Levels of racism: A theoretic framework and a gardener's tale

The author presents a theoretic framework for understanding racism on 3 lev els: institutionalized, personally mediated and internalized. This framewor k is useful for raising new hypotheses about the basis of race-associated d ifferences in health outcomes, as well as for designing effective intervent ions to eliminate those differences. She then presents an allegory about a gardener with 2 flower boxes, rich an d poor soil, and red and pink flowers. This allegory illustrates the relati onship between the 3 levels of racism and may guide our thinking about how to intervene to mitigate the impacts of racism on health. It may also serve as a tool for starting a national conversation on racism.