To understand the impact of racism on health, an epidemiologist suggests going beyond conventional methods | Science

The COVID-19 pandemic has revealed many vulnerabilities in healthcare, including how structural racism has created the pandemic’s disproportionate impact on marginalized groups. Age-adjusted infection, hospitalization and death rates for people of color in the United States were higher than those for white Americans, for example.

A big question for health researchers is how to measure structural racism — racism embedded in societal systems, including housing, work, and health care — across different places and systems. Columbia University epidemiologist Paris “AJ” Adkins-Jackson is among a growing number of scientists working on this topic.

Adkins-Jackson and her colleagues released a guide in 2021 to measuring structural racism for epidemiologists and other researchers. The authors call on researchers to use variables that capture the multiple dimensions of structural racism. For example, instead of simply measuring segregation in residential housing, researchers could include how local governments and banks enforce zoning laws and mortgage policies that discriminate against marginalized communities; these variables in turn influence access to quality public education and healthy food. To capture the spectrum of how racism may play a role in health disparities – and in a break from traditional epidemiological research – the guide recommends collecting qualitative data, examining work in the humanities and social and to partner with marginalized communities.

“I think science is like tofu,” says Adkins-Jackson. “Whatever seasonings you put in it, it’s just going to smother it. So if you season it with racism, it will become racist. It behooves me, as a scientist, to choose my marinade differently…to season it with multiplicity, to season it with different thoughts, to season it with change.

Last month, Adkins-Jackson spoke at a two-day National Academies of Sciences, Engineering, and Medicine workshop on structural racism and social inequality, and showed how the methodologies of anthropology and social sciences can inform health research. This conversation has been edited for length and clarity.

Q: What is structural racism?

A: As [epidemiologists] Camara Jones and Zinzi Bailey teach us that structural racism is…institutional policies and practices that unfairly minoritize and disadvantage certain groups while unfairly favoring racialized people such as white. Such a system was historically intended to create white privilege and cannot be divorced from the foundations of European colonization.

Q: What has been your journey to study it from a health perspective?

A: I’m a black woman raised by Salvadorans in South Los Angeles, and I remember asking my mother why our neighborhood had a curfew during the 1992 Los Angeles riots. Nobody really talked to me about what racism meant. So it started from this curious place of “Why are we in the circumstances that we live in? »

In high school, journalism gave me a home. I thought, “I could be Khadijah James,” the character from the TV show Living Single who is a journalist and started a magazine to give voice to the unknown. I needed more story and more context, so I applied all those journalistic skills directly to anthropology. But cultures and communities cannot thrive without life: if I want to enjoy all that culture, eat all the food, study all the books, learn all the languages, then I have to preserve their life and that’s why I I regained my health. I did two postdocs in health. … I really spent time studying and understanding how structures behave and how they project onto people.

Q: To study structural racism, you advocate a “mixed methods” approach. What exactly are these mixed methods and what do they bring?

A: Mixed methods take qualitative tools – like interviews and focus groups – and marry them with quantitative methods – like a survey that allows you to ask a very specific question and have a very specific, finite answer – which we can then translate into a number.

Qualitative research such as narratives, ethnography, interviews and photovoice [are] rich forms of knowledge that challenge us to consider multiple ways of knowing beyond numbers. You won’t find them in the top reviews because of the discrimination against methods that question this [quantitative] standard.

People like to use quantitative methods because they like to look at results on a large scale. But these methods can be limited… [and have] bias.

[For example,] clinical trials are one way structural racism works. You have five black people in the study; you have three Latinos, maybe Asians, and there are over 100 white people in your study. When you use probability, those few people from marginalized backgrounds who suffered from racism – which caused high blood pressure, which caused asthma, which changed their blood sugar levels – are not recorded in the study because that the stories of over 100 white people cover people of color because of the way we use averages.

This is why qualitative methods become important. The way we do population analyses, [such as averaging heath measurements], confuses the experiences of these few people. We still need to hear their stories because they are exposed to something that 100+ white people are not exposed to.

Q: What’s wrong with the idea of ​​only using statistical methods to correct for potential bias?

A: Our systems tell us that standardization will correct bias. Researchers are creating all these sensitivity tests to eliminate errors and biases, when in the beginning it was enough to add more people to the research team to be more inclusive step by step. Why standardize an approach rather than adding more interdisciplinary people to the table? Why isn’t the social worker there? Why is there no community advocate? Let’s bounce ideas off of each other and decide to address the bias upfront and account for it, instead of creating a statistical test to eliminate it later. It’s crazy! Some things require a more personal touch.

Q: Can you give an example of using mixed methods to measure structural racism?

A: [Social epidemiologist] Lorraine Dean, for example, used indicators reflecting education, housing, employment, criminal justice, and health care by county to show that structural racism was associated with lower body mass index among white people. and higher BMI in blacks, especially black men.

I study adverse policing at the community level across the lifespan, where quantitative data such as racial disparities in the number of arrests, police-involved killings, and incarceration rates do not reflect quite the constant pressure that my elders have been under since childhood when they were punished by the police. lynchings were commonplace. However, both the statistics we use and the stories we collect, as the great Ida B. Wells did in A red disc[: Tabulated Statistics and Alleged Causes of Lynchings in the United States]— illuminate a clear path for science to influence social change and health justice.

Q: What suggestions would you give to a new researcher doing this type of research?

A: Take control of yourself as a scientist, instead of a tool. Do science the way you want to, not the way someone told you or you saw it done by other researchers in a previous post. Rethink using a method just because someone said [you] do this. Be your person, be what you have in your belly.

Also, read! People just don’t read. We have long studied racism by giving it different names – like disparities –; it is disrespectful to act as if what you are bringing to the table is new. Frederick Douglass wrote about it and did not even call it the same terms.

Q: How do you explain the importance of studying structural racism and dealing with it?

A: Now, when I give presentations, I remind my colleagues of the impact of structural racism on me and those I love. It is a tangible example of how those of us affected are not just cases in a study. We are loved ones, colleagues and friends drowning in a sea of ​​stress and tension that can change if you do more.

If you have an idea, you have to get it executed by the communities. Will my research help you? Will it benefit you? Is it interesting for you? Are you able to join me on this? If not, how can I best serve you through this work? I will publish my scientific publications but I will also forge links, I will reach out to your legislators. Science just isn’t for academy, it’s just not for knowledge…it’s for change.

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