Structural Racism and Health

The focus of the 2022 IRL call for application (CFA) is structural racism and health. The aim for the new IRL cohort, beginning in November 2022, is to generate research useful for dismantling structural racism and improving health and health equity.

Each year, IRL organizes the CFA on a focus area to build cohort cohesiveness and to generate evidence for change. Achieving health equity through action-oriented research—especially for communities of color; those in low socioeconomic positions; and Indigenous populations—is a core value of the program. By action-oriented, we refer to research that examines and seeks to understand the delivery or impact of a policy, program, or other change on unequal distributions in population health. Within the broader area of structural racism and health, applicants are strongly encouraged to propose studies that reveal actionable solutions for improving the health of populations through public or private sector policies and/or programs. For the purposes of this CFA, IRL is only interested in proposed projects that address structural racism and provide actionable solutions, and not projects that document or describe individual experiences of racism.

Racism exists and contributes to health inequities. Structural racism refers to “the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice” (see Bailey et al., 2017, “Structural racism and health inequities in the USA: evidence and interventions,” The Lancet). Structural racism is manifested in policies, practices, and programs in ways that segregate and prioritize populations based on race and ethnicity, and create barriers to social opportunity and upward mobility. Structural racism results in systemic prejudicial treatment that disproportionately increases difficulty in accessing quality health care; education; employment; housing; fair treatment in the criminal justice system; and full participation in political systems and processes. There are decades of research that indicate that these barriers and threats drive marginalization and result in inequity in community health and well-being among Black, Indigenous, and other people of color. There is an urgent need to identify solutions for eliminating and reversing the devastating effects of structural racism.

Structural racism is a fundamental cause of poor health in populations (see Phelan, J. C., & Link, B. G., 2015, “Is racism a fundamental cause of inequalities in health?”, Annual Review of Sociology, 41, 311–330). Structural racism requires mitigation and approaches for change to improve health equity for populations that have been marginalized. IRL seeks proposals that build evidence for solutions to eliminate the structures that perpetuate racial inequities in health, rather than proposals that seek to further document the existence or impact of structural racism and racist policies.

IRL is interested in proposals based in institutional systems beyond health care. Projects that address historic and long-term discriminatory policies and practices that have increased and/or perpetuated segregation, health inequities, and wealth disparities are strongly encouraged. Additionally, IRL is interested in projects that explore strategies and interventions in social and economic systems, including transportation, land use, education, employment, and digital connectivity. IRL seeks applications that address questions such as: How can systems be changed to reduce the impact of racist, discriminatory, or exploitative practices, policies, or actions? How can systems be dismantled with additional information that is generated through systematic research?

For example, IRL is interested in projects that explore strategies that address the legacy of redlining, and the effect on health of dismantling racially restrictive covenants in property deeds. For information on redlining and covenants see: https://dsl.richmond.edu/panorama/redlining/ and https://mappingprejudice.umn.edu/.

The following studies are examples of potential research topics on structural racism and health. These examples are merely illustrative. IRL welcomes proposals on a range of topics and approaches, provided they are consistent with the discussion above.

• An analysis of policy language to support the siting for new transit lines based on existing and historical demographics and land development.
• A natural experiment assessing self-reported mental health among formerly incarcerated individuals as a function of neighborhood-level voter participation and civic health.
• An econometric analysis (e.g., comparing different states over time) to assess how a change in Medicaid reimbursement or enrollment eligibility affects outcomes for Black and white beneficiaries.