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."