Actions to Transform US Preventive Services Task Force Methods to Mitigate Systemic Racism in Clinical Preventive Services

Abstract

he US Preventive Services Task Force (USPSTF) is an independent body that works to improve health outcomes for all peopleintheUSthroughevidence-basedpreventivecarerecommendations,viaarigorousreviewofexistingevidenceassessingthe effects of clinical preventive services on peoples' health and quality of life. 1,2 The USPSTF adheres to transparent processes that are continually refined to ensure the trustworthiness of recommendations. 3,4 Significant issues affect evaluating the net benefits of preventive services. First, continued evidence of inequities in the delivery of preventive services persist for groups that experience racism. 5 Second, across preventive services, the evidence is often from studies with primarily White and male research participants. Foundational US trials of preventive services with adequate inclusion of participants who identify as people of color (specifically, Black, Indigenous, and Latino/Latina people) are limited and may not be feasible or ethical to replicate once evidence in White persons is established. Third, these observations are likely caused by systemic racism, the ways in which public and private policies, institutional practices, and cultural representations foster, reinforce, and perpetuate racial inequality throughout society. [6][7][8] In recognition of the dual crisis of centuries of systemic racism and enduring health inequities affecting people of color in the US, 8,9 the USPSTF in 2021 endorsed embedding considerations in every step of its recommendation development process to help rectify the effects of social injustices. 10 The USPSTF created a Race and Racism Workgroup and developed a roadmap that outlined 6 actions (Box). 10 A report was commissioned to provide information about how racism and health inequities are being addressed in preventive health care and guideline development; details are described in the accompanying article 11 and full report. 5 This article focuses on updates of USPSTF methods to address systemic racism and promote health equity in preventive services. Findings From the Commissioned Report Purpose of the Commissioned ReportThe Scientific Resource Center for the USPSTF was commissioned to conduct evidence syntheses on how racism and health inequities IMPORTANCE US life expectancy and health outcomes for preventable causes of disease have continued to lag in many populations that experience racism. OBJECTIVE To propose iterative changes to US Preventive Services Task Force (USPSTF) processes, methods, and recommendations and enact a commitment to eliminate health inequities for people affected by systemic racism. DESIGN AND EVIDENCEIn February 2021, the USPSTF began operational steps in its work to create preventive care recommendations to address the harmful effects of racism. A commissioned methods report was conducted to inform this process. Key findings of the report informed proposed updates to the USPSTF methods to address populations adversely affected by systemic racism and proposed pilots on implementation of the proposed changes. ...

Social Determinants of Health, Race, and Diabetes Population Health Improvement: Black/African Americans as a Population Exemplar

“…To illustrate the scope and impact of SDOH in the context of diabetes, and of racial disparities in diabetes and in SDOH factors, Black/African Americans are used as a population exemplar. Although race is a social construct, not a biological one [37,38], in the context of SDOH, the social construct of classifying and assigning value to people based on the color of their skin has import and serves as a proxy for racial discrimination [20,39].…”

“…US national committees and agencies have published recommendations for the health sector and health care organizations to address SDOH. These recommendations include National Academies of Sciences, Engineering, and Medicine (NASEM) reports on educating health care professionals to take action on SDOH [79], integrating social needs care into health care delivery [80], and addressing SDOH as a component of high-quality, patient-centered primary care [81], and United States Preventive Services Task Force (USP-STF) reports [12,38], among others. Several recommendations and resources address assessment and measurement of SDOH at both the individual patient level and community and population levels, as well as needs for data infrastructure for SDOH monitoring and evaluation [80,[82][83][84].…”

“…Racism is increasingly acknowledged in the USA as a public health issue and as a root cause of health inequities [38,98], with socioeconomic factors as downstream consequences of racism for marginalized populations [66,67]. Racism is defined by the CDC as "a system--consisting of structures, policies, practices, and norms-that assigns value and determines opportunity based on the way people look or the color of their skin" [98].…”

“…The USPSTF aims to address health inequities caused by systemic racism through a process of transforming the methods used by the task force in developing recommendations [38]. By transforming the recommendation-making process, the USPSTF intends to mitigate the influence of systemic racism in the recommendations it puts forth.…”

Race-Based Clinical Recommendations in Gastroenterology

“…Recently, those concerns have led to major shifts in how race and ethnicity are used in clinical algorithms and guidelines. 4 New equations that remove race and ethnicity from well-established models, including estimated glomerular filtration rate and vaginal birth after cesarean section calculators, have been proposed. 5,6 Within gastroenterology, there is a need to further examine, critique, and reconsider the use of race and ethnicity in clinical decision making.…”