Antiracist Methods

This post is the final entry in our series about the use of race and ethnicity in population health research. Our previous posts have detailed information around defining, measuring, coding, and analyzing data on race and ethnicity.

For states to move toward antiracist, equitable, and inclusive policies that build an economic recovery that extends to all people, three principles should guide state policymakers in these equity efforts.

At the root of structural issues is powerlessness. This primer examines how health equity can be achieved through a community power-building approach to structural change.

The Racial Equity and Policy (REAP) framework provides a conceptually sound, empirically grounded basis for systematically assessing racial equity in health policy

This work seeks to shift awareness and practice by centering racial equity and community voice within the context of data integration and use that supports power sharing and building across agencies and community members.

This report explains the Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government (“Equity EO”) launched a whole-of-government effort to incorporate the principle of equity throughout the federal government. Recognizing that the ability to conduct equity assessments and identify and remove barriers to equitable access to government programs is contingent on gathering the necessary data, President Biden ordered the formation of the Equitable Data Working Group. The President directed the Working Group to study existing federal data collection policies, programs, and infrastructure to identify inadequacies and provide recommendations that lay out a strategy for increasing data available for measuring equity and representing the diversity of the American people. The following recommendations are then discussed: make disaggregated data the norm while protecting privacy; catalyze existing federal infrastructure to leverage underused data; build capacity for robust equity assessment for policymaking and program implementation; galvanize diverse partnerships across levels of government and the research community; and be accountable to the American public. Key administration actions that address each of the recommendations are described.

Yeshimabeit Milner, founder and executive director of Data for Black Lives, calls for rejecting the concentration of Big Data in the hands of a few to challenge the structures that allow data to be wielded as a weapon of immense political influence.

This resource is the updated, digital version of A Guide to Planning Accessible Meetings, originally published by Independent Living Research Utilization in 1993, written by co?-authors June Isaacson Kailes and Darrell Jones. This version includes regulatory updates along with practical guidance from a host of meeting planning professionals, subject matter experts, and even June Kailes herself.

Designed for physicians and other health care professionals, this document provides guidance and promotes a deeper understanding of equity-focused, person-first language and why it matters.

The goal of this accessibility resource page is to provide information and resources on how to create and maintain an inclusive environment that is accessible to those with disabilities.

This article highlights synergies between antiracist principles and community-based participatory research (CBPR), examines the potential for CBPR to promote antiracist research and praxis, illustrates structural barriers to antiracist CBPR praxis, and offers examples of CBPR actions taken to disrupt structural racism. It also provides recommendations for the next generation of antiracist CBPR.

To unlock the full potential of data, researchers and analysts must consider and apply equity at every step of the research process. Ensuring responsible data collection, representing the communities surveyed accurately, and incorporating community input whenever possible will lead to more equitable data analyses and visualizations. Although there is no one-size-fits-all approach to working with data, for researchers to truly do no harm, they must build their work on a foundation of empathy. This article details three ways you can make your data analysis and communication more equitable and inclusive.

While each organization will follow its own path towards a Race Equity Culture, our research suggests that all organizations go through a cycle of change as they transform from a white dominant culture to a Race Equity Culture.

In this essay, two women of Color researchers examine the intersections of race and disability and ask, ?What is the power and purpose of positioning and positionality statements?? Informed by Black feminist theory, and drawing from the DisCrit tenets of intersectional oppressions, historicity, and whiteness and ability as property, the authors focus on researchers? positioning in relation to how they engage and communicate knowledge about multiply marginalized people.

A recent literature review revealed most studies of social need interventions were poorly designed, inadequately documented, and inconsistently presented. In this post, Robert Dubois of the National Pharmaceutical Council, an AcademyHealth Organizational Member, outlines the state of the research and provides recommendations to improve study design quality.

This expert roundtable focuses on how the disaggregation of data, especially race and ethnicity data, can improve equity.

Christopher F. Koller, President of the Milbank Memorial Fund, Lillie Tyson Head, President of VFOFLF, and Pamela Browner White, Chief Diversity, Equity and Inclusion Officer and Senior Vice President of Communications at the American Board of Internal Medicine and the ABIM Foundation, spoke about the importance of building trust by acknowledging past harm, committing to do better, and partnering for the long term to improve trust in the health system.

