Improving the health of populations and reducing health inequities requires that health services researchers explicitly name and examine the impact of structural racism within and across the health care system. Two years after me and my co-author Rachel Hardeman’s manuscript called on the field of health services research (HSR) to expand our understanding of racism’s impact by explicitly naming structural racism and considering new methodological approaches, I’m thrilled to have served as co-lead for this year’s Annual Research Meeting (ARM) Structural Racism, Disparities, and Equity in Health theme.

The sessions and presentations selected as part of this theme display the vast and varied impact of structural racism on health inequities, health care access, and patient quality of care. Throughout this theme researchers engage in the fundamental next phase of health equity research: not only naming but presenting policy solutions and evidence-based interventions that can reduce health inequities and improve the health care experiences of historically and contemporarily exploited, disregarded, and disenfranchised populations. The research presented at this year’s ARM asks: What data can we leverage to better understand how racism operates within health care settings? and What policy or programmatic changes can we make to create an antiracist care environment?

This theme offers two panel discussions that highlight how various forms of structural inequity are deeply embedded within the health care system. On Saturday June 4, during the panel discussion titled Stigmatizing Language in Medical Records: Emerging Evidence and Methodological Challenges, panelists  will highlight how social hierarchies and inequities are replicated through the use of stigmatizing language within patient medical records. In addition to highlighting the importance of medical records, panelists will also discuss the difficulties associated with leveraging this unique data source to study health care discrimination. A second panel discussion, chaired by Dr. Utibe Essien, goes beyond the issue of stigma and potentially lower quality care to explore how policy solutions can be leveraged to address pharmaco-inequities caused by structural racism.

Early and consistent exposure to structural threats to health over the life course

Structural racism, and the systems of disadvantage and vulnerability it creates for many populations, is consistent and pervasive from birth to later life. As health services researchers expand our understanding of the impact of structural and institutional bias, it is important to understand the life course implication of racialized exposures such as discrimination and contact with the criminal justice system. The session Early and Consistent Exposure to Structural Threats over the Life Course, features presentations focused not only on understanding the impacts of these exposures on health outcomes like hypertension and reduced cognition, but also work that aims to create safe and nurturing environments that combat the impact of these adverse experiences. Dr. Gladys Asiedu and co-authors present findings from a community based participatory study designed to provide better understanding and support pediatric patient needs related to multi-level experiences of racism. Through ten interviews with youth and parent dyads, these researchers found that parents and youth found it valuable when providers addressed the microaggressions and other forms of racism they experienced when seeking health care services. This intervention, and others like it, represent antiracist provider-led interventions that confront and attempt to address the many forms of structural racism that impact patients when seeking health services.

Implications of payment policies in addressing disparities

Creating an antiracist health services future also requires us to acknowledge that race-neutral policies will not be the answer to persistent health inequities. Without specific attention to the populations most impacted by health inequities, we often inadvertently recreate unequal systems through our policy approaches. Evidence of these consequences are presented by Dr. Sherry Glied and colleagues in the session Implications of payment policies in addressing disparities. This analysis of privately insured individuals in the National Health Interview Survey from 2007-2018 finds that even after the passage of the Medicare Modernization Act and the creation of health savings accounts (HSAs), Black and Hispanic individuals are still more likely to report difficulty affording care compared to their white counterparts. These findings suggest that race neutral policies, like the HSA policy, can sometimes have differential effects across racial and income groups. These unintended consequences call on us to be more race-conscious and intentional when developing health care policies aimed at increasing access and reducing costs for patients.

This post had outlined just a few examples of the important research being presented at ARM. For a comprehensive listing of sessions related to this topic, please click here.

There’s still time to register for the Annual Research Meeting taking place in Washington, D.C. June 4-7 to access these sessions.

J'Mag Karbeah

J'Mag Karbeah, M.P.H.

Ph.D. Student - University of Minnesota School of Public Health

J'Mag is a Ph.D. student in the sociology of illness track within the Health Services Research, Policy, Admini... Read Bio

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