Search

Data on the health and social determinants for Native Hawaiians and Pacific Islanders (NHPIs) in the United States (US) are hidden because data are often not collected or are reported in aggregate with other racial/ethnic groups, despite decades of calls to disaggregate NHPI data. As a form of structural racism, data omissions contribute to systemic problems such as inability to advocate, lack of resources, and limitations to political power. We conducted a data audit to determine how US federal agencies are collecting and reporting disaggregated NHPI data. Using the COVID-19 pandemic as a case study, we reviewed how states are reporting NHPI cases and deaths. Last, we calculated the extent of NHPI underrepresentation in communities targeted for COVID-19 resources in California using the state's neighborhood equity metric-Healthy Places Index (HPI). Our analysis shows that while there has been improvement in collection and reporting of NHPI data nationally, federal data gaps remain. States are vastly underreporting-over half of states are not reporting NHPI COVID-19 case and death data. The HPI, used to inform political decisions about allocation of resources to combat COVID-19, systematically underrepresents NHPI communities. We make recommendations for improving NHPI data equity to achieve health equity and social justice. more...

Despite increasing awareness of the importance of political determinants of health, place-based research has not interrogated one of the most common political statuses: the impact of living in a community without municipal incorporation. In 2010 an estimated 37% of the U.S. population lived in an unincorporated area; despite their ubiquity, unincorporated communities are largely absent from the public health literature. Residents of unincorporated areas typically do not have their own local (e.g., city or municipal) government. This lack of representation leads to political exclusion and diminished access to resources, especially for low-income communities of color, Furthermore, by not disaggregating health data to unincorporated communities, residents are subsumed into county or census tract data that may not be reflective of their community's composition or context. Without jurisdictional distinction in research, there is no accountability for the manufacturing of health inequities in unincorporated communities . In the absence of empirical research on unincorporated communities, this paper uses the Commission on Social Determinants of Health (CSDH) Framework of the World Health Organization to argue that lack of municipal status is a structural determinant of health responsible for social conditions which generate cumulative health risks for residents. This includes using existing evidence on social conditions typical of unincorporated communities to describe patterns of residential segregation, neighborhood disadvantage, and environmental hazards that may increase residents' exposure to unhealthy environments in unincorporated communities. Finally, we provide an agenda for future public health research that can begin to address this health and racial equity gap for low-income unincorporated communities of color who have, until now, been absent in health equity discourse. more...

Throughout history, doctors have distinguished themselves among healthcare providers by referencing special skills and accredited knowledge about the body and disease. Over centuries, increased rigor in educational standards and licensing have crafted the professional identity of physicians, establishing a privileged status in the healthcare hierarchy. This essay provides an overview of how the medical profession has defined itself over time, and it examines how policing professional boundaries has discriminated against and marginalized competitors in the marketplace for medical services. more...

Abstract Background We describe the rationale and study design for “TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN),” a prospective type 1 hybrid effectiveness/implementation study of a multi-level intervention using a stepped wedge design. TRUE HAVEN aims to lower rates of community gun violence by fostering the stability, wealth, and well-being of individuals and families directly impacted by incarceration through the provision of stable housing and by breaking the cycle of trauma. Design TRUE HAVEN is an ongoing, multi-level intervention with three primary components: financial education paired with housing support (individual level), trauma-informed counseling (neighborhood level), and policy changes to address structural racism (city/state level). Six neighborhoods with among the highest rates of gun violence in New Haven, Connecticut, will receive the individual and neighborhood level intervention components sequentially beginning at staggered 6-month steps. Residents of these neighborhoods will be eligible to participate in the housing stability and financial education component if they were recently incarcerated or are family members of currently incarcerated people; participants will receive intense financial education and follow-up for six months and be eligible for special down payment and rental assistance programs. In addition, trusted community members and organization leaders within each target neighborhood will participate in trauma-informed care training sessions to then be able to recognize when their peers are suffering from trauma symptoms, to support these affected peers, and to destigmatize accessing professional mental health services and connect them to these services when needed. Finally, a multi-stakeholder coalition will be convened to address policies that act as barriers to housing stability or accessing mental healthcare. Interventions will be delivered through existing partnerships with community-based organizations and networks. The primary outcome is neighborhood rate of incident gun violence. To inform future implementation and optimize the intervention package as the study progresses, we will use the Learn As You Go approach to optimize and assess the effectiveness of the intervention package on the primary study outcome. Discussion Results from this protocol will yield novel evidence for whether and how addressing structural racism citywide leads to a reduction in gun violence. Trial registration ClinicalTrials.gov Identifier: NCT05723614. Registration date: February 01, 2023. Please refer to https://clinicaltrials.gov/ct2/show/NCT05723614 for public and scientific inquiries. more...

This study has been conducted to examine the dual moderation of structural racism and economic fragility between team diversity and startup team performance. Team diversity is particularly important for new ventures or startups as the need or focus of such startups is on a diverse range of consumers. The role of racism and economic fragility cannot be ignored in this regard. To conduct this research the targeted population is the high-tech startups in France. For data collection, 351 questionnaires were received and processed for data analysis. The results indicated a significant impact of team diversity on startup team performance. The moderating role of structural racism was also significant between team diversity and startup team performance. Whereas, economic fragility also significantly moderates the relationship between team diversity and startup team performance. The practical importance of this study is greatly implied in those startups which incorporate diversity in their workplace. The policymakers are also devoted to performing their part concerning the policies that are being formulated to encourage and promote diversity in the workplace as well as in educational settings. Theoretically, this research contributes to the growing body of literature regarding startup performances. However, most of the high-tech startups in France did not contain the required data for gaining clear facts and figures. This limitation can be catered to in the future by targeting more advanced high-tech startups in France. more...

