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Health Affairs Challenges Systemic Racism in Health Care


The October issue of Health Affairs examines the multifaceted aspects of structural racism in health care, exploring historical roots, policy implications, public biases, innovative solutions, and institutional challenges, urging action to confront and dismantle disparities.

Health Insurance Concept | Image credit: A stockphoto - stock.adobe.com

Health Insurance Concept | Image credit: A stockphoto - stock.adobe.com

The October issue of Health Affairs delves deep into the heart of a critical issue: structural racism and its pervasive impact on health. According to an article written by editor-in-chief Alan R. Weil, JD, MPP, this issue serves as an extension of the February 2022 issue, which explored the foundation of racism and health.1

The articles featured in this issue dissect various forms of structural racism and the ongoing efforts to mitigate its detrimental effects.

Political and Policy Implications

The research of Jamila Michener, PhD, emphasizes the significant role housing plays in determining health and equity. By studying tenant organizing in marginalized communities, Michener highlightes the political power embedded in grassroots movements and local policy changes, along with their potential to create racially equitable communities.2

Jaquelyn Jahn, PhD, MPH, and her colleagues analyze structural racism–related legal domains across states and discovered states with harmful laws experience higher premature mortality rates, stressing the urgent need for legal reforms.3

Historical Context and Impact

An examination of redlining’s historical impact on communities demonstrates a direct correlation between past discriminatory practices and present-day health care disparities. Jason Semprini, MPP, and his team’s findings exhibit the vital role policies, like the Affordable Care Act and Medicaid expansion, play in bridging health care gaps created by historical injustices.4

Public Perception and Administrative Challenges

Simon Haeder, PhD, and Donald Moynihan, PhD, conducted research looking into public attitudes regarding administrative burdens that hinder Medicaid and Supplemental Nutrition Assistance Program enrollment. Their findings show racial resentment as a significant predictor of supporting such burdens, indicating deep-seated biases.5

Mitigating Algorithmic Bias

Michael P. Cary Jr, PhD, RN, and colleagues tackle the pressing issue of racial and ethnic bias in clinical algorithms. Their scoping review reveals the need for multidisciplinary approaches to combat algorithmic bias effectively, calling for a balanced approach that acknowledges disparities while avoiding reinforcing racial stereotypes.6

Innovative Approaches and Community Responses

In this issue, Denis Agniel, PhD, and investigators propose a groundbreaking concept: equity weighting, which tailors goals for each dimension of equity. According to the article, this would offer a nuanced approach to quality improvement incentives.7

Additionally, Chidinma Ibe, PhD, and her team display the pivotal role of community health workers. These workers were stated as indispensable in delivering resources and bridging gaps in health care delivery.8

Policy Reforms and Indigenous Communities

Shekinah Fashaw-Walters, PhD, MSPH, and Cydney McGuire, PhD, MPH, advocate for a "racism-conscious" policy-making approach, illuminating the importance of recognition related to existing inequities and structuring policies accordingly.9

In another context, Arielle Deutsch, PhD, and her colleagues shed light on the challenges faced by Indigenous-led community-based organizations, underscoring the urgency to reform funding policies to ensure sustainability and growth.10

Institutional Challenges

Joel Weissman, PhD, and his team demonstrate the obstacles experienced by hospital health equity officers. The findings indicate the pervasive nature of systemic and institutional racism, with investigators demanding a collective and sustained effort to dismantle these barriers.11

The October issue of Health Affairs serves as a call to action, urging policymakers, health care professionals, and society at large to confront the deep-seated roots of structural racism.


1. Weil AR. Tackling structural racism in health. Health Affairs. Published online October 2, 2023. doi:10.1377/hlthaff.2023.01191

2. Michener J. Racism, power, and health equity: the case of tenant organizing. Health Affairs. Published online October 2, 2023. doi:10.1377/hlthaff.2023.00509.

3. Jahn JL, Zubizarreta D, Chen JT, et al. Legislating inequity: structural racism in groups of state laws and associations with premature mortality rates. Health Affairs. Published online October 2, 2023. doi:10.1377/hlthaff.2023.00471

4. Semprini J, Ali AK, Benavidez GA. Medicaid expansion lowered uninsurance rates among nonelderly adults in the most heavily redlined areas. Health Affairs. Published online October 2, 2023. doi:10.1377/hlthaff.2023.00400

5. Haeder S, Moynihan D. Race and racial perceptions shape burden tolerance for Medicaid and the Supplemental Nutrition Assistance Program. Health Affairs. Published online October 2, 2023. doi:10.1377/hlthaff.2023.00472

6. Cary MP, Zink A, Wei S, et al. Mitigating racial and ethnic bias and advancing health equity in clinical algorithms: a scoping review. Health Affairs. Published online October 2, 2023. doi:10.1377/hlthaff.2023.00553

7. Agniel D, Cabreros I, Damberg CL, Elliott MN, Rogers R. A formal framework for incorporating equity into health care quality measurement. Health Affairs. Published on October 2, 2023. doi:10.1377/hlthaff.2022.01483

8. Ibe C, Hines A, Dominguez Carrero N, et al. Voices, images, and experiences of community health workers: advancing antiracist policy and practice. Health Affairs. Published online October 2, 2023. doi:10.1377/hlthaff.2023.00584

9. Fashaw-Walters SA, McGuire CM. Proposing a racism-conscious approach to policy making and health care practices. Health Affairs. Published online October 2, 2023. doi:10.1377/ hlthaff.2023.00482

10. Deutsch A, Frerichs L, Hasgul Z, et al. How funding policy maintains structural inequity within indigenous community-based organizations. Health Affairs. Published online October 2, 2023. doi:10.1377/hlthaff.2023.00483

11. Weissman J, Adler RR, Betancourt J, et al. How hospitals are addressing the effects of racism: a mixed-methods study of hospital equity officers. Health Affairs. Published online October 2, 2023. doi:10.1377/hlthaff.2023.00474

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