Four Ways to Integrate a Structural Racism Lens into Neighborhood Health Research [howhousingmatters.org]

Structural racism refers to the institutional practices, policies, and norms that shape opportunity and assign value based on race, including the macro-level forces that often appear race-neutral but maintain existing racial hierarchies. In health disparities research, structural racism is often represented as neighborhood disadvantage or racial residential segregation, but some scholars argue that this approach fails to acknowledge structural racism as the underlying driver of health disparities. From their perspective, neighborhood disadvantage is a consequence of structural racism and not a proxy for structural racism itself. Decades of work to isolate the independent influence of neighborhood factors have not yielded compelling evidence that neighborhood disadvantage drives health disparities independently of other factors such as segregation or race. Focusing on traditional neighborhood measures such as disadvantage and segregation rarely reveals how specific policies, powerful decisionmakers, and institutions built on racial hierarchy generate and maintain racial health disparities. To help researchers, policymakers, and practitioners consider how best to recognize and incorporate structural racism in the study of place-based health disparities, this literature review highlights four lessons researchers can use to more directly study the connection between structural racism and health.

Four lessons for research, policy, and practice

1. Shift away from census tracts as units of analysis. Researchers should use more meaningful units of analysis such as school districts, congressional districts, cities, counties, or states to make their findings connect more easily to policy. A national study focused on structural racism at the state level showcased the power of this approach. Using new state-level measures of structural racism (political participation, employment, educational attainment, and judicial treatment), researchers found that Black people in states with high structural racism were more likely to have experienced a heart attack than Black people in states with low structural racism and that many whites experienced health advantages from state-level structural racism.
2. Leverage historic and geographic variation in race relations. Racial and ethnic health disparities must be understood as a product of historic race relations and of current race relations and their maintenance. For example, researchers studying exposures to racism from pregnancy to later life need to consider the dynamic nature of race relations across age, period, and place. A study in Iowa demonstrated that a major immigration raid created such acute racialized fear for Latinos that there was a spike in risk of low birth weights among babies born to Latina mothers in the state.
3. Combine data from multiple sources. Research to reveal the health consequences of structural racism requires that scholars pull from multiple data sources and find new ways to combine data. Krieger and colleagues provided a model for bringing in historical data to study the health effects of legal institutionalized racism in the American South. Combining individual-level mortality data with the US Census Bureau’s population and income data, they estimated the effects of the 1964 Civil Rights Act on premature mortality and were able to show that the abolition of legal racial discrimination in 1964 had beneficial health effects for black people far beyond the influence of income.
4. Challenge normative framing that aims to explain away racial health disparities without discussing racism or racial hierarchy. Studying structural racism requires critically analyzing the white power structures, white decisionmakers, and even white people looking innocent and ignorant in the face of the racial hierarchy that shapes all our lives. In a study analyzing the difference between maintenance of recreational spaces in Latino and non-Latino neighborhoods in Los Angeles, researchers went beyond the documentation of disparities in access to parks and playgrounds to highlight that city planners, politicians, and white residents intentionally excluded people of color from recreational spaces through seemingly race-neutral policies, such as zoning laws and fiscal discrimination. By focusing on white privilege in their examination of race, the researchers revealed the local historical context of present day health inequities and urged new directions for intervention.

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