This article explores how two main narratives about slavery may lead to varying perspectives on social rights. Some collective narratives endorse a superficial idea of equality of rights, neglecting factors such as race and ethnicity, while others reject this apparent universalistic view, promoting more effective, de facto equality. The latter narrative supports horizontal redistribution, strongly contrasting with the former. Using Brazil’s affirmative action programs for Black students as a case study, this article will address two prevalent national narratives about the slavery of Black Africans and persons of Black African descent. Only one of those narratives could lead to what I would identify as a “contextualized theory of rights,” ensuring horizontal equality amidst a backdrop of brutal slavery and structural racism. This narrative offers a plurally faceted, dialogical approach to rights that can respond to the needs of differently situated individuals. The article will explore the evolution of such a collective narrative in Brazil’s race relations. more...

In this article, we describe the process we adopted in designing a financial education intervention situated within the cultural and systemic realities of structural racism in Black communities and offer new insights on conducting financial education that addresses healing from ethno-racial trauma. We adopted a community-based participatory research (CBPR) approach and assembled a Community Led Advisory (CLA) group to discuss how to address social and economic inequalities in teaching financial education. Specifically, we sought to address the psychological consequences of racism, income scarcity, and other forms of economic distress and what it means for people’s lives and their everyday ability to make sound financial decisions. By directly addressing how systemic barriers have hindered the ability to build wealth, we allow individuals to relinquish self-blame/shame about their financial circumstances. Relinquishment of self-blame/shame (which is energy-consuming) facilitates a shift in energy that enables individuals to focus on learning how to make better financial decisions. In addition to the results of the pilot, we include a discussion of the lessons we learned, our suggestions, and next steps for applying the approach for wider use. more...

Background: Sex workers face substantial health inequities related to sexual health and gender-based violence, many of which are amplified for the large proportion of workers who are racialized im/migrants. While criminalization and stigma are known barriers to health care for this population, we know little about health insurance coverage, and in particular how this relates to im/migration experience and racialization. We examined associations between im/migration status, duration, and racialization on gaps in health insurance coverage in a cohort of women sex workers. Methods: Analyses used data from a prospective, community-based cohort of women sex workers in Vancouver, BC (Sept 2014-August 2021). Interviewer-administered questionnaires were by experiential (current/former sex workers) and community-based staff. We developed multivariable logistic regression confounder models with generalized estimating equations (GEE) to examine associations between migration and racialization exposures of interest and health insurance coverage. Results: Of 644 sex workers, 411 (63.8%) reported lacking health insurance coverage for services needed during the 7-year study. In multivariable GEE analysis, precarious im/migration status (adjusted odds ratio (AOR) 2.37, 95% confidence interval (CI) 1.56 – 3.60), recent (AOR 4.22, 95% CI 2.42 – 7.35) and long-term (AOR 2.13, 95% CI 1.54 – 2.96) migration, and being a racialized Asian im/migrant (AOR 3.06, 95% CI 2.14 – 4.39) were associated with recent lack of health insurance coverage. Conclusion: Policy and program reforms are needed to decouple health insurance access from immigration status, remove mandatory waiting periods for health insurance coverage, and ensure that provincial insurance provides sufficient coverage for marginalized women's healthcare needs. more...

This manuscript undertakes a disciplinary self-critique of the field of implementation science, a field which attempts to bridge the gap between evidence-based interventions and their practical application. Despite the heightened emphasis on health equity and racial disparities, the field’s current discourse is limited by key epistemic shortcomings. First, even though prevalence of implementation gaps between racialized groups in the United States necessitates a comprehensive understanding of the systems perpetuating these disparities, the field does not operate with a general explanation for disparities not as a failure of systems, but a system historically and structural designed to produce disparities. Second, the field has attempted to address disparities without adequate dialog with a broad tradition of anti-racist and anti-colonial sociology, history and epistemology, and therefore risks a decontextualized analysis of disparities and under-informed approaches to achieving equity. Fortunately, scholarship from the Black radical tradition (BRT), such as the Public Health Critical Race Praxis (PHCRP), Critical Race Theory (CRT), and more broadly conceptual frameworks from post-modern, anti-colonial, Black feminist studies and social epistemology can offer to implementation science frameworks that center power dynamics and racialized oppression. This epistemic re-alignment of implementation research to “center at the margins” can enable the field of implementation science to more critically examine and dismantle systems that perpetuate racial inequalities in access to and utilization of health interventions. For example, normalization and dynamic fit, which are thought to be key mechanisms of implementation, are revealed in the light of this tradition of scholarship to be potentially problematic acquiescence to oppressive systems. Drawing from the concept of resistance anchored in the scholarship of the Black radical tradition as well as contemporary social epistemology such as the work of José Medina and Maria Fricker about epistemic justice, the authors further advance that implementation science could make more substantial contributions to the dismantling of racialized systems and actively work toward health justice through the transdisciplinary lens of resistance. This is a call to action for integrating implementation science with critical philosophical and theoretical perspectives rooted in Black studies and related insights, which have been acquired through the struggle for social justice, to inform the design of implementation strategies and research projects that improve health services and health outcomes for health disparity populations. more...

