Addressing Racism in Preventive Services

Lin, Jennifer S; Hoffman, Lynn; Bean, Sarah; O’Connor, Elizabeth; Martin, Allea; Iacocca, Megan O; Bacon, Olivia; Davies, Melinda

doi:10.1001/jama.2021.17579

Cited by 37 publications

(16 citation statements)

References 60 publications

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“…Our categorization framework can help individuals and groups that conduct systematic reviews by focusing on information with the highest utility for advancing racial health equity. For example, in 2021, the US Preventive Services Task Force (USPSTF) published 2 articles addressing racism in preventive services, with expectations for future USPSTF guideline recommendations . For systematic reviews that support clinical practice guideline development, routine synthesis of differences in effectiveness by race or ethnicity that do not consider analytical informativeness and conceptual thoughtfulness may exacerbate health inequities by perpetuating what has been termed scientific racism , or the belief that racial hierarchies are explained by biological differences .…”

Section: Discussionmentioning

confidence: 99%

Racial Health Equity and Social Needs Interventions

et al. 2023

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ImportanceSocial needs interventions aim to improve health outcomes and mitigate inequities by addressing health-related social needs, such as lack of transportation or food insecurity. However, it is not clear whether these studies are reducing racial or ethnic inequities.ObjectiveTo understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity.Evidence ReviewSources included a scoping review of systematic searches of PubMed and the Cochrane Library from January 1, 1995, through November 29, 2021, expert suggestions, and hand searches of key citations. Eligible studies evaluated interventions addressing social needs; reported behavioral, health, or utilization outcomes or harms; and were conducted in multiracial or multiethnic populations. Two reviewers independently assessed titles, abstracts, and full text for inclusion. The team developed a framework to assess whether the study was “conceptually thoughtful” for understanding root causes of racial health inequities (ie, noted that race or ethnicity are markers of exposure to racism) and whether analyses were “analytically informative” for advancing racial health equity research (ie, examined differential intervention impacts by race or ethnicity).FindingsOf 152 studies conducted in multiracial or multiethnic populations, 44 studies included race or ethnicity in their analyses; of these, only 4 (9%) were conceptually thoughtful. Twenty-one studies (14%) were analytically informative. Seven of 21 analytically informative studies reported differences in outcomes by race or ethnicity, whereas 14 found no differences. Among the 7 that found differential outcomes, 4 found the interventions were associated with improved outcomes for minoritized racial or ethnic populations or reduced inequities between minoritized and White populations. No studies were powered to detect differences.Conclusions and RelevanceIn this review of a scoping review, studies of social needs interventions in multiracial or multiethnic populations were rarely conceptually thoughtful for understanding root causes of racial health inequities and infrequently conducted informative analyses on intervention effectiveness by race or ethnicity. Future work should use a theoretically sound conceptualization of how race (as a proxy for racism) affects social drivers of health and use this understanding to ensure social needs interventions benefit minoritized racial and ethnic groups facing social and structural barriers to health.

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Section: Discussionmentioning

confidence: 99%

Racial Health Equity and Social Needs Interventions

et al. 2023

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“…Recognizing that inequities in the delivery of preventive services persist for people who experience racism, the USPSTF has committed to highlighting the likely effects of systemic racism and health inequities on clinical preventive services in our recommendations . In concert with these efforts, we commissioned a literature review to summarize the evidence on how systemic racism undermines the benefits of evidence-based clinical preventive services and causes preventable deaths …”

mentioning

confidence: 99%

US Preventive Services Task Force Recommendation Statement on Screening for Atrial Fibrillation—Reply

Davidson

Mangione

Ogedegbe

2022

JAMA

460

520

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“…As Archbishop Desmond Tutu said, "Language is very powerful, language does not just describe reality, language creates the reality it describes. 27 " As noted in the methods report, 5 race and ethnicity are complex terms with different meanings yet are often used interchangeably with little or no definition. [28][29][30] Although there is no consensus on preferred terminology, some consistent themes are discernable.…”

Section: Languagementioning

confidence: 99%

“…The USPSTF created a Race and Racism Workgroup and developed a roadmap that outlined 6 actions (Box). 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 and full report . This article focuses on updates of USPSTF methods to address systemic racism and promote health equity in preventive services.…”

Section: Introductionmentioning

confidence: 99%

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

Force¹,

Davidson

Mangione

et al. 2021

JAMA

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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. ...

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Addressing Racism in Preventive Services

Cited by 37 publications

References 60 publications

Racial Health Equity and Social Needs Interventions

Racial Health Equity and Social Needs Interventions

US Preventive Services Task Force Recommendation Statement on Screening for Atrial Fibrillation—Reply

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

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