How Can Health Policy Researchers Measure Structural Racism?

By Katy Backes Kozhimannil, PhD, MPA
June 11, 2021

Katy Backes Kozhimannil is the Distinguished McKnight University Professor of Health Policy and Management at the University of Minnesota School of Public Health and Director of the University of Minnesota Rural Health Research Center. Her research contributes to the evidence base for clinical and policy strategies to advance racial, gender and geographic equity.

Racialized differences in health have been recognized for decades, and U.S. health researchers and clinicians have long — and erroneously — interpreted the social construct of race to be a biological or behavioral risk factor. The paradigm has begun to shift to what some advocates (in the movement now termed reproductive justice) have asserted since the time of colonization and slavery: Racism, not race, is the true source of racial inequities in health outcomes and research, policy and clinical practice ought to focus on the structural aspects of injustice that produce population-level differences in health outcomes.

More and more health policy researchers are actively exploring complex health inequities and developing methodologies for measuring structural racism. Researchers Julianna Alson, Whitney Robinson, LaShawnDa Pittman and Kemi Doll recently added to this scholarship, publishing a narrative review in the journal Health Equity, analyzing 20 years of reproductive health studies that used quantitative measures of exposure to structural racism.

The authors identified four key domains of racism exposures that impact reproductive health outcomes (which data show are disproportionately worse for Black women): 1) civil rights laws and legal racial discrimination, 2) residential segregation and housing discrimination, 3) police violence and 4) mass incarceration.

As the U.S. marks one year since the murder of George Floyd, I want to highlight their analysis of racialized police violence and overpolicing as particularly urgent public health concerns that can impact reproductive health through direct physical and psychological injury, biological “weathering” induced by acute and chronic stress, and reduced access to health care due to police avoidance.

Alson, Robinson, Pittman and Doll describe existing databases and measures of police violence, identifying both the opportunities and limitations of these measures. For example, to improve current measures, they propose linking data on police exposure to nationally representative health surveys. Of note, the NIH recently funded a large-scale study that will examine associations between the killing of Black men by police and birth outcomes for Black infants in the surrounding communities. It is clear that racialized police violence is a continued threat to health and well-being for Black people and communities across the country, and studies like this will likely yield further insights on the effects of racism on health as well as much-needed new measures of exposure to racism.

While the focus of their review was on reproductive health outcomes, the authors’ findings provide an important contribution to broader health policy research efforts around the necessity of research that incorporates multidimensional measures of structural racism. Creating such methodological tools will better enable health policy researchers to empirically demonstrate how structural racism impact many clinical outcomes and how structural policy changes could mitigate racial injustice.

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