It took a white police officer's knee on George Floyd's neck before white people began to reckon with 400 years of slavery and its aftermath, the effects of which Black people have endured for generations. Monuments are being taken down, flags are being redesigned, and institutions that honored those who denied the humanity of Black people are being renamed. Unfortunately for Sandra Bland, Breonna Taylor, Sha-Asia Washington and countless other Black transgender people including those with capacity for pregnancy, there was no justice even prior to the global pandemic of SARS-Cov-2 or coronavirus; namely racism, violence, and the Black Maternal Health crisis that makes it less likely that Black women will survive pregnancy and childbirth. The purpose of this article is to situate the state of Black people with the capacity for pregnancy in the context of these existing crises to illuminate the myths that racism has perpetuated through science, health services provision and policy. The greatest of these is the myth of a default human that can serve as a standard for the rest of the population. This racist ideal underpins education, provision of care, research, policies, and public health praxis. Demolishing the myth starts with acknowledging that Black people are not the architects of their own destruction: the default standard of whiteness is. The article begins with a historical background on how this myth came to be and elucidates the development and perpetuations of the myth of the default human. Next, we present an evidence based scoping review of the literature to summarize current thinking with specific focus on the Black maternal health crisis, we make policy recommendations and retrofits of upstream public health approaches for existing programs toward health equity. We also situate Black maternal health as part of a reproductive justice frame that centers Black women and birthing people's autonomy and agency. In other words, we use the scoping review to end with reimagining public health policy and provide an actionable roadmap to specifically disrupt the myth of the default human and dismantle racism in education, provision of care, research, policies, and public health praxis. more...

Background: Improving access to healthcare for ethnic minorities is a public health priority in many countries, yet little is known about how to incorporate information on race, ethnicity, and related social determinants of health into large international studies. Most studies of differences in treatments and outcomes of COVID-19 associated with race and ethnicity are from single cities or countries. Methods: We present the breadth of race and ethnicity reported for patients in the COVID-19 Critical Care Consortium, an international observational cohort study from 380 sites across 32 countries. Patients from the United States, Australia, and South Africa were the focus of an analysis of treatments and in-hospital mortality stratified by race and ethnicity. Inclusion criteria were admission to intensive care for acute COVID-19 between January 14th, 2020, and February 15, 2022. Measurements included demographics, comorbidities, disease severity scores, treatments for organ failure, and in-hospital mortality. Results: Seven thousand three hundred ninety-four adults met the inclusion criteria. There was a wide variety of race and ethnicity designations. In the US, American Indian or Alaska Natives frequently received dialysis and mechanical ventilation and had the highest mortality. In Australia, organ failure scores were highest for Aboriginal/First Nations persons. The South Africa cohort ethnicities were predominantly Black African (50%) and Coloured* (28%). All patients in the South Africa cohort required mechanical ventilation. Mortality was highest for South Africa (68%), lowest for Australia (15%), and 30% in the US. Conclusions: Disease severity was higher for Indigenous ethnicity groups in the US and Australia than for other ethnicities. Race and ethnicity groups with longstanding healthcare disparities were found to have high acuity from COVID-19 and high mortality. Because there is no global system of race and ethnicity classification, researchers designing case report forms for international studies should consider including related information, such as socioeconomic status or migration background. *Note: "Coloured" is an official, contemporary government census category of South Africa and is a term of self-identification of race and ethnicity of many citizens of South Africa. [ABSTRACT FROM AUTHOR] more...

Objective: To provide a research agenda and recommendations to address inequities in access to health care. Data Sources and Study Setting: The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. Study Design: Multi‐stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. Data Collection/Extraction Methods: Through a stakeholder‐engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. Principal Findings: The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti‐racist practices (e.g., co‐production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. Conclusions: AHRQ is well‐positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations. [ABSTRACT FROM AUTHOR] more...

Social work's ethical mandate to engage in social justice, coupled with its fraught history of complicity in oppressive policies, makes critical the disruption of bias and racism within social work practice. As influencers and guides in clinical learning, social work supervisors have the potential to disrupt racism. There is an emerging body of literature on how to effectively engage in culturally-conscious social work supervision. However, research on anti-racism supervisory strategies in social work is limited and predominantly conceptual. This exploratory qualitative study's aim was to identify strategies used by social work supervisors who self-identify as "anti-racist" to disrupt racism in the practice of their supervisees. The major findings of this study include a foundational element in this process: the identification of biases. Based on these findings, this article outlines strategies that social workers can use to detect bias in their staff, as well as other implications for social work practice and research. [ABSTRACT FROM AUTHOR] more...

Racial and ethnic disparities in exposure to COVID-19-related stressors, pandemic-related distress, and adverse mental health outcomes were assessed among health care workers in the Bronx, New York, during the first wave of the pandemic. The authors analyzed survey data from 992 health care workers using adjusted logistic regression models to assess differential prevalence of outcomes by race/ethnicity and their interactions. Compared with their White colleagues, Latinx, Black, Asian, and multiracial/other health care workers reported significantly higher exposure to multiple COVID-19-related stressors: redeployment, fear of being sick, lack of autonomy at work, and inadequate access to personal protective equipment. Endorsing a greater number of COVID-19-related stressors was associated with pandemic-related distress in all groups and with adverse mental health outcomes in some groups; it was not related to hazardous alcohol use in any of the groups. These associations were not significantly different between racial and ethnic groups. Latinx health care workers had significantly higher probabilities of pandemic-related distress and posttraumatic stress than White colleagues. Despite greater exposure to COVID-19-related stressors, Black, Asian, and multiracial/other health care workers had the same, if not lower, prevalence of adverse mental health outcomes. Conversely, White health care workers had a higher adjusted prevalence of moderate to severe anxiety compared with Asian colleagues and greater hazardous alcohol use compared with all other groups. Health care workers from racial and ethnic minority groups reported increased exposure to COVID-19-related stressors, suggestive of structural racism in the health care workforce. These results underscore the need for increased support for health care workers and interventions aimed at mitigating disparities in vocational exposure to risk and stress. [ABSTRACT FROM AUTHOR] more...