Structural racism has been and remains a fundamental cause of persistent health disparities in the United States. The coronavirus disease 2019 (COVID-19) pandemic and the police killings of George Floyd, Breonna Taylor, and multiple others have been reminders that structural racism persists and restricts the opportunities for long, healthy lives of Black Americans and other historically disenfranchised groups. The American Heart Association has previously published statements addressing cardiovascular and cerebrovascular risk and disparities among racial and ethnic groups in the United States, but these statements have not adequately recognized structural racism as a fundamental cause of poor health and disparities in cardiovascular disease. This presidential advisory reviews the historical context, current state, and potential solutions to address structural racism in our country. Several principles emerge from our review: racism persists; racism is experienced; and the task of dismantling racism must belong to all of society. It cannot be accomplished by affected individuals alone. The path forward requires our commitment to transforming the conditions of historically marginalized communities, improving the quality of housing and neighborhood environments of these populations, advocating for policies that eliminate inequities in access to economic opportunities, quality education, and health care, and enhancing allyship among racial and ethnic groups. Future research on racism must be accelerated and should investigate the joint effects of multiple domains of racism (structural, interpersonal, cultural, anti-Black). The American Heart Association must look internally to correct its own shortcomings and advance antiracist policies and practices regarding science, public and professional education, and advocacy. With this advisory, the American Heart Association declares its unequivocal support of antiracist principles.

On this week?s episode of The Dose, host Joel Bervell speaks with Dr. Ziad Obermeyer, from the UC Berkeley School of Public Health, about the potential of AI to inform health outcomes ? for better and for worse.

The Commission’s report and recommendations make it clear that in our current system, data on health inequities are divorced from the history and community conditions that shape poor health outcomes.

This review provides a characterization and conceptualization of community voice in health-oriented collaborations that provides a new theoretical basis for future research.

Increasing the accessibility of public and patient involvement (PPI) in health research for people from diverse backgrounds is important for ensuring all voices are heard and represented.

This paper provides recommendations on how to appropriately engage in scientific inquiry aimed at understanding racial health inequities. Race should not be used as a measure of biologic difference, but as a proxy for exposure to systemic racism.

This guide was developed in response to librarians fielding multiple requests from UMN researchers looking to incorporate anti-racism into their research practices. This guide shares racist research systems and practices, followed by resources for mitigating those problematic systems and practices, but we wholeheartedly acknowledge that this guide is not a “solution” to the issues of racism embedded in research.

Racial and ethnic disparities figure prominently intomuch of the analysis conducted by
policy research organizations in the US. But too often our organizations give short shrift to
the centuries of subjugation, discrimination, exclusion, and injustice that have produced
these inequities.

Kimberle Crenshaw invites Barbara Arnwine, Camara Phyllis Jones, Jonathan Metzl, and Keeanga-Yamahtta Taylor to ask: What has become of the supposed reckoning with white supremacy since George Floyd?s death?

This article provides fourstrategies for how individuals and institutions can engage in anti-racism allyship: (1) be an upstander duringmicroaggressions, (2) be a sponsor and advocate for physicians of color, (3) acknowledge academic titles andaccomplishments, and (4) challenge the idea of a ??standard fit?? for academic faculty and research. Skills in aca-demic allyship should be taught toallphysicians throughout the educational continuum to mitigate feelings ofisolation that racialized minority physicians frequently experience.

To challenge our personal & professional ableist biases & practices, we must reframe how we think about disability in higher education, & work not just for access but for equity & inclusion for disabled students.

This publication presents the final recommendations of an external advisory group AcademyHealth convened to help shape a sustainable, action-oriented strategy to address diversity, equity, & inclusion in the field

For this follow-up volume, Do No Harm Guide: Additional Perspectives on Data Equity, we handed the pen to data experts and practitioners whose voices have been traditionally underrepresented.

In this guide and its associated toolkits, we focus on how data practitioners can approach their work through a lens of diversity, equity, and inclusion to encourage thoughtfulness in how analysts work with and present their data.

Dr. Ponce discusses how she devised the rationale and implementation of Asian ethnic oversamples, and the cultural and linguistic adaptation of the CHIS survey in Chinese, Korean, Vietnamese, and Tagalog.

This article examines what it means to use equity as a guiding principle throughout the components and functions of a modern public health data system.

The ACGME Equity Matters Video Library houses all the individual components of the ACGME Equity Matters curriculum and is accessible to anyone in the medical education community. No CME credit is provided for completion of the library?s resources. To ensure a safe environment, it is recommended that organizations using these videos show them under the proper guidance of a trained facilitator for large viewings.

This commentary will interrogate the ways we as health services researchers pose our research questions, create methodological approaches, and interpret our findings, and serve as a disciplinary self-critique that will expose how our disciplinary practices are steeped in white supremacy.

In a bonus episode of A Health Podyssey, Harriet Washington, author of Medical Apartheid, discusses the history of racism in medicine and research with Vabren Watt of Health Affairs and Aletha Maybank of the AMA.

