Racism and Health - Building Mental Wealth

Author'spersonalcopy478 Racism and Healthgroup while determining the extent of group discriminationin comparison to other ethnoracial groups. The use ofdifferent standards of comparison (which may result in this‘discrepancy’) raises broader questions about the cognitiveprocesses involved in reporting racism.Other research has demonstrated that self-reportedracism is not related to neuroticism, hostility, cynicism,social desirability, or impression management. Conversely,reports of racism have been found to relateinversely to both self-deception (i.e,. a pervasive lack ofinsight) and self-affirmation. Moreover, as noted by Clark(2004), it is not known to what extent individuals habituateto experiences of racism and how this affects processesthat may be related to health and well-being. In thecontext of such difficulties in operationalizing racism,the next section considers the ways in which racism canbe characterized as a determinant of health.Characterizing RacismTo date, the vast majority of research on racism and healthhas focused on perceived racism (and, more specifically,perceived racial discrimination). Figure 2 details the rangeof dimensions across which perceived racism has been characterizedin health research, including dimensions of exposureto racism as well as possible reactions and responses tothis exposure. As discussed previously, racism can be due toeither oppression or privilege. However, virtually noresearch has been conducted in relation to racism as privilegeand its association with health. As a result, the characterizationof racism in Figure 2 (and as discussed later)relates only to the oppressive aspects of perceived racism.The characteristics of racism include its mode, form,level, expression, and setting as well as its perpetratorsand targets. Racism can take a variety of forms includinglegal or illegal, direct or indirect, overt or covert, blatantor subtle, as well as vicarious by way of other targets ofracism such as family or friends. Racism can also beunintentional as well as intentional and may occurthrough both action and inaction.Some scholars contend that racism can occur betweenindividuals of the same ethnorace (intraracially) as well asbetween individuals of different ethnoraces (interracially).However, there is continuing debate in this field as towhether intraracial racism should be accepted as a formof racism. Although some argue that members of minorityethnoracial groups lack the power to be racist, it is wellestablished that minority group members discriminateagainst each other on the basis of racial characteristicssuch as skin color, and it is probable that such behavioraffects the social power of those targeted. While very littleresearch has examined intraracial racism, there is preliminaryevidence of its deleterious effect on health.Racism can be expressed through stereotypes, prejudice,or discrimination – that is, racist beliefs (cognition),emotions (affect), and behaviors, respectively – in a rangeof settings that correspond to the institutions representedin the structural realm of Figure 1. There is also a rangeof possible perpetrators or targets of racism, some ofwhich are shown in Figure 2. Exposure to racism canoccur at different stages of the life course with varyingfrequency at a range of intensities in relation to mental orphysical stress. The duration of exposure to racism canalso vary from fleeting to constant and can occur cumulativelyacross settings or over time.Reactions/responses to racism may be cognitive, affective,or behavioral and in active or passive as well asadaptive or maladaptive forms. Self-blame is a cognitive,active, maladaptive response that occurs when a racistexperience is given an internal attribution by an individual(i.e., through self-blame). In contrast, the cognitive,active, adaptive response of system-blame occurs when aracist experience is given an attribution external to theself. Another cognitive, maladaptive, active response toracism is hypervigilance in which an individual devotes anextreme amount of cognitive effort to anticipating racism,attempting to prevent racism, or in determining whetherracism has occurred. This coping response can result inadditional stress above and beyond the direct effects ofracism itself. ‘Denial of racism’ and ‘self-blame’ (activeresponses) and ‘resigned acceptance’ (passive response)are cognitive responses that negate the need to processexperiences of racism at all.Affective or emotional responses to racism can beclassified as either inner-directed or outer-directed.Inner-directed, disempowered, affective responses canbe either