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The October edition of Health Affairs wrestles with the long reach
structural racism has into our health and health care system.

This is our second theme issue on racism and health, following our
landmark February 2022 issue, Racism and Health
.

Understanding and addressing the impact of all forms of
racism-including interpersonal, institutional, and structural-is
essential to building equity in health systems and health care policy.

In the face of increasingly overt displays of interpersonal racism,
expressions of white supremacist ideology, denial of the existence of
structural racism, and challenges to anti-racist practice, we believe
this topic is critical and timely.

We at Health Affairs were struck by the overwhelming interest in this
topic and variety of populations and sectors that are impacted by
structural racism.

No single issue will ever cover the waterfront.

Our first theme issue (which is also open access) set the stage by
orienting readers to the complex relationship between racism and health.

This new issue will deepen readers' understanding of the relationship
of structural racism to health.

Putting together a theme issue is a more-than-year-long process.

Among the first steps is convening a group of researchers and
thought-leaders to help shape the types of content we solicit for the
issue.

In November 2022, we held a planning meeting, led by our theme issue
advisers Ruqaiijah Yearby and Gilbert Gee.

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The planning meeting discussions were rich and invaluable to helping us
shape the theme issue.

One of the conversations that stood out to me was the need to focus on
the systems and structures that shape health, not just the outcomes of
those systems and structures.

For instance, when considering differential access to quality care as an
outcome of racism in health, it's important to consider the systems
and structures that lead to the differential access to quality care in
the first place.

As one member of the planning meeting noted, the forces maintaining
those systems and structures have everything to do with power - who
holds power and who does not (but is nevertheless deeply impacted by
it).

Attendees also emphasized the need to include community voices in the
journal.

We issued our public request for abstracts, with an emphasis on
receiving contributions from junior faculty; authors with lived
experience of racism, including non-academic community members; and
authors from Historically Black Colleges and Universities and
Hispanic-Serving Institutions, tribal colleges and universities, and
Asian American & Pacific Islander Serving Institutions.

Using an idea from our planning meeting, we asked authors for the first
time to provide a positionality statement to address how aspects of
their identity and experiences with systematic privilege and oppression
may influence their work.

Authors of the papers we ultimately published in the issue were also
offered the option of providing a positionality statement.

We know navigating the request for abstracts (RFA) process can be
daunting, so we held a webinar to provide tips on navigating our RFA
process.

I hosted a Q&A session with Rachel Hardeman, a leading scholar on the
intersection of racism and health and an adviser on the 2022 Racism &
Health theme issue.

Our goal was to make the process as accessible as possible and reach
scholars not familiar with Health Affairs.

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We received 265 abstracts in all.

Our editors worked with our theme issue advisers through several stages
of selection, we invited 27 papers for consideration as full
manuscripts.

Following our standard peer review process, we ended up publishing 18
papers, including research articles, commentaries, personal essays, and
a poem, plus two perspective articles that deepen the discussion around
one of the papers.

A common thread throughout the issue is a deeper understanding of the
systems and structures that are shaped by racism and in turn shape
health and health care.

For example, Jamila Michener explores the political contours of health
equity through the lens of housing. Drawing on in-depth qualitative
evidence from tenants who confront health-threatening housing
conditions, Michener examines how people within racially and
economically marginalized communities organize to build political power
.

Jaquelyn Jahn and colleagues explore how structurally racist state laws
are associated with premature mortality

in the US.

Chanelle Diaz and colleagues argue that dismantling immigration
imprisonment

is critical to advancing health equity.

As two papers in the issue discuss, artificial intelligence

and clinical algorithms

are increasingly used to guide health care treatment, but can have
racial and ethnic biases built into them that must be addressed.

It is critical to document the impact of racism on health - as several
papers in the issue do, in areas including food policy, receipt of
medication for opioid use disorder, and administrative burdens in
safety-net programs.

To this end, Zachary Dyer and colleagues create a new measure called the
Structural Racism Effect Index

to quantify the impact of a host of discriminatory policies on health.

