Appendix A

Glossary¹

RACIAL AND ETHNIC GROUP DEFINITIONS

African American: U.S.-born people who have African ancestry, typically used for descendants of people from Africa who were enslaved in the United States as well as all people of African ancestry who are now citizens or permanent residents.

American Indian or Alaska Native: This population includes people having origins in any of the original peoples of North America, South America, and Central America, who maintain tribal affiliation or community attachment. Although these individuals are also often described along with other racial and ethnic groups, the phrase “American Indian and/or Alaska Native” is distinct because it is used in the context of legally enforceable obligations and responsibilities of the federal government to provide certain services and benefits to members or citizens (and, in some cases, descendants) of federally recognized Tribal Nations. “Indigenous” and “Native American” are also commonly used but not specific enough to describe the special political status of American Indian and Alaska Native Tribal Nations. These people may be served by policies or programs that relate to the U.S. federal government’s trust responsibility and government-to-government relationship with federally recognized Tribal Nations.

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¹ Several of these definitions were drawn or adapted from National Academies and government agency reports.

Asian American: A resident of the United States who self-identifies as Asian or as one of the ethnic or detailed origin groups classified by the U.S. government as Asian; an individual does not need to be a U.S. citizen or permanent resident.

Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. The committee recognizes that the term “Asian” is commonly used in research and acknowledges that it is inadequate to describe the diversity among these groups of people.

Black: A person who was born in or outside of the United States and has origins in any of the Black ethnic groups of Africa. An umbrella term including African American, African, Afro-Caribbean, and other people of African descent.

Hispanic or Latino/a/e: Refers to a person of Mexican, Puerto Rican, Salvadoran, Cuban, or other Latin American and Caribbean cultural origin, regardless of race.

Native Hawaiian or Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, American Samoa, Commonwealth of the Northern Mariana Islands, or other Pacific Islands, including all sovereign/independent Pacific Island countries, including the Compact of Free Association States.

White: A person having origins in any of the original peoples of Europe or the Middle East or North Africa.

Middle Eastern or North African (MENA): Refers to a person from Middle East or North Africa. Until the OMB update in March 2024 on how the federal government collects and reports data on race and ethnicity, the MENA category was included under the “White” reporting category.

Multiracial: people who identify with more than one race.

OTHER TERMS

Community: Any configuration of individuals, families, and groups whose values, characteristics, interests, geography, and/or social relations unite them in some way.

Community-based participatory research: Generally defined as a research approach in which members of the community targeted in the research

project are involved in the research process at every step, from conceptualization to dissemination, and share decision-making power and ownership with the research team.

Ethnicity: In contrast to race, ethnicity has a stronger relationship with place. It is a socially constructed term used to describe people from a similar national or regional background who share common national, cultural, historical, and social experiences.

Health: A state of complete physical, mental, and social well-being and not the absence of disease or infirmity.

Health care: The services provided to individuals, families, and communities for the purpose of promoting, maintaining, or restoring health across settings of care.

Health care system: Activities related to the delivery of care across the continuum of care.

Health disparity: A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to discrimination or exclusion.

Health equity: The attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities and historical and contemporary injustices and eliminate health and health care disparities.

Health-related social needs: Social and economic needs that individuals experience that affect their ability to maintain their health and well-being. These include employment, affordable and stable housing, healthy food, personal safety, transportation, and affordable utilities.

Implicit bias: The neurobiologically based, automatic attitudes and beliefs about particular social groups and their members.

Inclusion: Efforts used to embrace differences; also used to describe how much each person feels welcomed, respected, supported, and valued in a given context.

Institutional racism: Policies and practices within a societies’ institution that, intentionally or not, produce outcomes that chronically favor or disfavor one group of individuals over another based-on race.

Internalized racism: 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.

Interpersonal racism: Racist interactions between individuals.

Intersectionality: The complex, cumulative way in which the effects of multiple elements of identity (such as race, gender, and class) combine, overlap, or intersect, especially in the experiences of marginalized individuals or groups.

Limited English proficiency: A limited ability to read, speak, write, or understand English.

Minoritized populations: Groups that are marginalized or persecuted because of systemic oppression. The term emphasizes that something is being done by others to subjugate certain people, rather than using the permanent label of being a minority.

Oppression: A state in which people have unequal power and the process by which dominant groups use power to subjugate dominated groups.

Optimal health: A dynamic balance of physical, emotional, social, spiritual, and intellectual health.

Personal health literacy: The degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

Population health: The health outcomes of a group of individuals, including the distribution of such outcomes within the group. Population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two.

Race: A socially constructed, shorthand concept dating to the 15th century that categorized populations into an arbitrary, hierarchical classification framework, largely based on phenotypic characteristics, such as skin color. Although race is not a valid biological concept, the construct of race has profound implications on how the health care system is designed and operates

in the United States. It influences the outcome of the individuals experiencing the care, laws and policies pertaining to health care, and how health care is delivered. It is also a social construct that is linked to racism that gives or denies benefits and privileges to racially minoritized people and groups.

Racism: The combination of policies, practices, attitudes, cultures, and systems that affect individuals, institutions, and structures unequally and confer power and privilege to certain groups over others, defined according to social constructions of race and ethnicity.

Social determinants of health (SDOH): Conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Social risks: Specific adverse social conditions associated with poor health and health care–related outcomes.

Structural determinants of health: Macrolevel factors, such as laws, policies, institutional practices, governance processes, and social norms that shape the distribution (or maldistribution) of the social determinants of health, such as housing, income, employment, exposure to environmental toxins, and interpersonal discrimination, across and within social groups. Structural determinants of health, also referred to as the “determinants of the determinants of health,” include structural racism and other structural inequities and thus influence not only population health but also health equity.

Structural or systemic racism: The totality of ways in which a society fosters racial and ethnic inequity and subjugation through mutually reinforcing systems, including housing, education, employment, earnings, benefits, credit, media, health care, and the criminal legal system. These structural factors organize the distribution of power and resources (i.e., the social determinants of health) differentially among racial, ethnic, and socioeconomic groups, perpetuating racial and ethnic health inequities. The key difference between institutional and structural racism is that structural racism happens across institutions, and institutional racism happens within institutions.

Tribal: Describes Tribal Nations in the United States but is also used as an adjective to describe circumstances related to them, such as tribal communities or tribal policies. Not appropriate for Native Hawaiians or Pacific Islanders.

Xenophobia: Attitudes, prejudices, and behavior that reject, exclude, and often vilify persons based on the perception that they are outsiders or foreigners to the community, society, or national identity.

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