active (e.g., shame, self-hatred, humiliation,anxiety, fear, resentment) or passive (e.g., powerlessness,hopelessness, confusion, depression), while outerdirected,emotional responses, which are by definitionactive, can be either empowered or disempowered.Empowered responses occur when an individual whoexperiences racism projects inferiority onto the perpetratorand feels contempt, amusement, and/or sorrow orsympathy for them, while disempowered responsesinvolve emotions such as anger, hatred, annoyance, orfrustration.Behavioral responses to racism can either be adaptive ormaladaptive and within these categories can be problem- oremotion-focused. As with affective responses, adaptivebehavioral responses can be inner- or outer-directed.Inner-directed, problem-focused, adaptive responsesinclude avoiding situations in which racism is likely tooccur as well as strategic decisions not to respond to racism.Inner-directed, emotion-focused, adaptive responsesinclude contemplative/relaxing techniques such as prayingand meditation, while outer-directed, adaptive, behavioralresponses include the exclusively problem-focused approachInternational Encyclopedia of Public Health, First Edition (2008), vol. 5, pp. 474-483

personalcopyRacism and Health 479Characteristics of RacismMode: Inter- vs. intraracialForm: (Il)legal, blatant/subtle, (in)direct (vicarious), (c)overt, (un)intentional, (in)actionLevel: Internalized (dominance and oppression), interpersonal, systemicExpression: Stereotype, prejudice, discriminationSetting : Domestic/familial, academic/educational, employment, media, police/security,legal/justice, administrative/political, housing/infrastructure, financial, health,goods/services, recreational, publicPerpetrators/Targets: self, family, friends, ethnoracial groups, neighbors, acquaintances,employers/ees, peers, pets, property, strangers, officials, practices, policies, lawsExposure to RacismTiming: Intrauterine, infancy, childhood, adolescence, early/middle/late adulthood, elderlyIntensity: Degree of induced mental or physical stress (i.e., cognitive or allostatic load)Frequency: Acute/chronic, sporadic/regular, weekly, monthly, yearlyDuration: Fleeting, prolonged, constant, cumulativeReactions/Responses to RacismCognitiveActive: Adaptive – rejecting dominant ideology, strengthened ethnoracial identity,system blame, imagining responses to racism; maladaptive – hypervigilance(i.e. attribution anxiety), denial of racism, self-blamePassive: Maladaptive – adopting dominant ideology, weakened ethnoracial identity,resigned acceptanceAffectiveInner-directed disempowered: Active – shame, self-hatred, humiliation, anxiety, fear,resentment; Passive – powerlessness, hopelessness, confusion, depressionOuter-directed: Empowered – contempt, amusement, sorrow/sympathy;disempowered – anger, hatred, annoyance, frustrationBehavioralInner-directed adaptive: Problem-focused – passing, avoidance, strategic responses;emotion-focused – praying, meditationOuter-directed adaptive: Problem-focused – verbal, physical, or legal confrontation;emotion/problem-focused – establishing and utilizing social networks/safe spaces, writing,drawing, singing, or painting about racismMaladaptive: problem-focused – passing, over/under achievement/striving (e.g. stereotypethreat), retaliatory violence; emotion-focused – alienation from one’s ethnoracial group, risk taking/self-harming activitiesFigure 2 Characterizing oppressive perceived racism as a determinant of health. Reproduced from Paradies Y (2006a) Defining,conceptualizing and characterizing racism in health research. Critical Public Health 16(2): 143–157.of confronting the perpetrator(s) as well as establishingand/or using social networks and expressing/discussingracist experiences, which can act as either problem- oremotion-focused approaches, depending on the situation inquestion.Over- and underachievement or striving are maladaptive,problem-focused, behavioral responses to racism.The phenomenon of ‘stereotype threat’ is an exampleof underachievement that occurs when a negative stereotypeabout one’s ethnorace causes self-stigmatizationand reduced performance in an activity or situation.Retaliatory violence after experiencing racism is also anexample of a maladaptive, problem-focused, behavioralresponse. Emotion-focused, maladaptive, behavioral responsesinclude alienation from one’s ethnoracial groupmembers and risk-taking and/or self-harming activities.Finally, ‘passing’ is a problem-focused response,available to some people in some contexts, in which anindividual’s ethnoracial identity is either not deployed, oris denied to avoid racism. Passing can be either