An epidemiologist proposes to go beyond the usual methods to address the impact of racism on health

The COVID-19 pandemic has revealed many vulnerabilities in health care, including how structural racism caused the pandemic to have a tremendous impact on marginalized groups. Age-appropriate infection, hospitalization, and death rates were higher than those of white Americans in the United States, for example.

A big question for health researchers is how to measure structural racism — including racism, housing, employment, and health care — included in social systems — in different places and systems. Columbia University “Columbia AJ” Adkins-Jackson is one of the scientists working on this epidemiologist.

In 2021, Adkins-Jackson and colleagues published a guide to measuring structural racism for epidemiologists and other researchers. The authors call on researchers to use variables that encompass the various dimensions of structural racism. For example, instead of measuring housing segregation, researchers could include how local governments and banks implement zoning laws and mortgage policies that discriminate against marginalized communities; these variables, in turn, affect access to quality public education and healthy eating. The guide recommends collecting qualitative data to look at the impact that racism can have on health inequalities — and moving away from traditional epidemiological research — reviewing the work in the humanities and social sciences, and collaborating with marginalized communities.

“I think science is like tofu,” says Adkins-Jackson. “It simply came to our notice then. So if he is seasoned with racism, he will become a racist. As a scientist, it’s up to me to choose my marinade differently … seasoned with diversity, seasoned with different thoughts, seasoned with change. “

Last month, Adkins-Jackson gave a talk at the National Academy of Science, Engineering and Medicine’s 2-day workshop on structural racism and social inequality, and how anthropology and social science methodologies can inform health research. This interview has been edited for length and clarity.

Q: What is structural racism?

A: As [epidemiologists] As Camara Jones and Zinzi Bailey teach us, racism is structural … while institutional policies and practices that unduly diminish and disadvantage certain groups unfairly benefit people who are racist as white. Historically, such a system had the creation of white privileges and could not be freed from the foundations of European colonization.

Q: What was your way of exploring your angle?

A: I’m a black woman raised by Salvadorans in South Los Angeles, and I remember asking my mother why she had our neighborhood in the 1992 Los Angeles riots. No one really talked to me about what racism meant. So he started from this strange place: “Why are we in the situation we live in?”

In high school, journalism gave me a home. I thought, “I could be Khadijah James,” a journalist who created a character in a Living Single session and a magazine to give a voice to unheard people. I needed more history and more context, so I took all of these journalism skills directly to anthropology. But cultures and communities can’t thrive without life: enjoying all that culture, eating all the food, studying all the books, all the languages ​​I want to learn, then I have to save their lives and that’s why I got into health. I did two postdoctoral fellowships in health care. … I have really spent time studying and understanding how structures behave and how they are projected on people.

Q: In favor of structural racism, you favor a “mixed method.” What exactly are these mixed methods and what do they add?

A: Mixed methods are the use of qualitative tools — interviews and discussion groups — and marriage with quantitative methods — such as a survey that allows you to ask a very specific question and have a very specific and limited answer — which we can then translate into a number. .

Qualitative research such as narratives, ethnography, interviews, and photophobia [are] Rich forms of knowledge that challenge us to explore different ways of knowing beyond numbers. You won’t find them in major journals because of discrimination against methods that question this [quantitative] arau.

People like to use quantitative methods because they like to study large-scale discoveries. But these methods may be limited … [and have] bias.

[For example,] clinical trials are a way to work out structural racism. You have five blacks in the exam; you have three Latinos, maybe some Asians, and there are more than 100 white people in your study. When you use probability, these few people from marginalized backgrounds who suffered racism — who caused high blood pressure, who caused asthma, who changed their blood glucose — are not included in the study because more than 100 people are covered in white stories. because of the way people of color use averages.

This is why qualitative methods are important. How to analyze the population, [such as averaging heath measurements], is bringing together the experiences of these few people. We still have to listen to their stories because they are affected by something that no more than 100 white people suffer from.

Q: What about the idea of ​​using only statistical methods to correct potential biases?

A: Our systems teach us that normalization will fix bias. Researchers create all of these sensitivity tests to eliminate mistakes and biases, all that was initially needed to add more people to the research team to be more inclusive step by step. Why standardize an approach rather than add more interdisciplinary people to the table? Why is there no social worker? Why is there no community advocate? Let’s leave the ideas to each other and decide to deal with the bias and account for it, instead of creating a statistical test to eliminate it later. It’s crazy! Some things require a more personal touch.

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

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

I’ve been studying harmful community-level policing all my life, where quantitative data like racial differences in the number of arrests, police killings, and prison rates doesn’t hold up very well to the constant pressure my seniors have endured when they were punished by the police since childhood. lynchings predominated. However, the statistics we use and the stories we collect together — as the great Ida B. Wells did. Red Disk[: Tabulated Statistics and Alleged Causes of Lynchings in the United States]—Lighten the clear path of science to influencing social change and health justice.

Q: What are some suggestions you might have for a researcher who is doing this type of research?

A: Take control as a scientist, as opposed to being a tool. Practice science the way you want, not the way someone told you, or the way you saw other researchers in a previous post. Reconsider using a method because someone said so [you] for that. Be your own person, be what you have in your gut.

Also, read on! People don’t read it. We have been studying racism for a long time, calling it by different names — differences, for example; it is disrespectful to treat what you bring to the table as if it were a novel. Frederick Douglass was writing about this and not telling him the same terms.

Q: How do you explain the importance of studying and doing structural racism?

A: Now, as I make presentations, I remind my colleagues of the impact of structural racism on me and those I love. A tangible example of what has affected us is the empty cases in a non-investigation. We are loved ones, colleagues and friends who are drowning in a sea of ​​stress and tension that can be changed by doing more.

If you have an idea, you need to run it according to the communities. Will my research benefit you? Will this benefit you? Is this interesting to you? Do you have the skills to join me? If not, how can I best serve this purpose? I will publish my scientific publications but I will also build relationships, I will reach out to your legislators. Science is not for academia, it is not for knowledge … but for change.

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