This article examines the health disparities experienced by transgender people with disabilities. It analyzes the prevalence and types of disabilities among transgender people, examines the health outcomes and social determinants of health among this intersectional population, and makes recommendations for areas of future research.

ASTHO?s Health Equity toolkit is part of this work, to help public health leaders navigate the policy process and address health inequities by building diverse and inclusive coalitions. Tools discussed in this guide are designed to support a wide range of policy changes that can promote health equity.

This paper explores the rise & consequences of ?health equity tourism?, a phenomenon where previously unengaged investigators pivot into health equity research without developing the necessary scientific expertise for high-quality work.

This resource is intended to provide state policymakers with a suite of state approaches to address health disparities ? from targeted to cross-agency comprehensive strategies. Each section below comprises best practices and state
examples from a geographically diverse set of states to guide state policymakers to the opportunity that best suits their states? needs and capacity. Also included is a lexicon, recognizing the importance of common definitions in this domain, along with links to key tools and resources.

This expert roundtable focuses on how the COVID-19 pandemic brought to light the serious and pervasive data gaps facing marginalized groups and what cross-cutting themes the panels found in their work.

This article offers a simple, easy to remember framework for designing impactful research. We call this framework: ?The 7Cs of Impact? ? Context, Communities, Constituencies, Challenge, Channels, Communication and Capture.

This study discusses three ways in which implementation science can inform efforts to address disparities in COVID deaths: (1) quantify and understand disparities; (2) design equitable interventions; and (3) test, refine, and retest interventions

Racial and ethnic health disparities have been documented in the United States for over a century. In 1985 the Heckler Report provided the first national summary of these disparities, leading to the creation of the Department of Health and Human Services Office of Minority Health. In the 1990s and 2000s the study of gaps in health care access, utilization, and outcomes by race and ethnicity grew rapidly, but confronted a critical limitation of the available data: the lack of standardized, self-identified race and ethnicity. The COVID-19 pandemic provided stark proof that data limitations are far from being addressed, which has real consequences for the study and practice of public health. Though data have improved since the beginning of the pandemic, the Centers for Disease Control and Prevention can only identify the race and ethnicity of less than 60% of individuals testing positive for COVID-19 or receiving vaccines, significantly limiting the ability of policymakers and health care stakeholders to measure and improve equity in the pandemic?s effects and mitigation. This Roadmap builds on an earlier report, Federal Action Is Needed to Improve Race and Ethnicity Data in Health Programs,1 in three critical respects. First, it expands on that report?s summary of the current state of race and ethnicity data in health care programs, offering more detail about whether and how race and ethnicity data are collected across a range of insurance programs, federally administered health systems and public health databases. Second, it summarizes a range of barriers to improving collection and use of race and ethnicity data, and identifies general principles for improving the data. Finally, it expands the range of recommendations for improving the data, considering not only actions the federal government could take, but also identifying actions for states and the private sector. To advance these goals, the project team carried out a targeted search for information on the completeness and quality of race and ethnicity data; an environmental scan to identify previous reports summarizing challenges to collection and use of race and ethnicity data; and key informant interviews to better define and understand barriers and opportunities. The environmental scan and informant interviews pointed to a consistent set of barriers faced by health care organizations, including: (1) Legal and privacy concerns around collection and use of race and ethnicity data. (2) Lack of standardized collection procedures and category definitions. (3) Technical barriers to collection and storage of data. (4) Cost of collection and lack of financial incentives or program requirements to collect race and ethnicity data. (5) Lack of staff and resources in health care organizations to analyze and use data once collected. (6) Resistance from patients and clinical providers to collection and use of race and ethnicity data. Despite these challenges, prior reports and data from the key informant interviews pointed to several opportunities to improve collection and use of race and ethnicity data: (1) Highlight early, successful adopters of expanded race and ethnicity data collection. (2) Disseminate existing technical support resources and data standards. (3) Educate patients and providers about the potential of improved race and ethnicity data to improve outcomes and equity. (4) Provide incentives to encourage data collection and finance necessary technology investments and staffing. (5) Where incentives fail to produce action, consider mandates (e.g., require collection to meet certain standards as a condition of participating in federal programs or demonstration projects). (6) Identify existing resources that could be leveraged to improve analysis of health equity until consistent, complete, self-reported race and ethnicity data are available. The report concludes with a series of recommendations for federal and state regulators and legislators, health systems and health insurance companies, and a range of other health sector stakeholders. Recommendations are grouped under the following themes: (1) Improve data collection, storage and transfer systems. (2) Evaluate and expand incentives and requirements to collect. (3) Provide updated technical assistance to stakeholders. (4) Review, clarify and, if necessary, amend regulations.