adaptive ormaladaptive with the short-term benefit of avoiding racistsituations but long-term risk of weakening ethnoracialidentity and social isolation from one’s ethnoracial group.Racism, Health, and Well-BeingHaving detailed how the oppressive aspects of perceivedracism have been explicitly studied in public health, wecan now turn to a discussion of findings from this recentbody of research, which focus primarily on perceivedracial discrimination. First, however, let us consider thesmaller body of research that has explicitly examinedracism using indirect methods. This research has focusedprimarily on racial discrimination in health care as well asresidential segregation.International Encyclopedia of Public Health, First Edition (2008), vol. 5, pp. 474-483

Author'spersonalcopy480 Racism and HealthIndirect Studies of RacismIt is undeniable that the most pernicious effects of racismon health are exerted through institutional mechanismsthat are difficult to measure in standard epidemiologicalstudies. Residential racial segregation that refers to thephysical separation of ethnoraces in different residentialareas is one example of such an institutionalized mechanism.Historically, the dominant group in many racializedsocieties has restricted the areas in which nondominantgroups could reside. In countries like the United Statesand South Africa, residential segregation has persistedlong after the legal codes supporting them were repealed.Research from the United States reveals that residentialsegregation is a neglected but enduring legacy of racismthat adversely affects the health of African-Americans inmultiple ways. Residential segregation restricts access toeducation and employment opportunities and is a centralmechanism by which racial differences in SEP have beencreated and reinforced. Accordingly, all indicators ofSEP are strongly patterned by ethnorace, and ethnoracialdifferences in SEP contribute to ethnoracial disparities inhealth.Segregation also results in unhealthy physical andsocial environments for minority ethnoracial groupsthrough either the poor quality or high cost of nutritiousfoods, a lack of appropriate recreational facilities, exposureto toxic environmental substances, a high level ofcriminal victimization, and more retail outlets for (andexcessive marketing of ) alcohol and tobacco. Medical careis also of poorer quality in segregated areas, with segregationcontributing to racial disparities in preventive,screening, diagnostic, treatment, and rehabilitation services.Furthermore, the concentrated poverty and cumulativedisadvantage of segregated neighborhoods canresult in increased exposure to chronic stressors.U.S. research indicates that due to residential segregation,the worst urban residential conditions for Whites aresuperior to the average residential conditions for Blacks.Several empirical studies have also found that highlysegregated areas have higher rates of infant and adultmortality, as well as certain chronic and infectiousdiseases.In relation to health care specifically, recent researchhas demonstrated that despite presenting with the sameclinical indications and being treated at the same healthcareinstitution with the same health insurance coverage,members of ethnoracial minorities are less likely toreceive appropriate medical care (e.g., cardiovascular,renal, and general surgical procedures) than members ofdominant groups such as Whites (see, e.g., Smedley et al.,2003). Furthermore, research has found that health providerscontribute to this systemic racism by way of clinicaldecisions that are influenced by both explicit (VanRyn et al., 2006) and implicit (Green et al., 2007) racistperceptions of minority ethnoracial groups. This is anemerging area of research and further work is requiredto determine what contribution racism makes to ethnoracialdifferentials in medical care.Direct Studies of RacismA recent review by Paradies (2006b) demonstrated astrong association between self-reported racism and illhealth after adjustment for a range of confounders. Evidencefrom longitudinal studies also suggests that selfreportedracism precedes ill health rather than vice versa.Furthermore, the few dozen studies of racism and healththat have included both black and white populationsdemonstrate that self-reported racism accounts for someof the Black–White disparity in health outcomes.The most consistent finding in this body of research isthe association between racism and mental (ill) healthsuch as psychological distress, depression, and anxiety.Racism also appears to be consistently associated withmaladaptive behaviors such as smoking, alcohol, and