African American families navigate not only everyday stressors and adversities but also unique sociocultural stressors (e.g., "toxic upstream waters" like oppression). These adverse conditions are consequences of the historical vestiges of slavery and Jim Crow laws, often manifested as inequities in wealth, housing, wages, employment, access to healthcare, and quality education. Despite these challenges, African American families have developed resilience using strength-based adaptive coping strategies, to some extent, to filter these waters. To advance the field of resilience research, we focused on the following questions: (1) what constitutes positive responses to adversity?; (2) how is resilience defined conceptually and measured operationally?; (3) how has the field of resilience evolved?; (4) who defines what, when, and how responses are manifestations of resilience, instead of, for example, resistance? How can resistance, which at times leads to positive adaptations, be incorporated into the study of resilience?; and (5) are there case examples that demonstrate ways to address structural oppression and the pernicious effects of racism through system-level interventions, thereby changing environmental situations that sustain toxic waters requiring acts of resilience to survive and thrive? We end by exploring how a re-conceptualization of resilience requires a paradigm shift and new methodological approaches to understand ways in which preventive interventions move beyond focusing on families' capacity to navigate oppression and target systems and structures that maintain these toxic waters. [ABSTRACT FROM AUTHOR] more...

Nutrition education and policy, systems and environmental (PSE) change interventions may be able to address food insecurity and obesity, conditions which are disproportionately experienced by African Americans. Work that seeks to address these disparities and advance social justice should uplift and learn from participant voices, particularly from marginalised groups. This scoping review aimed to summarise the available literature describing African Americans' perceptions of and experiences participating in nutrition interventions. We conducted an electronic literature search with the assistance of a research librarian which encompassed six databases (MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX and ProQuest Dissertations & Theses) and identified thirty-five sources meeting our inclusion criteria. The majority of studies assessing African Americans' satisfaction with interventions examined educational interventions alone, and about half of the included studies assessed satisfaction through quantitative methods alone. The only studies which found participants to be dissatisfied with interventions used qualitative methods and examined interventions providing education alone. Future work should evaluate African Americans' experience with nutrition-focused PSE changes, interventions which may be better able to address racial disparities in obesity and food insecurity. Nutrition educators working with African Americans should also consider evaluating future interventions using qualitative inquiry, to obtain an in-depth understanding of participant experiences with interventions. [ABSTRACT FROM AUTHOR] more...

This paper centres geological matter in questions of marginality, inequality, and structural racism in the US. I follow the entanglements of geological matter with bodies, emotion‐laden imaginaries of place, and histories of slavery and colonialism, to illustrate how contemporary Black lives are intimately connected to processes of mineral extraction. Drawing on Saidiya Hartman's concept of 'afterlives', I situate heightened levels of ambient toxicity from geological refinement and industrial waste as extractive afterlives, connecting commonly felt precarity around extractive worlds to broader questions of race, inequality, and connections to place. Citing academic and artistic accounts of life in Southern Louisiana, a historically Black region with a large petrochemical industry, I demonstrate the relevance of geological entanglements to experiences of structural racism in the US. This paper centres geological matter in questions of marginality, inequality, and structural racism in the US. Following the entanglements of geological matter with bodies, emotion‐laden imaginaries of place, and histories of slavery, I illustrate how contemporary Black lives in Southern Louisiana are intimately connected to processes of mineral extraction through the intimacy of 'extractive afterlives' – the heightened levels of ambient toxicity from geological refinement and industrial waste in the region. [ABSTRACT FROM AUTHOR] more...

The COVID-19 pandemic has been one of the most acute global crises in recent history, which profoundly impacted the world across many dimensions. During this period, racism manifested in ways specifically related to the pandemic, including xenophobic sentiments, racial attacks, discriminatory policies, and disparate outcomes across racial/ethnic groups. This paper examines some of the pressing questions about pandemic racism and inequity. We review what research has revealed about the nature and manifestations of racism, the entrenchment of structural racism, and trajectories of racism during COVID-19. [ABSTRACT FROM AUTHOR] more...

Background: Social determinants of health (SDoH) can impact access to healthcare. We sought to assess the association between persistent poverty (PP), race/ethnicity, and opioid access among patients with gastrointestinal cancer near the end-of-life (EOL). Methods: SEER-Medicare patients with gastric, liver, pancreatic, biliary, colon, and rectal cancer were identified between 2008 and 2016 near EOL, defined as 30 days before death or hospice enrolment. Data were linked with county-level poverty from the American Community Survey and the US Department of Agriculture (2000–2015). Counties were categorized as never high-poverty (NHP), intermittent high-poverty (IHP) and persistent poverty (PP). Trends in opioid prescription fills and daily dosages (morphine milligram equivalents per day) were examined. Results: Among 48,631 Medicare beneficiaries (liver: n = 6551, 13.5%; pancreas: n = 13,559, 27.9%; gastric: n = 5486, 1.3%; colorectal: n = 23,035, 47.4%), there was a steady decrease in opioid prescriptions near EOL. Black, Asian, Hispanic, and other racial groups had markedly decreased odds of filling an opioid prescription near EOL (Black: OR 0.84, 95% CI 0.79–0.90; Asian: OR 0.86, 95% CI 0.79–0.94; Hispanic: OR 0.90, 95% CI 0.84–0.95; Other: OR 0.83, 95% CI 0.74–0.93; all p < 0.05). Even after filling an opioid prescription, this subset of patients received lower daily doses versus White patients (Black: −16.5 percentage points, 95% CI −21.2 to −11.6; Asian: −11.9 percentage points, 95% CI −18.5 to −4.9; Hispanic: −19.1 percentage points, 95%CI −23.5 to −14.6; all p < 0.05). The disparity in opioid access and average daily doses among was attenuated in IHP/PP areas for Asian, Hispanic, and other racial groups, yet exacerbated among Black patients. Conclusions: Race/ethnicity-based disparities in EOL pain management persist with SDoH-based variations in EOL opioid use. In particular, PP impacted EOL opioid access and utilization. [ABSTRACT FROM AUTHOR] more...

