Nutrition Interventions Addressing Structural Racism: A Scoping Review

African Americans experience high rates of obesity and food insecurity in part due to structural racism, or overlapping discriminatory systems and practices in housing, education, employment, health care, and other settings. Nutrition education and nutrition-focused policy, systems, and environmental changes may be able to address structural racism in the food environment. This scoping review aimed to summarize the available literature regarding nutrition interventions for African Americans that address structural racism in the food environment and compare them to the “Getting to Equity in Obesity Prevention” framework of suggested interventions. An electronic literature search was conducted with the assistance of a research librarian encompassing 6 databases—MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX, and ProQuest Dissertations & Theses. A total of 30 sources were identified detailing interventions addressing structural barriers to healthy eating. The majority of nutrition interventions addressing structural racism consisted of policy, systems, and/or environmental changes in combination with nutrition education, strategies focused on proximal causes of racial health disparities. Only two articles each targeted the “reduce deterrents” and “improve social and economic resources” aspects of the framework, interventions which may be better suited to addressing structural racism in the food environment. Because African Americans experience high rates of obesity and food insecurity and encounter structural barriers to healthy eating in the food environment, researchers and public health professionals should address this gap in the literature.

The Importance of Biobehavioral Research to Examine the Physiological Effects of Racial and Ethnic Discrimination in the Latinx Population

A growing body of research is documenting how racial and ethnic populations embody social inequalities throughout the life course. Some scholars recommend the integration of biospecimens representing the hypothalamic-pituitary-adrenal axis, neurological and endocrinological processes, and inflammation to capture the embodiment of inequality. However, in comparison to other racial and ethnic groups, there has been little research examining how Hispanic/Latinx persons embody racial and ethnic discrimination, much less resulting from institutional and structural racism. We provide a rationale for expanding biobehavioral research examining the physiological consequences of racism among Latinx persons. We identify gaps and make recommendations for a future research agenda in which biobehavioral research can expand knowledge about chronic disease inequities among Latinx populations and inform behavioral and institutional interventions. We end by cautioning readers to approach the recommendations in this article as a call to expand the embodiment of racism research to include the diverse Latinx population as the United States addresses racial inequity.

Structural Racism and Quantitative Causal Inference: A Life Course Mediation Framework for Decomposing Racial Health Disparities

Quantitative studies of racial health disparities often use static measures of self-reported race and conventional regression estimators, which critics argue is inconsistent with social-constructivist theories of race, racialization, and racism. We demonstrate an alternative counterfactual approach to explain how multiple racialized systems dynamically shape health over time, examining racial inequities in cardiometabolic risk in the National Longitudinal Study of Adolescent to Adult Health. This framework accounts for the dynamics of time-varying confounding and mediation that is required in operationalizing a “race” variable as part of a social process ( racism) rather than a separable, individual characteristic. We decompose the observed disparity into three types of effects: a controlled direct effect (“unobserved racism”), proportions attributable to interaction (“racial discrimination”), and pure indirect effects (“emergent discrimination”). We discuss the limitations of counterfactual approaches while highlighting how they can be combined with critical theories to quantify how interlocking systems produce racial health inequities.

Racism and Older Black Americans’ Health: a Systematic Review

We reviewed research that examines racism as an independent variable and one or more health outcomes as dependent variables in Black American adults aged 50 years and older in the USA. Of the 43 studies we reviewed, most measured perceived interpersonal racism, perceived institutional racism, or residential segregation. The only two measures of structural racism were birth and residence in a “Jim Crow state.” Fourteen studies found associations between racism and mental health outcomes, five with cardiovascular outcomes, seven with cognition, two with physical function, two with telomere length, and five with general health/other health outcomes. Ten studies found no significant associations in older Black adults. All but six of the studies were cross-sectional. Research to understand the extent of structural and multilevel racism as a social determinant of health and the impact on older adults specifically is needed. Improved measurement tools could help address this gap in science.

Structural Racism as an Environmental Justice Issue: A Multilevel Analysis of the State Racism Index and Environmental Health Risk from Air Toxics

Communities of color and poor neighborhoods are disproportionately exposed to more air pollution—a pattern known as environmental injustices. Environmental injustices increase susceptibility to negative health outcomes among residents in affected communities. The structural mechanisms distributing environmental injustices in the USA are understudied. Bridging the literatures on the social determinants of health and environmental justice highlights the importance of the environmental conditions for health inequalities and sheds light on the institutional mechanisms driving environmental health inequalities. Employing a critical quantitative methods approach, we use data from an innovative state racism index to argue that systematic racialized inequalities in areas from housing to employment increase outdoor airborne environmental health risks in neighborhoods. Results of a multilevel analysis in over 65,000 census tracts demonstrate that tracts in states with higher levels of state-level Black–white gaps report greater environmental health risk exposure to outdoor air pollution. The state racism index explains four-to-ten percent of county- and state-level variation in carcinogenic risk and noncarcinogenic respiratory system risks from outdoor air toxics. The findings suggest that the disproportional exposure across communities is tied to systematic inequalities in environmental regulation and other structural elements such as housing and incarceration. Structural racism is an environmental justice issue.