substancemisuse. Although racism has been associated withobjectively measured physical health outcomes such aslow birth weight and hypertension, the overall evidencefor an association between self-reported racism and physicalhealth is more equivocal than the concomitant associationwith mental health.There are a number of reasons that could explain whyself-reported racism is more strongly associated withmental rather than physical health. Because most researchin this area has measured health via self-report, it ispossible that the association between racism and mentalill health is exaggerated due to biases arising from the selfreportingof both exposure and outcome (Paradies,2006b). If not caused by measurement artifice, the relativelyweaker association between racism and physicalhealth may be due to a delayed effect of racism on physicalhealth that is mediated by mental ill health. However,we are aware of no longitudinal studies that could shedlight on this possibility as no such studies, to our knowledge,have examined the interactions between mental andphysical health outcomes and self-reported racism.Future DirectionsThe relatively stronger association between self-reportedracism and mental health outcomes raises questions aboutthe mechanisms by which racism affects health. It iscurrently unclear what combination of pathopsychologicaleffects on the mind and/or direct or indirect (i.e.,through other body systems) neurophysiological changesmediate the association between self-reported racism andill health. As suggested by Harrell et al. (2003) and MaysInternational Encyclopedia of Public Health, First Edition (2008), vol. 5, pp. 474-483

Author'spersonalcopyRacism and Health 481et al. (2007), studies that employ pharmacological blocksand functional neuroscience approaches may shed lighton the psychophysiology of racism. Researchers in thefield of stress are now examining biomarkers specificto body systems (i.e., cardiovascular, neuroendocrine,immune) with evidence emerging that particular stressorsdifferentially affect physiological systems. Evidence thatracism is more strongly associated with diastolic, thansystolic, blood pressure is an example of such specificity.Clearly, further physiological research on racism isrequired to uncover the biological processes throughwhich this phenomenon affects health. Moreover, thecontinuing debate on whether racism is a form of stressor a construct separate from stress (with evidence thatstress both mediates and moderates the relationshipbetween racism and health), may also be resolved throughsuch psychophysiological research.Other than preliminary evidence that a heightenedsense of ethnoracial identity attenuates the adverse effectsof self-reported racism on health, there has been limitedresearch on moderation/mediation of the relationshipbetween racism and health. Similarly, other than someevidence that the active coping is associated with betterhealth outcomes than passive coping, little is known aboutthe efficacy of various responses/reactions to racism inrelation to health.There has also been a scarcity of research on thehealth effects of racism across ethnoracial groups, withmost studies focusing only on African-Americans. Evenamong studies that do consider racism across ethnoracialgroups, it is common to statistically adjust for ethnoracerather than undertake stratified analyses. More nuancedanalysis will be required to understand the degree towhich associations between self-reported racism andhealth vary across ethnoracial groups. As part of suchresearch, the privileging aspects of racism for dominantethnoracial groups (e.g., Whites) could also be investigatedand further examination of intraracial racism mayresolve the continuing conceptual debate centered on thisphenomenon.Future research in this field of study is also required tocharacterize the multiple pathways through which institutionalizedracism affects health. Furthermore, despiteevidence of an association with ill health, limited attentionhas been focused on internalized racism. Work isneeded to identify the best approach to assessing thisphenomenon and to determine its impact on populationhealth.A significant limitation in this field is that directapproaches to studying racism have relied too heavilyon single-item and unvalidated measures of self-reportedracism, which are of limited utility (Paradies, 2006b). Thereare, however, three instruments that have been commonlyused to assess self-reported racism in this field: the EverydayDiscrimination Scale (Williams et al., 1997), Experiences ofDiscrimination scale (Krieger et al., 2005) and the Scheduleof Racist Events (Landrine et al., 