Purpose of review: Sudden cardiac arrest is associated with high morbidity and mortality. Despite having a disproportionate burden of sudden cardiac death (SCD), rates of primary and secondary prevention of SCD with implantable cardioverter-defibrillator (ICD) therapy are lower among eligible racially minoritized patients. This review highlights the racial and ethnic disparities in ICD utilization, associated barriers to ICD care, and proposed interventions to improve equitable ICD uptake. Recent findings: Racially minoritized populations are disproportionately eligible for ICD therapy but are less likely to see cardiac specialists, be counseled on ICD therapy, and ultimately undergo ICD implantation, fueling disparate outcomes. Racial disparities in ICD utilization are multifactorial, with contributions at the patient, provider, health system, and structural/societal level. Summary: Racial and ethnic disparities have been demonstrated in preventing SCD with ICD use. Proposed strategies to mitigate these disparities must prioritize care delivery and access to care for racially minoritized patients, increase the diversification of clinical and implementation trial participants and the healthcare workforce, and center reparative justice frameworks to rectify a long history of racial injustice. [ABSTRACT FROM AUTHOR] more...

Background: Racial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover. Methods: Using National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019). Results: In 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities. Conclusion: Urban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions. [ABSTRACT FROM AUTHOR] more...

Objective: Examine the association between historic residential redlining and present-day racial/ethnic composition of neighborhoods, racial/ethnic differences in social determinant of health domains, and risk of home evictions and food insecurity. Research Design and Methods: We examined data on 12,334 (for eviction sample), and 8996 (for food insecurity sample), census tracts in 213 counties across 37 states in the USA with data on exposure to historic redlining. First, we examined relationships between Home Owners' Loan Corporation (HOLC) redlining grades (A="Best", B="Still Desirable", C="Definitely Declining", D="Hazardous") and present-day racial/ethnic composition and racial/ethnic differences in social determinant of health domains of neighborhoods. Second, we examined whether historic redlining is associated with present-day home eviction rates (measured across eviction filings rates, and eviction judgment rates for 12,334 census tracts in 2018) and food insecurity (measured across low supermarket access, low supermarket access and income, low supermarket access and low car ownership for 8996 census tracts in 2019). Multivariable regression models were adjusted for census tract population, urban/rural designation, and county level fixed effects. Results: Relative to areas with a historic HOLC grading of "A (Best)", areas with a "D (Hazardous)" grading had a 2.59 (95%CI=1.99–3.19; p-value<0.01) higher rate of eviction filings, and a 1.03 (95%CI=0.80–1.27; p-value<0.01) higher rate of eviction judgments. Compared to areas with a historic HOLC grading of "A (Best)", areas rated with a "D (Hazardous)" had a 16.20 (95%CI=15.02–17.79; p-value<0.01) higher rate of food insecurity based on supermarket access and income, and a 6.15 (95%CI =5.53–6.76; p-value<0.01) higher rate of food insecurity based on supermarket access and car ownership. Conclusions: Historic residential redlining is significantly associated with present-day home evictions and food insecurity, highlighting persistent associations between structural racism and present-day social determinants of health. [ABSTRACT FROM AUTHOR] more...

Objective: we aim to understand how racism tangibly manifests in the lives of Black women, limiting their agency as they navigate social spaces through cultural expressions in the city of Belo Horizonte. Theoretical approach: we draw upon the concepts of structural racism and narcissistic pact, identifying convergences and divergences in the understanding of organizations as racialized spaces. Methods: we employ a qualitative approach within the context of ethnographic research, opting to conduct a semi-structured interview with Zuri, the president of an Afro block. As an analytical tool, we apply the concept of intersectionality. Results: we highlight that both structural racism and the narcissistic pact manifest in the daily life of organizations. Both phenomena are even more pernicious for Black women, particularly when they challenge a racist and sexist structure. Conclusions: the collective dimension of racism presents challenges to organizations and their stakeholders. This effect may lead individuals, especially organizational leaders who should be more committed to structural change, to hide behind the racism within their institutions and pacts among their team members. [ABSTRACT FROM AUTHOR] more...

Though the 2011 'riots' attracted a huge amount of political, media and academic attention, the state's punitive reaction to the unrest received far less analysis, despite being characterised by exceptionally harsh practices at every stage from arrest to sentencing. Drawing on interviews with criminal justice professionals who were at the heart of this response, and focusing in particular on the Crown Prosecution Service's unusually punitive approach, this article examines the imaginations, assumptions and claims that allowed professionals to variously justify and problematise this vindictive backlash. The article shows how an imagination of the disturbances as an apolitical and unprecedented outbreak of violence was central to many professionals' accounts. Yet this imagination, I contend, requires significant erasure and elision. Forgetting England's long history of unrest, and ignoring or dismissing the police killing of Mark Duggan that immediately precipitated the disturbances, were vitally important in allowing professionals to ignore the vital connections between the unrest and entrenched structural racism that has consistently underpinned post-war urban unrest – and to position the harsh law and order response as reasonable, proportionate, necessary and adequate. In doing so, the article makes a significant contribution to scholarship on the unrest, and on the importance of amnesia and ignorance - conceived as active, collective and inherently political processes - in normalising punitive and discriminatory state practices, both in the wake of the riots and in their longer aftermath. [ABSTRACT FROM AUTHOR] more...