Our latest episode highlights how the current equity efforts can integrate with established performance management practices. It also discusses how health agencies can use planning documents to integrate equity in health assessments, health improvement plans, strategic plans, and performance management systems.

This article highlights methodological approaches that will move the field forward in its ability to validly measure structural racism for the purposes of achieving health equity

This tool describes how to conduct intensive equity assessments of existing programs, policies, and processes. The tool first describes the scoping work that needs to be done before conducting an equity assessment and then describes and provides guiding questions for each of the six steps in the in-depth equity assessment process.

This resource defines intersectionality and describes its manifestations in education. It also offers strategies for addressing implicit biases in Integrated Co-Teaching (ICT) classrooms and provides a list of anti-racist and intersectionality resources for educators.

This Horizon Scan provides an overview of existing DEI programs and practices to ultimately stimulate conversations and action that can advance DEI within health services and policy research.

This 3 level framework is useful for raising new hypotheses about the basis of race-associated differences in health outcomes, as well as for designing effective interventions to eliminate those differences.

This commentary uses Black Feminism and Womanism (BFW) as epistemologies to critically address Black women’s health policy, building on the legacy of Black women’s experiences, theories, & knowledge production.

Despite decades of research exposing health disparities between populations and communities in the US, health equity goals remain largely unfulfilled. We argue these failures call for applying an equity lens in the way we approach data systems, from collection and analysis to interpretation and distribution. Hence, health equity requires data equity. There is notable federal interest in policy changes and federal investments to improve health equity. With this, we outline the opportunities to align these health equity goals with data equity by improving the way communities are engaged and how population data are collected, analyzed, interpreted, made accessible, and distributed. Policy priority areas for data equity include increasing the use of disaggregated data, increasing the use of currently underused federal data, building capacity for equity assessments, developing partnerships between government and community, and increasing data
accountability to the public.

Examines the measurement of sex, gender identity, & sexual orientation to produce recommendations for specific measures that can be used in surveys & research, administrative, clinical, & other health settings.

The goal of this commentary is to inspire the use of up-to-date and theoretically driven approaches to increase discourse among public health researchers on capturing racism as well as to improve evidence of its role as the fundamental cause of racial health inequities.

Despite racism?s alarming impact on health and the wealth of scholarship that outlines its ill effects, preeminent scholars and the journals that publish them routinely fail to interrogate racism as a critical driver of racial health inequities.

Objective: To describe the perception of professional climate in health services and policy research (HSPR) and efforts to advance diversity, equity, and inclusion (DEI) in the HSPR workforce and workplaces.Data source: We administered the HSPR Workplace Culture Survey online to health services and policy researchers. Study design: Our survey examined participants’ sociodemographic, educational, and professional backgrounds, their perception on DEI in HSPR, experience with DEI initiatives, feeling of inclusion, and direct and witnessed experiences of discrimination at their institutions/organizations. We calculated sample proportions of responses by gender identity, sexual orientation, race/ethnicity, and disability status and compared them with Fisher’s exact test. Data collection: We administered the survey online from July 28 to September 4, 2020. HSPR professionals and trainees aged 18 and older were eligible to participate. Analyses used complete cases only (n = 906; 70.6% completion rate). Principal findings: 53.4% of the participants did not believe that the current workforce reflects the diversity of communities impacted by HSPR. Although most participants have witnessed various DEI initiatives at their institutions/organizations, nearly 40% characterized these initiatives as “tokenistic.” Larger proportions of participants who identified as female, LGBQI+, underrepresented racial/ethnic groups, and those with a disability held this perception than their male, heterosexual, White, and non-disabled counterparts. Current DEI initiatives focused on “planning” activities (e.g., convening task forces) rather than “implementation” activities (e.g., establishing mentoring or network programs). 43.7% of the participants felt supported on their career development, while female, Black, Hispanic/Latino, LGBQI+ participants and those with a disability experienced discrimination at their workplace. Conclusions: Despite an increasing commitment to increasing the diversity of the HSPR workforce and improving equity and inclusion in the HSPR workplace, our results suggest that there is more work to be done to achieve such goals.

The Pulse Check is not a downloadable tool, it is an interactive application. Access to the Pulse Check means you are taking it on behalf of/as an organization rather than receiving permission to view all of the questions.

A Racial Equity Impact Assessment (REIA) is a systematic examination of how different racial and ethnic groups will likely be affected by a proposed action or decision.

Tools, research, tips, and curricula for people who want to increase their own understanding and to help those working for racial justice at every level in systems, organizations, communities, & the culture at large.

