To grasp the impact of racism on health, an epidemiologist suggests going beyond conventional methods | Science

The COVID-19 pandemic has exposed many vulnerabilities in health care, including how structural racism has created the pandemic’s disproportionate impact on marginalized groups. For example, infection, hospitalization, and mortality rates for black people in the United States were higher than for white Americans.

A big question for health researchers is how to measure structural racism, racism built into social systems, including housing, work and health care, in different places and systems. Epidemiologist Paris “AJ” Adkins-Jackson of Columbia University is among the growing number of scientists working on this.

Adkins-Jackson and his colleagues published a 2021 guide to measuring structural racism for epidemiologists and other researchers. The authors urge researchers to use variables that capture the multiple dimensions of structural racism. For example, instead of measuring segregation in residential housing, researchers could include how local governments and banks implement zoning laws and mortgage policies that discriminate against marginalized communities; these variables in turn influence access to quality public education and healthy diets. To capture the specter of how racism can play a role in health disparities and a move away from traditional epidemiological research, the guide recommends collecting qualitative data, reviewing work in the humanities and social sciences, and collaborating with marginalized communities.

“I think science is like tofu,” says Adkins-Jackson. “Whatever seasoning you put in it, it will sweeten it. So, if you season him with racism, he will become racist. It is up to me as a scientist to choose my marinade differently … season it with multiplicity, season it with different thoughts, season it with change.

Last month, Adkins-Jackson gave a talk at a 2-day seminar by the National Academies of Science, Engineering, and Medicine on Structural Racism and Social Inequity, and showed how anthropology and social science methodologies can inform society. health research. This conversation has been edited for length and clarity.

Q: What is structural racism?

A: How [epidemiologists] Camara Jones and Zinzi Bailey teach us that structural racism is … institutional policies and practices that unfairly minorize and disadvantage certain groups while unfairly benefiting racialized white people. Such a system was historically meant to create white privilege and cannot be untangled from the foundations of European colonization.

Q: What was your path to studying it with a moor corner?

A: I’m a black woman raised by Salvadorans in southern Los Angeles and I remember asking my mom why our neighborhood had a curfew during the 1992 Los Angeles riots. Nobody really told me what racism meant. So, it started from this curious place of “Why are we in the circumstances we live in?”

In high school, journalism gave me a home. I thought, “I could be Khadijah James”, the character from the Living Single TV show who is a journalist and has founded a magazine to give voice to unheard people. I needed more story and more context, so I brought all those journalistic skills straight into anthropology. But cultures and communities cannot thrive without life: if I want to enjoy all that culture, eat all the food, study all the books, learn all the languages, then I have to preserve their life and that’s why I got healthy. I did two postdocs in health. … I really spent time studying and understanding how structures behave and how they project themselves onto people.

Q: To study structural racism, you advocate a “mixed methods” approach. What exactly are these mixed methods and what do they add?

A: Mixed methods use qualitative tools, such as interviews and focus groups, and associate them with quantitative methods, such as a survey that allows you to ask a very specific question and have a very specific and finite answer, which we can then translate into a number.

Qualitative research such as narratives, ethnography, interviews and photo voices [are] forms rich in knowledge that challenge us to consider multiple ways of knowing beyond numbers. You won’t find them in major magazines due to discrimination against methods that question this [quantitative] norm.

People like to use quantitative methods because they like to look at results on a large scale. But these methods can be limited … [and have] prejudice.

[For example,] clinical trials are one way structural racism works. You have five blacks in the study; you have three Latinos, maybe you have Asians and there are more than 100 whites in your studio. When using probability, those few people from marginalized backgrounds who experienced racism – which caused high blood pressure, asthma, which changed their blood sugar – are not recorded in the study because the stories of the more than 100 whites cover people of color because of the way we use averages.

This is why qualitative methods become important. The way we do population analyzes, [such as averaging heath measurements], is merging the experiences of these few people. We still need to hear their stories because they are exposed to something the 100+ whites aren’t exposed to.

Q: What’s wrong with the idea of ​​only using statistical methods to correct potential bias?

A: Our systems teach us that standardization will resolve bias. Researchers create all these sensitivity tests to eliminate errors and prejudices, when at first it was enough to add more people to the research team to be more inclusive step by step. Why should you standardize an approach instead of adding more interdisciplinary people to the table? Why is there no social worker? Why isn’t there a community supporter there? We bounce ideas off each other and decide to address the bias early and take it into account, instead of creating a statistical test to eliminate it later. This is crazy! Some things require a more personal touch.

Q: What is an example of using mixed methods to measure structural racism?

A: [Social epidemiologist] Lorraine Dean, for example, used indicators reflecting education, housing, employment, criminal justice, and health care by county to show that structural racism was associated with a lower BMI in whites. and a higher BMI in blacks, especially black men.

I study adverse police at the community level over the course of life, where quantitative data such as racial disparities in the number of arrests, police-involved murders and incarceration rates do not quite capture the constant pressure my elders have endured since childhood. their childhood when they were sanctioned by the police lynchings prevailed. However, together with both the statistics we use and the stories we collect, as did the great Ida B. Wells A red record[: Tabulated Statistics and Alleged Causes of Lynchings in the United States]- illuminate a clear path for science to influence social change and health justice.

Q: What are some tips you would give to an incoming researcher doing this type of research?

A: Take control of yourself as a scientist, instead of being a tool. Practice science the way you want, not the way someone told you or as you saw other researchers do it in a previous publication. Rethink using a method simply because someone said it [you] to do so. Be your own person, be what you have in your gut.

Also, read! People just don’t read. We have studied racism for a long time, calling it by different names, such as disparity; it is disrespectful to act as if what you are bringing to the table is new. Frederick Douglass was writing about this and didn’t even call it the same terms.

Q: How do you explain the importance of studying structural racism and continuing to do so?

A: Now, when I give presentations, I remind my colleagues of the impact of structural racism on me and on those I love. It is a tangible example of how those of us affected are not mere cases in a study. We are loved ones, colleagues and friends who are drowning in a sea of ​​stress and tension that can change if you do more.

If you have an idea, you need to manage it by the communities. Will my research help you? Will this benefit you? Is this interesting to you? Do you have the ability to join me on this? If not, how can I best serve you through this work? I will publish my scientific publications but I will also create a report, I will contact your legislators. Science isn’t just for academia, it’s not just for knowledge… it’s for change.

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