Social Capital, Black Social Mobility, and Health Disparities

This review aims to delineate the role of structural racism in the formation and accumulation of social capital and to describe how social capital is leveraged and used differently between Black and White people as a response to the conditions created by structural racism. We draw on critical race theory in public health praxis and restorative justice concepts to reimagine a race-conscious social capital agenda. We document how American capitalism has injured Black people and Black communities’ unique construction of forms of social capital to combat systemic oppression. The article proposes an agenda that includes communal restoration that recognizes forms of social capital appreciated and deployed by Black people in the United States that can advance health equity and eliminate health disparities. Developing a race-conscious social capital framing that is inclusive of and guided by Black community members and academics is critical to the implementation of solutions that achieve racial and health equity and socioeconomic mobility. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Systemic Racism in Canadian Occupational Therapy: A Qualitative Study with Therapists

Background. Research on racism within occupational therapy is scant, though there are hints that racialized therapists struggle. Purpose. This paper examines experiences of racism in occupational therapy, including coping strategies and resistance. Method. Ten therapists from racialized groups (not including Indigenous peoples) were recruited for cross-Canada, in-person or telephone interviews. Transcripts were coded and inductively analysed, with data thematically organized by types of racism and responses. Findings. Interpersonal racism involving clients, students, colleagues and managers is supported by institutional racism when incidents of racism are met with inaction, and racialized therapists are rarely in leadership roles. Structural racism means the experiences of racialized people are negated within the profession. Cognitive sense-making becomes a key coping strategy, especially when resistance is costly. Implications. Peer supports and community building among racialized therapists may be beneficial, but dismantling structures of racism demands interrogating how whiteness is built into business-as-usual in occupational therapy.

Developing an Anti-Racist Foundations Course in MCH for MPH Students

Introduction Over the past decade, foundational courses in MCH have been revised and revamped to integrate the life course perspective and social determinants of health in ways that bring these essential issues to the core of the learning experience. Yet the racial reckoning of 2020 and the racially disparate health impacts of the COVID-19 pandemic underscore that a deeper, more focused approach to anti-racist pedagogy is now imperative for MCH educators and others responsible for developing the MCH workforce. Methods In this paper, we discuss our experience of building a ‘community of practice’ of anti-racist MCH trainees through our course, ‘Foundations of Maternal and Child Health Policy, Practice, and Science.’ Results We identify four principles which guided our course: (1) building on students’ experience, knowledge, identities and social justice commitments; (2) creating a common purpose and shared vocabulary related to racism; (3) organizing classroom activities to reflect real-world problems and professional practices related to addressing structural racism as a root cause of health inequities; and (4) building students’ skills and confidence to recognize and address structural racism as MCH professionals. Discussion We hope that this description of our principles, along with examples of how they were put into practice, will be useful to MCH educators who seek to build anti-racist frameworks to guide MCH workforce development.

The Persistence of Racial Constructs in Spain: Bringing Race and Colorblindness into the Debate on Interculturalism

In this article, I argue that persisting racial constructs in Spain affect conceptions of national belonging and continue to shape and permeate contemporary discriminations. I begin by describing several recent political events that demonstrate the urgent need for a discussion about “race” and racialization in the country. Second, some conceptual foundations are provided concerning constructs of race and the corollary processes of racism and racialization. Third, I present data from various public surveys and also from ethnographic research conducted in Spain on mixedness and multiraciality to demonstrate that social constructs of race remain a significant boundary driving stigmatization and discrimination in Spain, where skin color and other perceived physical traits continue to be important markers for social interaction, perceived social belonging, and differential social treatment. Finally, I bring race into the debate on managing diversity, arguing that a post-racial approach—that is, race-neutral discourse and the adoption of colorblind public policies, both of which are characteristic of the interculturalist perspectives currently preferred by Spain as well as elsewhere in Europe—fails to confront the enduring effects of colonialism and the ongoing realities of structural racism. I conclude by emphasizing the importance of bringing race into national and regional policy discussions on how best to approach issues of diversity, equality, anti-discrimination, and social cohesion.