Race & Ethnicity as a Social Determinant of Health (SDOH)

This essay compares the application and use of Public Health Critical Race Methodology (PHCRP) in the following works: “Anti-Racism Methods for Big Data Research:” by Ford, Takahashi, Chandanabhumma, Ruiz, and Cunningham (2018) and “Tilted images:” by Lawson-Borders (2019). PHCRP is a semi-structured research method for applying critical race theory values to health equity study. The approach is applicable when the researcher explores the subtle means racism impacts both health disparities and approaches applied to study them. PHCRP guides researchers through a logical process to carry out a self-reflective and race-conscious study into the significant causes of health inequalities (Ford & Airhihenbuwa, 2010).

In their study, Ford, Takahashi, Chandanabhumma, Ruiz, and Cunningham (2018) argue that PHCRP adapts Critical Race Theory (CRT), an antiracism approach borrowed from the field of law and legal research, for health equity studies. The researchers argue that Critical Race Theory (CRT) offers three functional components to the health process: self-critique or systematic reflective method, an antiracism lexicon taken mainly from CRT, and race-conscious orientations. PHCRP has four loci, knowledge production, contemporary racial relation, measurement and conceptualization, and action, vital domains under which racialization impact studies. The study points out that most health and social epidemiology studies increasingly rely on electronic medical record (EMR) systems and big data to establish the link between social inequalities, including health disparities and racism, but rarely employ the functional components of PHCRP, presenting challenges in integrating antiracism into the health research process. The researchers address the study gaps by presenting the application of PHCRP to Human Immunodeficiency Virus Testing, Linkage, and Retention in care (HIV TLR) scholarship.

Ford and colleagues adopted The Behavioral Model for Vulnerable Populations (BMVP) framework for health services as a conceptual model for quantitative data analytic to achieve the study goal. The model postulates that the patient’s behavior within the healthcare setting is a factor of the environment outside and within the healthcare setting, and individual-level influencing needs and enabling factors, impacting their clinical outcomes. The selection of the model was guided by the primacy of racism and racial realism, which are fundamental principles of CRT. To study the theorized racialized care context and HIV Care Continuum (HCC) disparities, the research’s principal investigator (PI) integrated PHCRP hypotheses into the conceptual model and study proposal. Based on Gilmore’s description of racism as “the state-sanctioned and extralegal production and exploitation of group-differentiated vulnerability to premature death,” the researchers conceptualized institutional and structural racism as reinforcing and sustaining disparities. The study incorporated a team of racially diverse and multidisciplinary teams, including social scientists, nurses, physical, and other fields with diverse levels of CRT and experiences living in social margins. In the first year of study, the researchers initiated racial consciousness-raising and advanced the protocols for extracting patient data from databases, and patient medical records and self-reflexive discussions were adopted to clarify potential racial considerations. To adopt the functional component of critical self-reflection, the researchers  completed short close questionnaires evaluating their possible priori expectations compared with every set of study questions at the start of the consultation and immediately prior to each research aim. The priors served as qualitative checks to improve the researchers’ transparency and rigor to interpret the data and make conclusions. The patient outcomes reflected the racial undercurrents in healthcare contexts, not necessarily apparent to patients and providers. The researchers considered race as a social concept, capturing the social aspect under which race is meaningful, and offer illustration on integrating CRT into social and health research, as shown in figure 1.

Figure 1: Integrating PHCRT (CRT) into Research Process

Source: (Ford et al. 2018, p 263).

On the one hand, Lawson-Borders (2019) adopted CRT as a theoretical framework to study the 2016 report concerning Racism’s Toll, illustrating the difficulties faced concerning the disparities relating to social problems and the tilted/lop-sided representations in the media reporting. According to the researcher, several people get stunted before developing because of current practices alongside historical exigencies, which marginalize people by socioeconomic status, ethnicity, and race. If one is not privy to the proper economic support, school, and neighborhoods, some problems are magnified when progressing to college, owning a home, getting a good job, and other social enhancements. Nurture, nature, and everything else in between is vital for a person’s success in society.

In this study, CRT helps contextualize the continual impact of race in the economic and social progress of racial minorities. The groups are often underprivileged by mainstream cultural, educational, economic, and political opportunities (Williams & Mohammed, 2013). Lawson-Borders uses CRT as a prism to study issues concerning education, housing, and health disparities. Racism’s Toll report, 2016 is examined to offer background on the impacts of particular policies and possible alternatives to better lives and human conditions. The study on media reporting of race and poverty and analysis of 2016 Racism’s Toll report reflect the disparities in society’s economic ecosystems and associated challenges. In the Racism’s Toll report, the state of Illinois is used as a road map, representing diverse social issues the US faces at a national scale, from the legacy of inequalities to poverty. The report looks into the historical summary of policies and laws that have added to the inequalities in housing, education, employment, and health, which have occurred for centuries. Lawson-Borders uses some of the policies and laws to demonstrate the arguments vital to CRT that contemporary society normalizes racism. The authors question several aspects of societal laws and policies, including: a) why has the American antidiscrimination law been ineffective all along? b); and why most CRT writers are discontent with liberalism to tackle American racism issues, among others, as shown in figure 2.

Figure 2: CRT Study Themes

Source: (Lawson-Borders, 2019, p 6).

Both writers have extensively adopted Public Health Critical Race Methodology (PHCRP) to explore race and inequalities in society from different angles. Ford et al. explore the application of PHCRP to HIV TLR studies. CRT offers three functional components to the health process as adopted in the study self-critique or systematic reflective method, an antiracism lexicon taken mainly from CRT, and race-conscious orientations. Lawson-Borders (2019), on the other hand, applied PHCRT to analyze and contextualize the continual impact of race in the economic and social progress of the racial minorities. The two sources have provided the framework for integrating CRT into the study process, as shown in Figures 1 and 2, illustrating the potential themes CRT themes explore in the texts. As discussed in the two articles, the race is an organized system founded on ranking and categorizing social groups into races, disempowers devalues, and allocates opportunities desirable resources to the race considered inferior.

Between the two studies, Lawson-Borders (2019) did a better job than Ford et al. (2018) in using PHCRT to contextualize the continuous impact of race on the economic and social progress of Blacks and other people of color in the US. Lawson-Borders outshine the other article in how the researcher defines modes of knowledge of production, antiracism tenets, and systemic approaches racism presently operates. The author separately dealt with health issues, employment, health and quality of life, and their link to economic, social, and political factors. On the contrary, Ford et al. (2018) duel most in the meaning and application of PHCRT, with few spaces left to discuss the interlink between the model and race and inequality issues.

References

Ford, C. L., & Airhihenbuwa, C. O. (2010). The public health critical race methodology: praxis for antiracism research. Social science & medicine, 71(8), 1390-1398.

Ford, C. L., Takahashi, L. M., Chandanabhumma, P. P., Ruiz, M. E., & Cunningham, W. E. (2018). Antiracism Methods for Big Data Research: Lessons Learned from the HIV Testing, Linkage, & Retention in Care (HIV TLR) Study. Ethnicity & disease, 28(Suppl 1), 261.

Lawson-Borders, G. (2019). Tilted images: Media coverage and the use of critical race theory to examine social equity disparities for blacks and other people of color. Social work in public health, 34(1), 28-38.

Williams, D. R., & Mohammed, S. A. (2013). Racism and health I: Pathways and scientific evidence. American behavioral scientist, 57(8), 1152-1173.