2006). Given thatthese instruments have been subjected to psychometricvalidation and are able to assess different types of oppressionacross a range of ethnoracial groups, future researchshould (where possible) use these instruments ratherthan developing measures de novo.Only a minority of direct studies of racism have specifieda time frame over which exposure to racism should bereported by respondents and there is ongoing debate onthe appropriateness of specifying time frames for selfreportedracism. Utsey and Ponterotto (1996) have arguedthat an unspecified time frame is appropriate given thelong-lasting nature of racist experiences. However, it isunclear whether respondents report recent and/or highlysalient/traumatic experiences of racism when respondingto questions without a specified time frame. Also, Blanket al. (2004) have noted that the inclusion of an explicittime frame on surveys is necessary to estimate the rate ofexposure and to avoid confounding time-series analyses.By measuring self-reported racism with and without specifiedtime frames in the same study, as well as investigatingdiary methods that capture events as they occur (Hillet al., 2004), future research will be able to shed light onthis unresolved issue.Most research in this emerging field has assessed selfreportedinterpersonal racism. As such, further research oninternalized racism, vicarious racism (racism experiencedby family or friends), systemic racism, and setting-specificracism (e.g., racism in the workplace) is warranted. Psychologicalresearch into the factors affecting perception, attribution,and reporting of racism (including the interplaybetween objective and subjective racism) is also required,especially studies that can uncover the factors affectingrespondents’ retrospective estimate of racism exposureacross a range of settings, contexts, and time frames.Measuring exposure to racism in its full complexityrequires attention not only to racist incidents over the lifecourse, but also to the potential intergenerational effectsof racism. Historical trauma is the cumulative psychologicalwounding of an individual and his/her ethnoracialgroup due to a history of genocide and oppression. Theimportance of assessing this dimension of racism is highlightedby recent research on the health effects of historicaland transgenerational trauma in relation to AmericanIndians and Indigenous Australians, respectively. Assessmentinstruments with good psychometric propertieshave been developed to assess historical trauma andhave found, for example, that some 50% of AmericanIndians think regularly about these historical losses.Empirical studies have also linked exposure to historicaltrauma to multiple poor health outcomes, emphasizingthe need for further research on this aspect of racism.The study of racism and health is a newly emergingarea of study in public health. It is clear that conceptualInternational Encyclopedia of Public Health, First Edition (2008), vol. 5, pp. 474-483

Author'spersonalcopy482 Racism and Healthclarity and rigorous, theoretically based empiricalresearch will be required to both unravel the complexpathways through which racism acts as a determinant ofhealth and to help address the deleterious effect of racismon health and well-being.AcknowledgmentsYP is supported by the CIPHER Program, which is anAustralian National Health and Medical Research CouncilPopulation Health Capacity-Building Program(#236235) and an in-kind project of the CooperativeResearch Centre for Aboriginal Health.See also: Health-Related Stigma and Discrimination;Race, Human Variation, and Health, The Interaction of.CitationsBlank R, Dabady M, and Citro C (2004) Measuring Racial Discrimination.Washington, DC: National Academies Press.Clark R (2004) Significance of perceived racism: Toward understandingethnic-group disparities in health, the later years. In: Anderson NB,Bulatao RA, and Cohen B (eds.) Critical Perspectives on Racial andEthnic Differences in Health in Late Life, pp. 540–566. Washington,DC: National Academy Press.Green AR, Carney DR, Pallin DJ, et al. (2007) Implicit bias amongphysicians and its prediction of thrombolysis decisions for black andwhite patients. Journal of General Internal Medicine 22(9):1231–1238.Harrell JP, Hall S, and Taliaferro J (2003) Physiological responses toracism and discrimination: an assessment of the evidence. AmericanJournal of Public Health 93(2): 243–248.Hill CV, Neighbors HW, and Gayle HD (2004) The relationship betweenracial discrimination and health for Black Americans: measurementchallenges and the realities of coping. African American ResearchPerspectives 10: 89–98.Jones CP (2000) Levels