior human beings. Reinforcing these beliefs was scientific racism – supposedly scientific theories that purported to prove the innate inferiority of Black people. Even after slavery ended, economic competition, racist laws, and social norms created social and economic disadvantages for Black people. The second process involves the ways humans think about the people they encounter. Humans place themselves and other people in social groups largely based on physical characteristics, particularly those that society considers to be important. Perceived race is a major determinant of how people socially categorize others, which forms the psychological foundation for racial biases at both the conscious and nonconscious levels. Thus, even in the absence of malevolent intent, it is likely that people will develop negative racial beliefs and feelings. These biases lead to the tendency of White Americans to justify the disadvantages experienced by Black Americans by attributing them to inherent defects in Black people.