Finally, the issue explores responses to racism, including rethinking
how funding is allocated to marginalized groups; creating or
reengineering policies to be "racism-conscious;" listening to the
voices of those impacted by structural racism; and understanding the
role that hospitals can play.

Rounding out the issue, we have two essays in the Narrative Matters
section - on a Black woman's birth experience

and racism in dental care

- along with an original poem
.

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But there is also a wealth of content outside of the print journal that
readers should not miss!

We have virtual events available to Health Affairs Insiders, including a
Journal Club

and a Professional Development event

on writing about racism in health care.

Check out A Health Podyssey, hosted by Alan Weil, for in-depth
interviews with authors

from the issue.

We worked with A Will Productions to produce a short film

to accompany the issue, featuring a robust discussion on how structural
racism manifests in health.

You can also view video abstracts

for several of the manuscripts, produced by the authors themselves,
giving a quick glimpse into their research.

And visit the interactive gallery

on our website to explore the photos and voices of community health
workers in Baltimore, who leverage their experiences to serve
structurally vulnerable communities.

Finally, over on Health Affairs Forefront
,
we have published several articles on racism and health - with more
content to come.

It has been an honor to work with my colleagues, our advisers, and other
leading experts on the Tackling Structural Racism in Health issue.

We hope you will explore the open access issue and all its related
content.

Jessica Bylander
Senior Editor and Correspondent, Health Affairs

Read The October Issue

 

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For this issue, eight authors filmed a video version of their abstracts.

These video abstracts are available with open access on the article's
pages and on our YouTube channel
.
(Please subscribe!)

Here are the authors and articles associated with these exciting new
videos:
* Denis Agniel et al. A Formal Framework For Incorporating Equity Into
Quality Measurement

* Michael P. Cary et al. Mitigating Racial And Ethnic Bias And Advancing
Health Equity In Clinical Algorithms: A Scoping Review

* Shekinah A. Fashaw-Walters and Cydney M. McGuire Proposing A
Racism-Conscious Approach To Policy Making and Health Care Practices

* Simon F. Haeder and Donald Moynihan Race And Racial Perceptions Shape
Burden Tolerance For Medicaid And The Supplemental Nutrition Assistance
Program

* Tina Hernandez-Boussard et al. Promoting Equity In Clinical Decision
Making: Dismantling Race-Based Medicine

* Jason Semprini et al. Medicaid Expansion Lowered Uninsurance Rates
Among Nonelderly Adults In The Most Heavily Redlined Areas

* Milkie Vu et al. Low-Income Asian Americans: High Levels Of Food
Insecurity And Low Participation In The CalFresh Nutrition Program

* Maranda C. Ward Changing How The Health Care Workforce Sees Patients
Like Me

 

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Jamila Michener on the Power Imbalances Fueling Housing Inequities

Health Affairs' Editor-in-Chief Alan Weil interviews Jamila Michener
from Cornell University on her recent paper examining the relationship
between racism, power, and health equity through the lens of tenant
organizations and housing rights.

Listen

 

Exploring Regulatory Frameworks For Psychedelic Services To Treat Mental
Illnesses

Varun Saraswathula and Molly Candon

Ryan J. Petteway On Poetry, Place-Health Research, And Structural Racism

Ryan J. Petteway

 

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Mental Health and Health Equity

Listen to the fourth episode of our new health equity podcast, Research
and Justice For All
!

Research and Justice For All is sponsored by CVS Health and cohosted by
Sree Chaguturu, Chief Medical Officer (CVS Health), and Joneigh Khaldun,
Chief Health Equity Officer (CVS Health).

On the fourth episode
,
Chaguturu and Khaldun interview Nicole Christian-Brathwaite of Headway
and Well Minds Psychiatry & Consulting about the impact that mental
health care disparities have had on historically marginalized
communities and strategic approaches that can improve mental health
outcomes.

If you missed it, listen to the third episode

with Mary-Ann Etiebet.

Listen to the Fourth Episode

 

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mailto:[email protected]

About Health Affairs

Health Affairs is the leading peer-reviewed journal
at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org , Health Affairs
Today , and Health Affairs
Sunday Update .  

Project HOPE is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.
Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States

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