The COVID-19 pandemic has revealed many health vulnerabilities, including how structural racism has created a huge pandemic impact on marginalized groups. Age-corrected infections, hospitalizations, and deaths for black people in the United States are higher than those of 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 health – in different places and systems. Epidemiologist Paris JJ Adkins-Jackson of Columbia University is among the growing number of scientists working on it.
Adkins-Jackson and her colleagues published a guide in 2021 to measure structural racism for epidemiologists and other researchers. The authors call on researchers to use variables that capture the many dimensions of structural racism. For example, instead of simply measuring segregation in housing, researchers could include 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 food. To cover the spectrum of how racism can play a role in health disparities – and a departure from traditional epidemiological research – the guide recommends collecting quality data, reviewing work in the humanities and social sciences, and partnering with marginalized communities.
“I think science is like tofu,” says Adkins-Jackson. “Whatever spices you put in it, it will just soak it up. So if you forge it with racism, it will become racist. It is my duty as a scientist to choose my marinade in a different way … to forge it with many, to forge it with different thoughts, to forge it with change. ”
Last month, Adkins-Jackson spoke at a two-day seminar at the National Academy of Sciences, Engineering and Medicine on structural racism and social inequality and showed how anthropology and social sciences methodologies can inform health research. This conversation has been edited for length and clarity.
Question: “What is structural racism?”
A: Like [epidemiologists] The Jones Chamber and Zinsey Bailey teach us that structural racism is … institutional policies and practices that unfairly minority and disadvantage certain groups, while giving preference to people racially white. Such a system has historically been designed to create a privilege for whites and cannot be separated from the foundations of European colonization.
Q: What was your path to studying it with a hate angle?
A: I am a black woman raised by Salvadorans in southern Los Angeles, and I remember asking my mother why there was curfew in our neighborhood during the 1992 Los Angeles riots. No one actually tells me what racism means. So, it started from this curious place of “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,” the hero of the Living Single TV show, who is a journalist and created a magazine to give voice to unheard of people. I needed more history and more context, so I took all these journalistic skills straight into anthropology. But cultures and communities cannot thrive without life: if I want to enjoy this whole culture, eat all the food, study all the books, learn all the languages, then I have to save their lives, and that’s why I recovered. I did two postdoctoral programs in healthcare. … I really spent time learning and understanding how structures behave and how they are projected onto people.
Question: To study structural racism, you advocate a “mixed method” approach. What exactly are these mixed methods and what do they add?
A: Mixed methods use qualitative tools – such as interviews and focus groups – and combine them with quantitative methods – such as a survey, which allows you to ask a very specific question and have a very specific, final answer – which we can then translate into numbers.
Qualitative research such as short stories, ethnography, interviews and photo voice [are] rich forms of knowledge that challenge us to consider many ways of knowing beyond numbers. You will not find them in top magazines because of discrimination against methods that challenge this [quantitative] norm.
People like to use quantitative methods because they like to look at large-scale discoveries. But these methods can be limited … [and have] addiction.
[For example,] clinical trials are one of the ways in which structural racism works. You have five blacks in the office; you have three Latinos, maybe you have Asians, and there are over 100 white people in your office. When you use probability, those few people from marginalized backgrounds who have suffered from racism – which has caused hypertension, which has caused asthma, which has altered their blood glucose – are not enrolled in the study because the stories of more than 100 white people cover people of color due to the way we use the averages.
That is why quality methods are becoming important. The way we analyze the population, [such as averaging heath measurements], unites the experiences of these few people. We still need to hear their stories because they are exposed to something that the 100 white people are not exposed to.
Question: What is wrong with the idea of using only statistical methods to correct potential deviations?
A: Our systems teach us that standardization will correct bias. Researchers created all of these sensitivity tests to eliminate mistakes and biases, when all it took in the beginning was adding more people to the research team to be more inclusive step by step. Why standardize an approach instead of adding more interdisciplinary people to the table? Why is the social worker not there? Why is there no advocate for the community? Let’s reject the ideas from each other and decide to deal with the biases in advance and take them into account, instead of creating a statistical test to weed it out later. This is crazy! Some things require more personal contact.
Question: What is the example of using mixed methods to measure structural racism?
A: [Social epidemiologist] Lorraine Dean, for example, uses indicators reflecting education, housing, employment, criminal justice and county health to show that structural racism is associated with a lower body mass index for whites and a higher BMI for blacks, especially in black men.
I study unfavorable community-level policing throughout my life, where quantitative data such as racial differences in the number of arrests, police killings and imprisonment rates do not fully capture the constant pressures that my elders have endured since childhood. when they were sanctioned by the police, lynchings were prevalent. However, together with the statistics we use and the stories we collect – as did the great Ida B. Wales Red record[: Tabulated Statistics and Alleged Causes of Lynchings in the United States]- illuminating a clear path for science to influence social change and health justice.
Q: What are some suggestions you would make to an incoming researcher doing this type of research?
A: Take control of you as a scientist, not as a tool. Practice science the way you want to, not the way someone told you or how you saw it done by other researchers in a previous post. Rethink using a method simply because someone said so [you] to do it. Be your man, be what is in your gut.
Also, read on! People just don’t read. We have been studying racism, calling it by different names – as differences – for a long time; it is disrespectful to behave as if what you offer at the table is new. Frederick Douglas wrote about it and didn’t even call it by the same terms.
Q: How do you explain the importance of studying structural racism and dealing with it?
A: 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 affected by us are not ordinary cases in research. We are loved ones, colleagues and friends who are drowning in a sea of stress and tension that can be changed if you do more.
If you have an idea, you have to manage it from communities. Will my research help you? Will this benefit you? Is this interesting to you? Do you have the capacity to join me in this? If not, how can I best serve you through this work? I will publish my scientific publications, but I will also build a connection, I will contact your legislators. Science is simply not about academia, it is simply not about knowledge … it is about change.