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.

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.

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.

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

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.

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.

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