The Commission’s report and recommendations make it clear that in our current system, data on health inequities are divorced from the history and community conditions that shape poor health outcomes.

This brief provides an overview of the origins of racial hierarchy, distinguishes between biological concepts ofrace and socially defined race, reviews perspectives on the meanings and uses of race, and describes ongoing andpotential efforts to address prevailing misunderstandings about race and racism.

While it is important for college and university senior administrators to embrace the traditional roles of their administrative positions, senior administrators interactions with students also shape institutional culture, students? engagement, and ultimately play a role in students’ motivation to succeed. This engagement is especially evident in the Historically Black College and University (HBCU) context as senior administrators’ engagement with students can directly or indirectly affect how students perceive themselves and their ability to succeed. This article aims to illuminate the role that HBCU senior level administrators play in students’ motivation toward success. We also highlight the notion that senior level administrator’s role in organizational culture ultimately led historically-disempowered Black women students toward success in even the most historically inaccessible pathways in the science, technology, engineering, and math (STEM) fields. The study used semi-structured interviews with 71 Black women STEM students across 10 HBCUs and asked questions to better understand how events in their lives and on their campuses shaped their choice to pursue and persist through a STEM degree program. The study found that the women were highly motivated by their HBCUs family-like community of support. Integral to this article, this support was not confined to professors and peers, but extended to senior administrators. We conclude that Black women STEM students’ perception of their ability to succeed and their motivation is influenced by the institution’s senior administration.

Taking the model from the American Alliance of Museums? guides for transgender inclusion, these toolkits provide a common framework for analysis, a shared vocabulary, and best practices to address racial disparities specific to the scholarly publishing community.

The current evaluation paradigm must shift and mindsets and practices evolve. The Equitable Evaluation Initiative’s Equitable Evaluation Framework provides principles and orthodoxies to guide organizations.

Using stories we collected from American Indian people who have experienced the results of racist policies, we describe historical trauma and its links to the health of American Indians and Alaska Natives.

In this episode, Dr. Brownsyne Tucker Edmonds and Dr. Sylk Sotto talk with Dr. Aaron Carroll about the importance of diversity and equity in research, higher education, and medicine.

Using a blend of personal narrative and insights from a 23-year career as a Black critical health equity researcher, I share 10 critical lessons for Black and other health equity researchers of color.

We provide recommendations on how to implement systems-level change and educational reform to infuse racial equity in future policy and practice for Asian American communities.

This content was initially created to inform federal staff at the U.S. Department of Health and Human Services. In an effort to increase collaboration and share promising practices, the Office of the Assistant Secretary for Planning and Evaluation has made this tool available for both public and private partners.

The report highlights major lessons from the Building Healthy Communities initiative that contribute knowledge to philanthropy and to the on-going racial justice and health equity movement in California and the nation

This Implementation Guidebook will help individuals, organizations, communities and First Nations in planning, implementing and evaluating the W.K. Kellogg Foundation’s Truth, Racial Healing & Transformation efforts.

As 14 Truth, Racial Healing & Transformation places approach the fourth year of implementation, these briefs offer a glimpse into the opportunities, nuances & complexities of implementing a community-based collaboration.

Margo Edmunds and Abdul Shaikh lead attendees through an exercise on priority-setting for methods and data followed by a discussion of the results of the exercise.

Abdul Shaikh facilitates a discussion on emerging methods to advance health equity. Lisa Goldman Rosas presents on community-based participatory research, and Suzanne Tamang discusses how using big data can improve outcomes.

In this session, presenters Ninez Ponce and Juanita Chinn describe approaches to improving data collection and analysis with Asian/Pacific Islander, Native American people, and other under-represented groups.

Derek Griffith draws on his experience developing strategies to improve Black men?s health and to achieve racial, ethnic and gender equity in health to reflect on future directions for health equity research.

Rashida Dorsey leads a conversation with J?Mag Karbeah, Reginald Tucker-Seeley, and Jameta Barlow on topic areas including structural racism, measuring and reporting health disparities, and understanding intersectionality.

Tools to improve communication about social needs, social determinants of health, and structural determinants of health equity.

A virtual coffee chat between two noted changemakers about how to better align health services research to the priorities of policymakers and health system leaders.

In 2021, Fund for Shared Insight launched a participatory grantmaking initiative exploring power-sharing around the decisions funders make in supporting advocacy and policy work aimed at issues of climate change and environmental justice.

This guidebook proposes an equity-based approach as a way to restore communities as the true authors and owners of research, and to shift the way researchers and funders work with community-based organizations to uncover knowledge together.