Background: With the unanimous approval of the Intersectoral Global Action Plan on epilepsy and other neurological disorders by the World Health Organization in May 2022, there are strong imperatives to work towards equitable neurological care. Aims: Using epilepsy as an entry point to other neurologic conditions, we discuss disparities faced by marginalized groups including racial/ethnic minorities, Americans living in rural communities, and Americans with low socioeconomic status. Materials and Methods: The National Institute on Minority Health Disparities Research Framework (NIMHD) was used to conduct a narrative review through a health equity lens to create an adapted framework for epilepsy and propose approaches to working towards equitable epilepsy and neurological care. Results: In this narrative review, we identified priority populations (racial and ethnic minority, rural‐residing, and low socioeconomic status persons with epilepsy) and outcomes (likelihood to see a neurologist, be prescribed antiseizure medications, undergo epilepsy surgery, and be hospitalized) to explore disparities in epilepsy and guide our focused literature search using PubMed. In an adapted NIMHD framework, we examined individual, interpersonal, community, and societal level contributors to health disparities across five domains: (1) behavioral, (2) physical/built environment, (3) sociocultural, (4) environment, and (5) healthcare system. We take a health equity approach to propose initiatives that target modifiable factors that impact disparities and advocate for sustainable change for priority populations. Discussion: To improve equity, healthcare providers and relevant societal stakeholders can advocate for improved care coordination, referrals for epilepsy surgery, access to care, health informatics interventions, and education (i.e., to providers, patients, and communities). More broadly, stakeholders can advocate for reforms in medical education, and in the American health insurance landscape. Conclusions: Equitable healthcare should be a priority in neurological care. [ABSTRACT FROM AUTHOR] more...

This analysis is based on semi-structured interviews examining the work–life experiences of Black African immigrant nurses in Vancouver, British Columbia, conducted from June 2013 to June 2014. The article argues that nurses experience systemic barriers in which their sense of Canadian belonging and professionalism are called into question by patients, colleagues, and managers. Using the framing device of everyday racism, findings suggest that nurses navigate and counter these socio-cultural barriers by repurposing their daily actions into powerful subversive acts of resistance. The article uses the concept of everyday racism to relate the day-to-day experiences recounted by Black nurses to the larger macrostructural contexts that define the intersecting inequalities they describe. Grounded in Black Canadian feminist theory, this article contends that the lives of Black nurses offer critical insights to challenge structures of dominance. This article builds on existing scholarship discussing experiences of racism among Black and largely Caribbean nurses in Canada. The contribution is important because it offers the opportunity to analyze the lived realities of continental African nurses in Vancouver, in the historical context of a racialized Canadian state policy. [ABSTRACT FROM AUTHOR] more...

Background: Research examining the effects of historical redlining on present-day health outcomes is often complicated by the misalignment of contemporary census boundaries with the neighborhood boundaries drawn by the US Home Owners' Loan Corporation (HOLC) in the 1930s. Previous studies have used different approaches to assign historical HOLC grades to contemporary geographies, but how well they capture redlining exposure is unknown. Methods: Our analysis included 7711 residences identified in the Multiple Listing Service database in Atlanta, Georgia (2017-2022). We evaluated the classification of HOLC grade assignment (A, B, C, D, or ungraded) when assigning exposure under four area-level approaches (centroid, majority land area, weighted score, and highest HOLC) compared with using complete address data (gold standard). We additionally compared approaches across three 2020 census geographies (tract, block group, and block). Results: When comparing the use of census tracts to complete address data, sensitivity was highest for the weighted score approach, which correctly identified 77% of residences in truly A-D graded neighborhoods as compared with the majority land area (44%), centroid (54%), and highest HOLC (59%) approaches. Regarding specificity, the majority land area approach best-classified residences in truly ungraded neighborhoods (93%) as compared with the weighted score (65%), centroid (81%), and highest HOLC (54%) approaches. Classification improved regardless of approach when using census block compared with the census tract. Conclusions: Misclassification of historical redlining exposure is inevitable when using contemporary census geographies rather than complete address data. This study provides a framework for assessing spatial misalignment and selecting an approach for classification. [ABSTRACT FROM AUTHOR] more...

Debt is an overlooked social determinant of health that reinforces systems of discrimination. This study examined the impact of debt among individuals with serious mental illness. Individuals with serious mental illness who identified as Black, Indigenous, or other people of color carried a disproportionate amount of debt, often from attempting to meet basic needs. Increased levels of debt were associated with symptoms of depression. Addressing debt inequity is essential to both financial justice and mental health recovery. [ABSTRACT FROM AUTHOR] more...

Universities and colleges, K-12 schools, corporations, professional associations, and other social institutions advocate for change at the same time they are taking steps to prevent it from actually occurring. The result is an endless cycle of words of support followed by inaction, obfuscation, and outright lies. It is no wonder that burnout and frustration face those who would like to do some good but are experiencing gaslighting by those determined to set society back to what it has always been—one that excludes those who deign to speak truth to power. This presidential address sheds personal and professional insight into the difficulties that I have faced at my institution and within the Pacific Sociological Association as a Black woman. Having been witness and victim of those who are incapable or unwilling to see the inconsistency in what they are like and what they would actually like to be has shown me how difficult changing the status quo can be. Individual and institutional claims to "do better" in the future ignore the fact that one is likely part of the problem if they are just now realizing they need to do better. It is my sincerest hope that the increasing numbers of diverse voices that were present at the 2023 PSA conference can move the organization as well as their institutions forward to make them better places for all of us and not just some of us. [ABSTRACT FROM AUTHOR] more...

