Addressing Structural Racism to Improve Health

Racism, prejudice, and discrimination have been indelible sins of our country since its founding. Throughout our history, our collective failure to live up to the declaration that all are created equal has simmered and festered, pervasively impacting people of color but largely ignored by white people like me. Periodically, this collective failure to address racism can no longer be contained. George Floyd’s murder last May, and the social unrest that followed, is only the latest manifestation of a serious underlying problem of our society that we can no longer ignore, especially in light of the recently disturbing increases in White supremacy violence.

Many of us who are white are eager to point out that most of us are not racists, and if by this we mean that most of us do not explicitly and actively discriminate against those different from us or wish them ill will, that statement is largely true. However, there has been research for as long as there has been an Office of Behavioral and Social Sciences Research at the NIH (25 years) showing that implicit bias influences how we make various judgments and decisions based on race even though we may not be fully aware that we are. But our problems with racism extend far beyond our explicit or implicit prejudices. Since the racial unrest of the 1960s, social scientists have been studying structural racism, a mutually reinforcing system of institutions, structures, policies, and practices built predominately by white people for white people. Even if we could eradicate every racial prejudice and bias of everyone in our country, the structures and systems currently in place would continue to disadvantage people of color including where they live, how they are educated, how they are considered for employment, and how they can access capital and build wealth. One stark example is that for every dollar of wealth acquired by white households, Hispanic and Black households have been able to acquire 7¢ and 6¢ respectively.

What does this have to do with the NIH? Structural racism influences health. Even after accounting for differences in health care access, environmental exposures, and health risk behaviors, race is still a factor that contributes to the health disparities in this country. The NIH has funded considerable health disparities research, but, as others have argued, there are considerable gaps in our understanding of how structural racism impacts health and the effectiveness of interventions directly addressing structural racism and their impacts on health. For example, residential segregation is a significant contributor to structural racism, and the NIH has funded research, for instance, on the impact of housing vouchers on health (e.g., Pollack et al., 2019), but these voucher programs have produced mostly modest health improvements. And while such programs and other societal factors have reduced residential segregation, these improvements have been primarily the result of a few Black families moving into predominately white neighborhoods while Black neighborhoods remain segregated and isolated with high levels of poverty and limited access to services. Clearly, there is a need to reconsider what the NIH funds that will make a substantial impact on how to address this problem. A working group of the Behavioral and Social Sciences Research Coordinating Committee has been charged with evaluating the research on racism and health that we fund and to make recommendations for future directions. This working group has and will continue to provide input to larger NIH-wide efforts.

The leadership of NIH has been substantially engaged and committed to making progress on racism, not only to address the racism and health research we fund, but also how the NIH functions and addresses structural racism within our own system. For some time, we have been aware that the grant award success for Black investigators has been less than would be expected from the pool of potential investigators. Recent analyses indicate that one factor contributing to the lower success of Black investigators is that Black applicants are more likely to propose research in topic areas with lower funding success rates. Those topic areas are the very areas that OBSSR has a role in encouraging - community or population-level research and health disparities research. By funding more research to address the role of racism on health, we would also fund more Black researchers who gravitate to these topic areas of research.

NIH also is taking a closer and serious look at how our institution perpetuates structural racism and disadvantages people of color who work at the NIH. As difficult as it is to shake up existing structures, systems, policies, and procedures, I feel a sense of optimism at how seriously the NIH, from leadership on down, has been willing to take a hard look at what we do and how we can do it differently so as to no longer perpetuate the status quo. On February 26 at the Advisory Committee to the Director (ACD), the NIH will present on the initial NIH-wide efforts to address racism at multiple levels, and I encourage you to listen in. The social and behavioral sciences applicable to addressing racism have and will continue to contribute to these NIH efforts.