TMHERR: Volume 1
The Monthly Health Equity Research Reader Volume 1
“Explaining Health Inequities-- The Enduring Legacy of Historical Biases” (Jones, Hammonds, Gone, and Williams 2024 in New England Journal of Medicine)
This is a Perspective Article examining the ways in which the NEJM gave voice to and perpetuated racism and discrimination. Notable quotes:
“Physicians’ willingness to embrace and promote racist ideas bolstered societal preoccupations with racial hierarchies.”
“Editors share responsibility for this focus. For most of the Journal’s history, the editors alone decided what to publish. External reviews were sought occasionally by the 1930s, but not consistently until the 1970s. As the Journal gained a national and then international audience after World War II, its editorial decisions had ever-wider impact.”
“The medical profession must reckon with this history and take deliberate action to address its legacies.”
Keywords: historical bias, racism in medicine, racism in science
“Unveiling Early Childhood Health Inequities by Age Five through the National Neighborhood Equity Index and the Early Development Instrument” (Aguilar, Perrigo, Pereira, Russ, Bader, and Halfon 2024 in SSM- Population Health)
Aguilar et al (2024) examines equity gaps in children's health and development by investigating the relationship between neighborhood socio-economic context and early child development. The study authors used the National Neighborhood Equity Index (NNEI) and the Early Development Instrument (EDI) to measure these factors. Aguilar et al analyzed data from 144,957 kindergarteners across neighborhoods in the US and found that children living in neighborhoods with more equity barriers were more likely to experience vulnerable developmental trajectories compared to those in neighborhoods without such barriers. By incorporating both the EDI and NNEI, this multi-dimensional measurement approach can help identify and address structural disadvantages, ultimately improving children's health and development on a population level.
Keywords: child health inequities, National Neighborhood Equity Index, early child development
“Policy Solutions to Eliminate Racial and Ethnic Child Health Disparities in the U.S.A.”(Jindal, Barnert, Chomilo, Clark, Cohen, Crookes, et al. 2024 in The Lancet Child and Adolescent Health)
Societal systems, through policies and practices at local, state, and federal levels, perpetuate structural racism, leading to racial and ethnic health disparities in children. Historical and current policy approaches in housing, employment, health insurance, immigration, and criminal legal sectors impact child health equity. To address disparities and improve health equity, policies must focus on structural racism in multiple sectors. This paper (which is second in a series) continues the work of summarizing existing disparities in child health and discussing multi-sector policy that can be leveraged to improve health equity, especially among racially and ethnically minoritized children.
Keywords: Child health, policy solutions, multi-sector approaches
“Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care Among Minoritized Populations in the United States” (Lopez, Allen, Baker-Smith, Bravo-Jaimes, Burns, et al 2024 in The Journal of Cardiovascular Development and Disease)
For patients with congenital heart disease (CHD), achieving health equity means addressing disparities impacting marginalized populations across the lifespan, in multiple systems and system levels. Lopez et al (2024) review the literature on health equity solutions and consider the health policy ramification for minoritized CHD patient populations. This literature includes actionable strategies and policies regarding social determinants of health, systemic inequities, and structural racism. Additionally, Lopez et al explore the challenges faced by these groups, strategies for mitigating disparities, culturally competent care, and aiding lower-health-literacy populations.
Keywords: CHD, health policy, minoritized populations
“Social Work’s Opportunity and Obligation to Achieve Population Health Equity” (Bussey and Dobrof 2024 in Social Work in Health Care)
The US healthcare system faces a crisis where costs outpace improvements in health equity. The result is inequalities in health that resemble emerging market economies. Rooted in a history of white supremacy, structural racism perpetuates enduring race-based disparities. While a population health approach offers a preventive framework, the absence of explicit race-conscious design risks replicating disparities. Bussey and Dobrof (2024) contextualize the evolution of population health in the US, emphasizing policy changes and underscoring the vital contributions of social work. The authors advocate an approach that challenges colorblindness to achieve race-based health equity, highlighting opportunities for social work practice, leadership, and research to address systemic issues within the healthcare system.
Keywords: social work, social work practice, social work research, color blindness
“In Search of the Promised Land: County-Level Disadvantage and Low Birth Weight among Black Mothers of the Great Migration” (Vu, Arcaya, Kawachi, and Williams 2023 in Journal of Urban Health).
Vu et al (2023) investigated the association between destination county disadvantage and the likelihood of LBW during the final decade of the Great Migration, a significant movement of Black Southerners to the North and West from 1910 to 1980. Using data from the 1970 US Census and birth records of first-time Black mothers who migrated between 1973 and 1980, the study examined three measures of area-based opportunity: Black male high school graduation rate, Black poverty rate, and racialized economic residential segregation (ICE Race*Income). After accounting for individual risk factors, the authors found no relationship between county opportunity measures and LBW among migrators, suggesting that persistent racial discrimination in the North may have hindered infant health despite better economic opportunities.
Keywords: LBW, The Great Migration, racial residential segregation
“Voices, Images, and Experiences of Community Health Workers: Advancing Antiracist Policy and Practice” (Ibe, Hines, Carrero, Fuller, Trainor, Scott, Hickman, and Cooper 2023 in Health Affairs)
This paper is one in a special issue of Health Affairs that examines structural racism in Health (Volume 42, issue 10). This particular study examines the unique experiences of community health workers (CHWs) working in marginalized communities in Baltimore City, Maryland. The researchers used the photovoice method to understand how the lived experiences of CHWs intersect with their job responsibilities. Ibe et al (2023) collaborated with sixteen participants largely identifying as racial and ethnic minorities. The authors discovered how CHWs navigate social risk factors rooted in structural racism and use their experiences to shape their approach in delivering interventions to structurally vulnerable communities. The study also highlighted the occupational hazards faced by CHWs due to their identities. The findings emphasize the importance of incorporating anti-racist principles into policies and practices that impact the CHW workforce.
Keywords: CHWs, anti-racist policy, public health practice
