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Recent work has emphasized the benefits of patient–physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn–physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.

The Dobbs decision rolls back fundamental rights for many people, and it is a direct assault on efforts to improve racial equity in health care. Indeed, abortion access is fundamentally a racial justice issue.

Antiracist health policy research requires methodological innovation that creates equity-centered and antiracist solutions to health inequities by centering the complexities and insidiousness of structural racism. The development of effective health policy and health equity interventions requires sound empirical characterization of the nature of structural racism and its impact on public health. However, there is a disconnect between the conceptualization and measurement of structural racism in the public health literature. Given that structural racism is a system of interconnected institutions that operates with a set of racialized rules that maintain White supremacy, how can anyone accurately measure its insidiousness? This article highlights methodological approaches that will move the field forward in its ability to validly measure structural racism for the purposes of achieving health equity. We identify three key areas that require scholarly attention to advance antiracist health policy research: historical context, geographical context, and theory-based novel quantitative and qualitative methods that capture the multifaceted and systemic properties of structural racism as well as other systems of oppression.

Structural racism leads to increased rates of premature death and reduced levels of overall health and well-being — an epidemic affecting our whole society. As clinicians and researchers, we wield power, privilege, and responsibility for dismantling structural racism. On July 7, 2016, in our Minneapolis community, Philando Castile was shot and killed by a police officer in the presence of his girlfriend and her 4-year-old daughter. Acknowledging the role of racism in Castile’s death, Minnesota Governor Mark Dayton asked rhetorically, “Would this have happened if those passengers [and] the driver were white? I don’t think it would have.” Such incidents are tragic — and disturbingly common. Indeed, in recent weeks, our country has witnessed the well-publicized deaths of at least three more black men at the hands of police: Terence Crutcher, Keith Scott, and Alfred Olango. Disproportionate use . . .

Racially or ethnically targeted events may have adverse health implications for members of the group not directly targeted, a phenomenon known as peripheral trauma. Recent evidence suggests that mass incarceration, police brutality, and immigration actions all have such effects, as did medical exploitation by the US government during the Tuskegee Study of Untreated Syphilis in the Negro Male. We summarize recent findings in the economics literature on population-level effects of the Tuskegee study, including a decline in health-seeking behavior and a rise of both mortality and medical mistrust among African-American men not enrolled in the study. We highlight the relevance of our findings for present-day racial health disparities. Practitioner awareness of peripheral trauma is an important element of cultural competency. But among options to substantially improve minority trust in the healthcare system, the diversification of medical practitioners may hold greatest promise.

In the wake of George Floyd’s public execution, uprisings have ignited in cities throughout the United States. The words “I can’t breathe” hang heavy in the air. Black people cannot breathe because we are currently battling at least two public health emergencies.

In the United States, COVID-19 unfolded alongside profound racial trauma. Drawing on a populationrepresentative sample of twenty- to sixty-year-olds who were married or cohabiting, the National Couples’ Health and Time Study (N = 3,642), we examine two sources of stress: COVID-19 and racial trauma. We leverage the fully powered samples of respondents with racial-ethnic and sexual minority identities and find that COVID-19 and racial trauma stress were higher among individuals who were not White or heterosexual most likely due to racism, xenophobia, and cis-heterosexism at the individual and structural levels. Both COVID-19 and racial trauma stress were associated with poorer mental health outcomes even after a rich set of potential mechanistic indicators, including discrimination and social climate, were taken into account. We argue that the inclusion of assessments of stress are critical for understanding health and well-being among individuals affected by systemic and interpersonal discrimination.

To determine whether perceptions of the medical school diversity climate are associated with depression symptoms among medical students. Longitudinal web-based survey conducted in the fall of 2010 and spring of 2014 administered to a national sample of medical students enrolled in 49 schools across the U.S. (n = 3756). Negative diversity climate measured by perceptions of the institution's racial climate; exposure to negative role modeling by medical educators; frequency of witnessing discrimination in medical school. Depression symptoms measured by the PROMIS Emotional Distress–Depression Short-Form. 64% of students reported a negative racial climate; 81% reported witnessing discrimination toward other students at least once, and 94% reported witnessing negative role modeling. Negative racial climate, witnessed discrimination, and negative role modeling were independently and significantly associated with an increase in depression symptoms between baseline and follow-up. Adjusting for students' personal experiences of mistreatment, associations between depressive symptoms and negative racial climate and negative role modeling, remained significant (.72 [.51–.93]; .33 [.12–.54], respectively). Among medical students, greater exposure to a negative medical school diversity climate was associated with an increase in self-reported depressive symptoms.

Abstract Progress toward racial health equity cannot be made if we cannot measure its fundamental driver: structural racism. As in other epidemiologic studies, the first step is to measure the exposure. But how to measure structural racism is an ongoing debate. To characterize the approaches epidemiologists and other health researchers use to quantitatively measure structural racism, highlight methodological innovations, and identify gaps in the literature, we conducted a scoping review of the peer-reviewed and gray literature published during 2019–2021 to accompany the 2018 published work of Groos et al., in which they surveyed the scope of structural racism measurement up to 2017. We identified several themes from the recent literature: the current predominant focus on measuring anti-Black racism; using residential segregation as well as other segregation-driven measures as proxies of structural racism; measuring structural racism as spatial exposures; increasing calls by epidemiologists and other health researchers to measure structural racism as a multidimensional, multilevel determinant of health and related innovations; the development of policy databases; the utility of simulated counterfactual approaches in the understanding of how structural racism drives racial health inequities; and the lack of measures of antiracism and limited work on later life effects. Our findings sketch out several steps to improve the science related to structural racism measurements, which is key to advancing antiracism policies.

Objectives. To measure neighborhood exposure to proactive policing as a manifestation of structural racism and its association with preterm birth. Methods. We linked all birth records in New Orleans, Louisiana (n = 9102), with annual census tract rates of proactive police stops using data from the New Orleans Police Department (2018–2019). We fit multilevel Poisson models predicting preterm birth across quintiles of stop rates, controlling for several individual- and tract-level covariates. Results. Nearly 20% of Black versus 8% of White birthing people lived in neighborhoods with the highest rates of proactive police stops. Fully adjusted models among Black birthing people suggest the prevalence of preterm birth in the neighborhoods with the highest proactive policing rates was 1.41 times that of neighborhoods with the lowest rates (95% confidence interval = 1.04, 1.93), but associations among White birthing people were not statistically significant. Conclusions. Taken together with previous research, high rates of proactive policing likely contribute to Black‒White inequities in reproductive health. Public Health Implications. Proactive policing is widely implemented to deter violence, but alternative strategies without police should be considered to prevent potential adverse health consequences. (Am J Public Health. 2023;113(S1):S21–S28. https://doi.org/10.2105/AJPH.2022.307079 )