of racism: A theoretic framework and agardener’s tale. American Journal of Public Health 90(8):1212–1215.Krieger N, Rowley D, Hermann AA, Avery B, and Phillips MT (1993)Racism, sexism and social class: implications for studies of health,disease, and well-being. American Journal of Preventive Medicine9(6): 82–122.Krieger N, Smith K, Naishadham D, Hartman C, and Barbeau EM (2005)Experiences of discrimination: validity and reliability of a self-reportmeasure for population health research on racism and health. SocialScience and Medicine 61(7): 1576–1596.Landrine H, Klonoff EA, Corral I, Fernandez S, and Roesch S (2006)Conceptualizing and measuring ethnic discrimination in healthresearch. Journal of Behavioral Medicine 10: 1–16.Lauderdale DS (2006) Birth Outcomes for Arabic-named Women inCalifornia Before and After September 11. Demography 43(1):185–201.Mays VM, Cochran SD, and Barnes NW (2007) Race, race-baseddiscrimination, and health outcomes among African Americans.Annual Review of Psychology 58: 201–225.Nazroo JY and Williams DR (2006) The Social Determination of Ethnic/Racial Inequalities in Health. In: Marmot M and Wilkinson RG (eds.)Social Determinants of Health, 2nd edn., pp. 238–266. Oxford, UK:Oxford University Press.Paradies Y (2006a) Defining, conceptualizing and characterizing racismin health research. Critical Public Health 16(2): 143–157.Paradies Y (2006b) A systematic review of empirical research on selfreportedracism and health. International Journal of Epidemiology35(4): 888–901.Smedley BD, Stith AY, and Nelson AR (2003) Unequal treatment:confronting racial and ethnic disparities in health care. Washington,DC: National Academy Press.Utsey SO and Ponterotto JG (1996) Development and validation of theindex of race-related stress (IRRS). Journal of CounselingPsychology 43(4): 490–501.Van Ryn M, Burgess D, Malat J, and Griffin J (2006) Physicians’perceptions of patients’ social and behavioral characteristics andrace disparities in treatment recommendations for men with coronaryartery disease. American Journal of Public Health 96(2): 351–357.Williams DR, Yu Y, Jackson JS, and Anderson NB (1997) Racialdifferences in physical and mental health: socioeconomic status,stress, and discrimination. Journal of Health Psychology 2(3):335–351.Further ReadingAtkinson J (2002) Trauma Trails, Recreating Songlines: TheTransgenerational Effects of Trauma in Indigenous Australia.Melbourne, Australia: Spinifex Press.Brown TN (2001) Measuring self-perceived racial and ethnicdiscrimination in social surveys. Sociological Spectrum 21: 377–392.Branscombe NR, Schmitt MT, and Harvey RD (1999) Perceivingpervasive discrimination among African Americans: Implications forgroup identification and well-being. Journal of Personality and SocialPsychology 77(1): 135–149.Clark R, Anderson NB, Clark VR, and Williams DR (1999) Racism as astressor for African Americans: a biopsychosocial model. AmericanPsychologist 54(10): 805–816.Cutler DM, Glaeser EL, and Vigdor JL (1997) Are Ghettos Good or Bad?Quarterly Journal of Economics 112(3): 827–872.Harrell SP (2000) A multidimensional conceptualization of racism-relatedstress: implications for the well-being of people of color. AmericanJournal of Orthopsychiatry 70(1): 42–57.Hill CV, Njai RS, Neighbors H, Williams-Flournoy DF, and Jackson JS(2003) Racial discrimination and the physical health of BlackAmericans: A review of the literature on community studies ofrace and health. African American Research Perspectives 9(1):10–23.Krieger N (1999) Embodying inequality: a review of concepts, measures,and methods for studying health consequences of discrimination.International Journal of Health Services 29(2): 295–352.Major B, Quinton WI, and McCoy SK (2002) Antecedents andconsequences of attribution to discrimination: theoretical andempirical advances. Advances in Experimental Social Psychology34: 251–330.Sechrist GB, Swim JK, and Stangor C (2004) When do the stigmatizedmake attributions to discrimination occurring to the self and others?The roles of self-presentation and need for control. Journal ofPersonality and Social Psychology 87(1): 111–122.Sellers RM and Shelton JN (2003) The role of racial identity in perceivedracial discrimination. Journal of Personality and Social Psychology 84(5): 1079–1092.Whitbeck LB, Adams GW, Hoyt DR, and Chen X (2004)Conceptualizing and measuring historical trauma amongAmerican Indian people. American Journal of CommunityPsychology 33(3/4): 119–130.Williams DR and Collins C (2001) Racial residential segregation: afundamental cause of racial disparities in health. Public HealthReports 116(5): 404–416.Williams DR, Neighbors HW, and Jackson JS (2003) Racial/ethnicdiscrimination and health: findings from community studies.American Journal of Public Health 93(2): 200–208.International Encyclopedia of Public Health, First Edition (2008), vol. 5, pp. 474-483

