Racism Measurement Framework: A Tool for Public Health Action and Accountability

Abstract

Racism is a principal determinant of health inequity, but recent events have galvanized local and state leaders across Ohio to declare racism a public health emergency. In addition to the renewed call to racial justice, sustained progress will require ongoing measurement to determine which anti-racist efforts are working, and why. In this review, we present existing measures categorized by 3 dimensions of racism that interact and build off of one another: (1) systemic racism, considering the health effects of policies in housing, voting, criminal legal system, economic opportunity, and health care; (2) interpersonal racism, and measures of provider bias and cultural competency; (3) internalized racism, measured as allostatic stress and heightened vigilance in distinct contexts. After identifying knowledge gaps, we developed a racism measurement framework that more comprehensively depicts the disparities caused by racism within Ohio and can be used to monitor and evaluate the effectiveness of anti-racist efforts implemented across the state. As such, this framework provides not only a call for action against racism in Ohio, but an opportunity for organizations to measure the extent to which efforts have intervened on supposedly entrenched pathways to health inequities and disparities caused by racism.

Community engagement and clinical trial diversity: Navigating barriers and co-designing solutions—A report from the “Health Equity through Diversity” seminar series

“…While historical events play a significant role in increasing mistrust of the healthcare field in Black populations, there is also the issue of present-day discrimination and racism in healthcare [ 38 , 58 , 59 ]. This racism can be manifested as overt, interpersonal racism in interactions with healthcare staff [ 58 , 59 ].…”

“…While historical events play a significant role in increasing mistrust of the healthcare field in Black populations, there is also the issue of present-day discrimination and racism in healthcare [ 38 , 58 , 59 ]. This racism can be manifested as overt, interpersonal racism in interactions with healthcare staff [ 58 , 59 ]. Additionally, there is extensive evidence that racial/ethnic minority populations in general and especially Black populations have worse health outcomes due in part to receiving lower quality of care [ 60 ].…”

“…Not only should race and the reason for its inclusion be specifically identified and defined, but studies examining race should also include discussions on how racism affects health outcomes [ 66 ]. Dr. Boyd’s comments also speak to the need to measure racism in healthcare, and researchers and investigators in the webinar shared tools and strategies for measurement [ 59 ].…”

Virtual Community Engagement for Retention of Black Men in Clinical Research

“…Black Americans were overrepresented in the low-wage essential workforce, which is typically associated with the absence of paid time-off and inflexible schedules (Gould & Wilson, 2020). All of these components, coupled with medical mistrust and past experiences of racism and discrimination in health care and clinical trial settings, may have contributed to the lack of Black participation in clinical trials (Gray, Joseph, et al, 2020; Gray, Nolan, Bignall, et al, 2021; Gray, Nolan, Gregory, & Joseph, 2021; Nawaz et al, 2020; Watson, Turner, & Hines, 2020).…”