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The COVID-19 pandemic has exposed many health vulnerabilities, including how structural racism has led to the pandemic’s excessive impact on marginalized groups. Age-adjusted infection, hospitalization, and death rates for people of color in the United States were higher than white Americans, for example.

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

Adkins-Jackson and colleagues published Management in 2021 to measure structural racism for epidemiologists and other researchers. The authors encourage researchers to use variables that capture multiple aspects of structural racism. For example, rather than simply measuring residential segregation, researchers could look at how local governments and banks enforce zoning laws and mortgage policies that discriminate against marginalized communities; these variables, in turn, affect access to quality public education and healthy diets. To cover the spectrum of how racism can play a role in health inequalities—and in a departure from traditional epidemiological research—the guide recommends collecting qualitative data, analyzing 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 just soaks it up right now. So if you season it with racism, it becomes racist. It is my duty as a scientist to choose my marinade differently… to spice it up with variety, spice it up with different thoughts, spice it up with change.”

Last month, Adkins-Jackson gave a talk during Two-day seminar of the National Academy of Sciences, Engineering and Medicine about structural racism and social inequality, and showed how the methodologies of anthropology and the social sciences can help in health research. This conversation has been edited for length and clarity.

Q: What is structural racism?

BUT: As [epidemiologists] Kamara Jones and Zinzi Bailey teach us that structural racism is… institutional policy and practices that to unfairly belittle and disadvantage certain groups while unfairly favoring people who are considered racially white. Such a system was historically meant to create white privilege and cannot be separated from the foundations of European colonization.

Q: What was your path to learning this from a heather point of view?

BUT: I am a black woman raised by Salvadorans in south LA and I remember asking my mom why our neighborhood had a curfew during the 1992 LA riots. No one really talked to me about what racism is. So it all started with a curious question: “Why are we in the circumstances in which we live?”

In high school, journalism gave me a home. I thought, “I could be Khadija James,” a character from the TV show Living Single who is a journalist and founded a magazine to give voice to unheard people. I needed more story and more context, so I applied all my journalistic skills directly to anthropology. But cultures and communities cannot flourish without life: if I want to enjoy all this culture, eat all food, study all books, learn all languages, then I must keep them alive, and that is why I became healthy. I have done two postdocs in healthcare. … I just took the time to study and understand how structures behave and how they project onto people.

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

BUT: Mixed methods use qualitative tools like interviews and focus groups and combine them with quantitative methods like a survey, which allows you to ask a very specific question and get a very specific, final answer that we can then turn into a number. .

Qualitative research such as narratives, ethnography, interviews and photo voice. [are] rich forms of knowledge that force us to consider several ways of knowing beyond numbers. You won’t find them in leading magazines because of the discrimination against methods that challenge this. [quantitative] norm.

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

[For example,] clinical trials are one way in which structural racism manifests itself. You have five blacks in the study; you have three Hispanics, maybe you have a few Asians, and you have over 100 white people in your study. Using probability, the few marginalized people who suffered from racism that caused hypertension, that caused asthma, that changed blood glucose levels, are not included in the study because the stories of more than 100 white people cover people of color because how we use averages.

This is why qualitative methods become important. The way we do population analysis, [such as averaging heath measurements], brings together the experience of these few people. We still need to hear their stories because they are being exposed to more than 100 white people.

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

BUT: Our systems teach us that standardization will correct bias. Researchers create all these sensitivity tests to weed out errors and biases, when all it took at the beginning was to add more people to the research group in order to become more inclusive step by step. Why would you standardize the approach rather than adding more interdisciplinary people to the table? Why is there no social worker? Why is there no public defender there? Let’s brainstorm ideas with each other and decide to deal with the bias up front and explain it instead of creating a statistical test to weed it out later. This is madness! Some things require a more personal approach.

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

BUT: [Social epidemiologist] Lorraine Dean, for example, used measures of education, housing, employment, criminal justice, and health care by county to show that structural racism has been associated with lower body mass index in white people and higher BMI in blacks, especially black men.

I study adverse community-based policing throughout life, where quantitative data such as racial differences in arrest rates, police-involved murders, and incarceration rates do not quite reflect the constant pressure my elders have been subjected to since childhood when they were sanctioned. police. lynchings were common. However, the combined statistics we use and the stories we collect are, as the great Ida B. Wells did in red record[: Tabulated Statistics and Alleged Causes of Lynchings in the United States]– light a clear path for science to influence social change and health equity.

Question: What suggestions would you give to an aspiring researcher doing this kind of research?

BUT: Take control of yourself as a scientist, not as a tool. Practice science the way you want to, not the way someone told you or the way you saw other researchers do it in a previous post. Rethink using a method just because someone said [you] to do this. Be yourself, be what you have inside.

Also, read on! People just don’t read. We have been studying racism for a long time, calling it in many ways, for example, inequality; it is disrespectful to act as if what you bring to the table is new. Frederick Douglass wrote about it and didn’t even call it the same terms.

Q: How do you explain the importance of studying structural racism and how to do it?

BUT: Now, when I give presentations, I remind my colleagues of the impact of structural racism on me and those I love. This is a tangible example of how those of us affected by this are not just cases in the 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 launch it through the communities. Will my research serve you? Will it benefit you? Is it interesting for you? Do you have the opportunity to join me in this? If not, how can I best serve you through this work? I’m going to publish my scientific publications, but I’m also going to build rapport, I’m going to contact your legislators. Science is simply not for the academy, just not for knowledge… it is for change.

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