Author'spersonalcopyRadiation Therapy 483Relevant Websiteshttp://www.crcah.org.au/ – The Impact of Racism on Indigenous Healthin Australia and Aotearoa: Towards a Research Agenda.http://www.nap.edu/ – Measuring Racial Discrimination.http://www.vichealth.vic.gov.au/ – More than tolerance/Embracingdiversity for health.http://www.nap.edu/ – Unequal treatment–Confronting Racial andEthnic Disparities in health care.Radiation TherapyF Casas, Hospital Clínic i Universitari, Barcelona, SpainN Bese, Cherrapasa University, Istanbul, TurkeyD van der Merwe, University of the Witwatersrand, Johannesburg Hospital, Johannesburg, South AfricaJ Hendry and B Jeremic, International Atomic Energy Agency, Vienna, Austriaã 2008 Elsevier Inc. All rights reserved.Radiation oncology is the discipline of human medicinefocused on generation, conservation, and dissemination ofknowledge concerning etiology, prevention, and treatmentof cancer and some benign diseases involving specialexpertise in the therapeutic applications of ionizing irradiation(Smith and McKenna, 2004). It addresses thetherapeutic uses of ionizing irradiation given eitheralone or in combination with other treatment modalities,such as surgery or chemotherapy. Radiation oncology alsoincludes investigation of basic principles of tumor biology,the biologic interaction of irradiation with tissues, normalor malignant, as well as the physical principles of therapeuticirradiation. As a medical profession, radiationoncology involves patient care, scientific research, andeducation of professionals within the discipline.Radiation therapy is a clinical modality dealing withthe use of ionizing irradiation in the treatment of patientswith cancer and occasionally benign disease (Smith andMcKenna, 2004). Its aim is to deliver a precisely measuredirradiation dose to a defined tumor volume with as minimaldamage as possible to surrounding healthy tissue,thus resulting in tumor eradication, improved quality oflife, and prolonged survival. Indications for radiation therapyinclude cases in which it can improve either localcontrol, hence overall survival, or ameliorate symptoms ofthe disease.The aim of therapeutic irradiation can be either curativeor palliative (Price and Sikora, 2005). The aim ofcurative radiation therapy is to eradicate the tumor andcure the patient, in cases in which the patient is willing toaccept a small risk of significant adverse events in returnfor the possibility of cure. Palliative radiation therapy hasthe aim of either ameliorating the symptoms of the diseaseor preventing it to increase the quality of life withouta significant risk of serious adverse events.Specific issues of radiation oncology are the volume,techniques, and the dose (Halperin et al., 2004). Althoughthe appropriate volume to be irradiated needs to be specifiedfor achieving the desired goal, the appropriate techniqueto irradiate a specified volume of tissue must also betaken into account. There are two techniques: teletherapy,using either distant-positioned focal source of cobalt-60machines or linear accelerators as external beam treatmentmachines, and brachytherapy, with various radioactiveisotopes that could be used interstitially, intracavitary,or intraluminally, or as molds. Although teletherapyremains the standard technique for the majority ofpatients, there is an increasing interest in the use of novelbrachytherapy applications in tumors such as prostatecancer. Finally, the irradiation dose must be chosen bytaking into account total dose, total number of fractions,number of fractions per day, irradiation dose per fraction,and the overall treatment time. Choice of irradiation doseis therefore a complex issue encompassing treatment goals,volumes, and techniques, as well as knowledge of radiobiology,such as the dose–response relationship for a particulartumor type and normal tissue tolerance.This article provides an introduction into the scienceof radiation oncology from the standpoint of clinicalexercise, radiobiology, and medical physics, all representingspecific aspects merged into an important treatmentmethod that nowadays represents an indispensable part oftreatment of cancer.RadiobiologyRadiobiology is a branch of science that deals with theaction of ionizing radiation on biological tissues and theircellular and molecular components (Hall and Giacca,International Encyclopedia of Public Health, First Edition (2008), vol. 5, pp. 474-483