Watch our new short film about Structural Racism In Health!
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Sunday, October 8, 2023 | The Latest Research, Commentary, And News From
Health Affairs

Dear John,

The October issue of Health Affairs, building on the February 2022 issue
that explored racism
and health, focuses specifically on structural racism.

Articles published in this issue describe different types of structural
racism and explore efforts to address its harms.

Read the Issue

Politics and Policy

"Housing is a key determinant of health and health equity
,"
says Jamila Michener, who examines tenant organizing as a source of
political power to address poor housing.

Based on interviews with tenants from racially and economically
marginalized communities, she identifies direct action and local policy
change as "ways organizing can contribute to creating healthier, more
racially equitable communities."

Jaquelyn Jahn and coauthors use latent class analysis to divide states
into groups based on thirteen structural racism-related legal domains,
such as fair housing and racial profiling
.

They find that "age-adjusted premature mortality rates overall were
highest in [the twenty-nine] states with predominantly harmful laws."

Jason Semprini and coauthors categorize census tracts by the degree of
redlining that occurred in them. Tracts with the highest rates of
historical redlining had the highest proportion of the population
without health insurance

as of 2014.

The Affordable Care Act helped close the gap, as the authors found that
"Medicaid expansion had its greatest impact on uninsurance rates in the
highest redline category."

Simon Haeder and Donald Moynihan use national survey data to explore
public beliefs about the acceptability of administrative burdens imposed
by states that impede enrollment

in Medicaid and the Supplemental Nutrition Assistance Program.

They find "varying levels of support for state actions that would either
create or mitigate burdens" and note that racial resentment is one of
the major predictors of favoring administrative burdens.

Leighton Ku

and Carolyn Barnes

offer perspectives on the article.

Read More

Using Data

Michael P. Cary Jr. and coauthors conduct a scoping review of literature
related to mitigating racial and ethnic bias in clinical algorithms
.

They find that studies "tended to be either highly specific technical
guidance or high-level, nontechnical surveys of strategies," with
limited evidence of the multidisciplinary approaches needed to overcome
algorithmic bias.

In a Commentary regarding clinical algorithms, Tina Hernandez-Boussard
and coauthors call for "striking the right balance between the
race-neutral approach, which avoids using race as a risk factor in
clinical decision making, and the race-aware approach, which
incorporates data on disparities in an effort to advance health equity
."

Noting the need to address inequities across multiple dimensions (such
as race and rurality), Denis Agniel and coauthors describe how assigning
quantitative goals for each dimension of equity, or "equity weighting
,"
can yield more optimal results than traditional quality improvement
incentives.

Zachary Dyer and coauthors identify forty-two variables available at the
census tract level that they combine into a Structural Racism Effect
Index
.

Deciles of the index are monotonically related to life expectancy,
diabetes prevalence, and the percentage of residents identifying as
people of color.

Read More

Responses to Racism

Community health workers (CHWs) are front-line public health workers who
are also members of the marginalized communities they serve.

Drawing on a series of interviews, Chidinma Ibe and coauthors conclude:
"Efforts to embed CHW-delivered resources within health care delivery
and public health organizations must be accompanied by CHW-centered
policies and practices

anchored in the centrality of these workers' unique intersectional
backgrounds."

Shekinah Fashaw-Walters and Cydney McGuire propose a "racism-conscious
"
approach to policy making.

In contrast to race-neutral or race-based policies, their approach
involves examining current inequities and identifying prevalent health
issues experienced by minoritized groups, identifying inequity-related
policies, dissecting policy mechanisms and consequences, elucidating the
impact of racism, and creating new policies that consider implementation
strategies.

Based on discussions with members of Indigenous communities, Arielle
Deutsch and coauthors find that "funding policies for the grants that
[Indigenous-led community-based organizations] attain are incompatible
with their needs to thrive," leaving these organizations with inadequate
infrastructure

to compete with larger, White-led ones.

Joel Weissman and coauthors survey hospital health equity officers and
find that most of them "recognized both systemic and institutional
racism

as obstacles to their work."

Order The Issue

If you haven't already, join Health Affairs Unlimited to access our
current and past issues

as well as our premium newsletters and virtual events.

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The October 2023 issue of Health Affairs covers the theme of Tackling
Structural Racism In Health.

In conjunction with the issue's release, we will be premiering a short
film entitled "Tackling Structural Racism in Health: A Conversation
."

We convened a panel of experts, including Dr. Michael Cary, Dr. Chanelle
Diaz, and Dr. Siobhan Wescott, to discuss ideas from the October 2023
journal issue on systemic racism and health care.

Topics include immigration, AI, and the interplay between policy and
lived experience in health.

Watch the short film to learn more about how structural racism manifests
in health and health care.

Watch the Short Film

 

Fifth Circuit Second-Guesses The FDA's Scientific Judgment: A Dangerous
Precedent

Daniel G. Aaron et al.

The Future Of COVID-19 Vaccine Development

Florian Krammer

Navigating The Crossroads Of Opportunity And Challenge In On-Demand
Nursing

Y. Tony Yang et al.

Exploring Regulatory Frameworks For Psychedelic Services To Treat Mental
Illness

Varun Saraswathula and Molly Candon

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

Ryan J. Petteway

Delegation Of Chronic Care Management In The Medicare Shared Savings
Program

Sean Cavanaugh et al.

Making The Promise Of Value-Based Care Meaningful To Consumers

Jocelyn Frye

 

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Leveraging Data to Drive Outcomes in Health Equity

Listen to the fifth 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 fifth episode
,
Chaguturu and Khaldun interview Karen DeSalvo of Google on how to
leverage data and partnerships to drive positive, equitable health
outcomes. They also discuss both the public and private sector
approaches to promoting health equity.

If you missed it, listen to the fourth episode

with Nicole Christian-Brathwaite.

Listen to the Fifth Episode

 

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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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A Health Podyssey: 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.

Health Affairs This Week: Behind The Pages: Tackling Structural Racism
In Health

Health Affairs' Jessica Bylander and Ellen Bayer explore the new October
issue focusing on Structural Racism In Health. Their conversation
provides insight into unique online features exclusive to this issue as
well as highlighting a number of the journal articles featured.

 

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Join us for the following events:
* October 12: Journal Club: Voices, Images, And Experiences Of Community
Health Workers: Advancing Antiracist Policy And Practice

(For Health Affairs Insiders Only)

* October 19: Briefing: Key Challenges Encountered By The Medicare and
Medicaid Dually-Eligible Population

* October 24: Professional Development: Writing About Racism In Health
Care

(For Health Affairs Insiders Only)

 

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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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