Black women living with HIV in the USA frequently endure structural racism, racial biases and discrimination in healthcare that affect their access to care. To explore their experiences in healthcare settings as they relate to HIV-treatment accessibility and medical mistrust we used intersectionality and structural intersectionality as guiding frameworks. Four focus groups were conducted with 20 low-income Black women living with HIV in a large urban region. Using thematic analysis, we identified four themes: (1) multilevel stigma and discrimination; (2) medical mistrust of providers across multiple settings; (3) varying responses to stigma, discrimination, and medical mistrust; and (4) preferences for patient-provider relationships. Participants described how medical providers, nurses and other healthcare staff perpetuated negative treatment, including multiple forms of discrimination and stigmatisation based on their HIV diagnosis, race, class and gender. The stigma, discrimination and resulting mistrust experienced often caused hurt feelings and decisions to disengage from treatment or remain with providers while feeling unwelcome. Participants described the strong desire to feel seen, supported and validated by healthcare providers. Narratives reveal that feelings of being discriminated against can cultivate mistrust not only towards doctors, but other provider types and settings. Findings can inform care models for low-income Black women living with HIV. [ABSTRACT FROM AUTHOR] more...

In this discussion, I engage the politics of intention to explore how structural racism structures the production of meaning and the practice of reason. Building on María Lugones's analysis of intention formation as a form of practical reasoning, I explore the reasoning at work during the 2011 Stand Your Ground (SYG) hearing of black survivor of domestic violence, Marissa Alexander, to contend that structural racism—in this case, both intimate personal violence and intimate state violence against black women—enacts race/gender domination through projecting constructed intentions onto black women as a strategy to rationalize punishing black women. I also discuss two key black feminist critiques of reason—Patricia Hill Collins' discussion of "controlling images" (2000) and Michelle Cliff's concept of the "mythic mind" (1982)—to propose controlling intentions as a framework to theorize how structural racism produces fictive intentions used to rationalize the criminal punishment of survival and justify that outcome as common sense. [ABSTRACT FROM AUTHOR] more...

INTRODUCTION: With the rapid expansion of the aging population, the burden of Alzheimer's disease related dementias (ADRD) is anticipated to increase in racialized and minoritized groups who are at disproportionately higher risk. To date, research emphasis has been on further characterizing the existence of racial disparities in ADRD through comparisons to groups racialized as White that are assumed to be normative. Much of the literature on this comparison insinuates that racialized and minoritized groups experience poorer outcomes due to genetics, culture, and/or health behaviors. METHODS: This perspective shines a light on a category of ADRD research that employs ahistorical methodological approaches to describe racial disparities in ADRD that puts us on a merry‐go‐round of research with no benefits to society. METHODS: This commentary provides historical context for the use of race in ADRD research and justification for the study of structural racism. The commentary concludes with recommendations to guide future research. [ABSTRACT FROM AUTHOR] more...

This article discusses mortuary memory and ritual among subalternised populations, in their struggle against necropolitical violence, in the city of Rio de Janeiro, as of the late 2010s. The case study analyses the conception, vandalisation and restoration of two graffiti works, made by Brazilian artists Panmela Castro and Simone Siss, with a decisive contribution from Malala Yousafzai. These works, made in honour of the late Councillor Marielle Franco, are often celebrated as material memories of the intersectional and anti-racist resistance against the mounting authoritarianism of the Brazilian socio-political regime. Yet, they are also confronted by discourses that seek to delegitimise Black and intersectional bodies as effective members of Brazilian society, deeming them disposable and unworthy of mourning. The analysis highlights the importance and the agency of mortuary graphisms as factors of mobilisation and memorial (in)justice, which question and destabilise hegemonic narratives concerning the racialised character of Brazilian society. [ABSTRACT FROM AUTHOR] more...

Evidence shows that Black individuals have higher rates of coercive emergency psychiatric interventions than other racialized groups, yet no studies have elevated the voices of Black patients undergoing emergency psychiatric evaluation. This qualitative study sought to explore the experiences of Black individuals who had been evaluated in a locked psychiatric emergency unit (PEU). Electronic health records were used to identify and recruit adult patients (ages ≥18 years) who self-identified as Black and who had undergone evaluation in a locked PEU at a large academic medical center. In total, 11 semistructured, one-on-one interviews were conducted by telephone, exploring experiences during psychiatric evaluation. Transcripts were analyzed with thematic analysis. Participants shared experiences of criminalization, stigma, and vulnerability before and during their evaluation. Although participants described insight into their desire and need for treatment and identified helpful aspects of the care they received, they noted a mismatch between their expectations of treatment and the treatment received. This study reveals six major patient-identified themes that supplement a growing body of quantitative evidence demonstrating that racialized minority groups endure disproportionate rates of coercive interventions during emergency psychiatric evaluation. Interdisciplinary systemic changes are urgently needed to address structural barriers to equitable psychiatric care. [ABSTRACT FROM AUTHOR] more...

PurposeThe purpose was to use Twitter to conduct online surveillance of negative sentiment towards Mexicans and Hispanics during the 2016 United States presidential election, and to examine its relationship with mental well-being in this targeted group at the population level.MethodsTweets containing the terms Mexican(s) and Hispanic(s) were collected within a 20-week period of the 2016 United States presidential election (November 9th 2016). Sentiment analysis was used to capture percent negative tweets. A time series lag regression model was used to examine the association between percent count of negative tweets mentioning Mexicans and Hispanics and percent count of worry among Hispanic Gallup poll respondents.ResultsOf 2,809,641 tweets containing terms Mexican(s) and Hispanic(s), 687,291 tweets were negative. Among 8,314 Hispanic Gallup respondents, a mean of 33.5% responded to be worried on a daily basis. A significant lead time of 1 week was observed, showing that negative tweets mentioning Mexicans and Hispanics appeared to forecast daily worry among Hispanics by 1 week.ConclusionSurveillance of online negative sentiment towards racially vulnerable population groups can be captured using social media. This has potential to identify early warning signals for symptoms of mental well-being among targeted groups at the population level. more...

Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness but little research has examined the relationship between race and homelessness. We aimed to understand the relationship between race and the experience of homelessness for older adults. We used grounded theory methodology to analyze in-depth qualitative interviews (n = 65) of persons experiencing homelessness. We recruited participants who were enrolled in two sub-studies of the Health Outcomes of People Experiencing Homelessness in Older Middle AgE (HOPE HOME) Study in Oakland California. We identified two major themes within interviews with Black participants (n=52) related to race: (1) participants experienced overt racial discrimination in early life and (2) structural racism precipitated and perpetuated adult homelessness. Further, we identified sub-themes of structural racism that contributed to participants becoming or staying homeless: criminal justice discrimination, employment discrimination, exposure to violence, premature death, and limited family wealth. We developed a theoretical model of how these elements of structural racism may increase susceptibility to homelessness. These relationships between racial discrimination and homelessness may serve as targets for policies aimed at preventing homelessness. more...

Toward the Abolition of Biological Race in Medicine: Transforming Clinical Education, Research, and Practice, written by the Abolishing Biological Race in Medicine Working Group of the Freedom School for Intersectional Medicine and Health Justice, bridges existing research by critical theory scholar-activists and researchers to guide clinicians and student learners in medicine, public health, and beyond on why the use of biological race must be abolished in medicine and clinical research, education, and practice. We begin with how medicine is rooted in a violent history of racism and has scientifically codified race as a biological construct throughout history. From this foundation, this report draws on current examples of the use of biological race in medicine to highlight the urgent need to transform these outdated practices and center patient care. Throughout the paper, the authors intersperse quotes and anecdotes that have been shared with them by their medical student peers. more...

Research supports that exposure to stressors (e.g., perceived stress and racism) during pregnancy can negatively impact the immune system, which may lead to infection and ultimately increases the risk for having a preterm or low-birthweight infant. It is well known that Black women report higher levels of stressors at multiple timepoints across pregnancy compared with women of all other racial and ethnic groups. This study addresses gaps in the literature by describing pregnant and early post-partum Black women's exposures to structural racism and self-reported experiences of racial discrimination, and the extent to which these factors are related. We used a cross-sectional study design to collect data related to exposures to racism from pregnant and early post-partum Black women residing in Oakland, California, from January 2016 to December 2017. Comparative analysis revealed that living in highly deprived race + income neighborhoods was associated with experiencing racial discrimination in three or more situational domains (p = .01). Findings show that Black women are exposed to high levels of racism that may have negative impacts on maternal health outcomes. more...

Abstract Background Racism in medicine represents a global problem. It takes place on the individual, institutional and structural level. Especially structural racism can have serious effects on the health of individual people. Furthermore, racist discrimination is not always based on race solemnly but frequently intersects with other social categories such as gender, class or religion. To describe this multidimensional form of discrimination the term intersectionality has been coined. However, the understanding of structural intersectional racism in medicine is still fragmented, especially in the German context. Yet, medical students need to be trained in understanding structural and intersectional racism to see the impact of racist structures on the patient’s health. Method We conducted a qualitative study to explore the knowledge, awareness and perception of racism in medicine and health care of medical students in Germany. Our research questions are how do medical student understand structural racism and its effects on health in Germany? Do students see interrelations with other forms of discrimination and in this context to what extent are they familiar with the concept of intersectionality? Which categories intersect from their point of views with race in context of medicine and health care? We conducted focus groups with medical students (n = 32) in Germany. Results Our results demonstrate that students have a wide spectrum of knowledge, awareness and perceptions about racism from being rather elaborate to very little knowledge about it. The students have particular problems to understand and situate structural racism in Germany. Some raised doubts about the relevance. Yet, other students are aware of the concept of intersectionality and are convinced that racism must be looked at from an intersectional perspective. Conclusions The diverse knowledge, awareness and perceptions of medical students about structural racism and intersectionality hints to a lack of systematic education of medical students about these issues in Germany. Yet, in context of diversifying societies an understanding about racism and its impact on health is imminent for future medical doctors to provide good care for their patients. Therefore, this knowledge gap must be systematically filled by the medical education. more...

Anthropologists studying mental healthcare tend to do so through observational and analytic attention to how individuals experience specific clinical and cultural contexts. While narrating lived experience may serve to humanise conditions like mental illness, those of us observing from a White, colonist-descended position can overlook the structural and racialised forces that determine entrance into particular treatment spaces. In doing so, we inadvertently obscure structural racism. This Position Piece critiques my approach as a student-in-training in anthropology, who conducted an ethnography of outpatient, government-funded clozapine clinics in the United Kingdom and Australia. In documenting how these clinics unexpectedly became a central source of moral agency for its clients, I stopped short of examining the demographic dynamics that helped to cultivate moral agency. Focused on other questions of health disparity, I missed the role of race and racism in treatment access pathways, trustworthiness, and experiences of moral agency. Engaging now with disciplinary legacies that shaped my inattention, I reflect on my silencing of racism at an interpersonal, institutional and structural level in my early analysis. I encourage similarly positioned anthropologists studying psychiatric treatment spaces and moral experience to confront how racism can be filtered through the stories we tell. more...