5 things to know about measuring structural racism to strategize equity goals

As healthcare companies look to address health disparities, the industry is grappling with how to measure inequities, especially when it comes to the effects of structural racism, a new paper concludes.

In a Health Affairs article published Monday, University of Minnesota researcher Rachel Hardeman and colleagues aim to provide a guide to evaluating structural racism and its impact on population health. Here are five things to know:

1. Look at state policy

Structural racism varies based on geography. State laws and regulations related to employment, education, incarceration, housing, taxes and healthcare contribute to social and political determinants of health, the authors wrote. Policies such as Medicaid expansion and voting laws are linked to varying rates of infant mortality, depression and high body mass index among Black people, she wrote.

2. Know your neighborhood

Individual health is deeply connected to where they live. Local policies and the built environment may disadvantage certain populations. The locations of grocery stores and health clinics, as well law enforcement practices, play key roles in population health. For example, women who live in areas with larger police presences are also at higher risk for pre-term childbirths.

"Neighborhoods play an important role as a risk factor for poor health through structural racism, but also we have to be thinking about measuring structural racism at the neighborhood level as a way to inform policy as well," Hardeman said.

3. Reference historical trends of racism

Racism has evolved over time. Overt manifestations such as colonization, slavery, lynchings, forced sterilizations and Jim Crow laws have shifted to more stealthy aspects of structural racism such as mass incarceration, voter disenfranchisement and redlining in housing, insurance and other areas, the report says. Understanding the links between historical and contemporary forms of structural racism can provide key insights into population health, the authors wrote.

"We have measures of individual level experiences of racism and discrimination, but we don't have robust measures that actually get at how the structures and systems within our society perpetuate inequity and perpetuate racism," Hardeman said. "Without that, we can't answer the question: How is racism operating here? And if we can't answer that question, then we can't do anything to change it, which means that we're not moving towards health equity."

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4. Seek out new data sources

The report says that traditional forms of data used to analyze the impact of racism are flawed because they lack context. The authors recommend using information from the federal Census of Governments, which includes financial information broken down to below the county level.

"These data provide information on how public money is spent and its flow across levels of government, providing insight on financial decision-making by government entities. Patterns in education funding, police expenditures, cash assistance and other pecuniary choices related to structural forces influencing the health and well-being of constituents can be abstracted from these data," the report says.

5. Know your role

No one has a defined role in dismantling racism, so institutions must work together, the authors wrote. Hardeman defines structural racism as the "totality of ways in which inequity and disadvantage is manifesting itself in a lot of different domains." That includes housing, education, political participation and healthcare, she said. Healthcare organization must consider how other institutions influence individual health, she said.

"Folks who have had a negative encounter with law enforcement, for a variety of reasons, are more likely to report that they have distrust for healthcare delivery systems as well," Hardeman said. "There is sort of this overlap that is incredibly important to think about as we explore ways to measure structural racism and address it in the lives of the patient populations that systems are serving."