Institutional Racism Research Articles

Valuing lived experience and co-design solutions to counter racial inequality in data and algorithmic systems in UK’s digital services

ABSTRACT In the United Kingdom, the COVID-19 pandemic has accelerated the movement towards large-scale digitisation of everyday services: from healthcare, social housing, social security to utilities. However, what is lesser known are the vulnerabilities minoritised ethnic citizens face in datafication processes and how they are racialised within data and algorithmic systems of these services. Its potential to amplify systemic racism and inequalities is concerning yet under-studied, particularly in the UK context. This paper argues it is imperative to understand, and value, racialised minorities’ lived experience to inform and improve digital services’ design to be more inclusive and equitable. Drawing on qualitative interviews and workshops with individuals who identify as a minoritised ethnic individual across England and Scotland, we explore people’s lived experience of everyday digital services. The findings highlight issues related to trust, data privacy, and poorer quality access to services. Such experiences are shaped by the fears and lived experience of racism, both structural and institutional. This paper concludes the use of co-design methods can strengthen capacity amongst racialised communities and stakeholders to articulate where inequities are occurring, understand how to counter harm, and co-create solutions. We outline our case for a co-design approach to guide public and private sectors’ decision-making and policies, so digital services are equitable and responsible by design.

Nursing student perceptions of racism and health disparities in the United States: A critical race theory perspective

BackgroundLimited research has been done on nursing students’ awareness of racial disparities and their readiness to address bias and racism in clinical practice. PurposeThis study investigated nursing students' perceptions of how racial disparities affect health outcomes, including maternal outcomes, in the United States. MethodsInterpretive description was used and supported by the critical race theory as a framework to guide the data collection, analysis, and interpretation to understand participants’ perceptions surrounding racism and health disparities. DiscussionNurse educators should guide students to look beyond individual behavioral and risk factors and consider systemic issues as a leading contributors to health disparities. ConclusionThe most critical finding was the lack of participants’ understanding of systemic racism and its impact on health disparities. While they often attributed racial disparities to low socioeconomic status and lack of education, they did not understand the relationships between social determinants of health and systemic racism.

Persistent environmental lead exposures disrupting black children’s neurodevelopment and quality of life trajectories: an under-recognized ACE in the hole

Persistent environmental lead exposures disrupting black children’s neurodevelopment and quality of life trajectories: an under-recognized ACE in the hole

Intergenerational transmission of incarceration among Black men and boys: A vicious cycle caused by structural racism

IntroductionThe widespread incarceration of Black men and boys in the US is a stark manifestation of structural and institutional racism, significantly impacting health and economic disparities within this community. While there is substantial research on the immediate effects of Black men's imprisonment, there remains a scarcity of longitudinal studies exploring the enduring impact of a father's incarceration on his children's health and well-being, particularly over decades. This study aims to explore the extensive intergenerational consequences of incarceration among Black fathers, focusing specifically on its impact on the educational achievements, likelihood of imprisonment, and mental health of their children 22 years later. MethodsWe analyzed data from the Future of Families and Child Wellbeing Study (FFCWS), formerly known as the Fragile Families and Child Wellbeing Study. Our sample included a cohort of births where the fathers were Black. These children were followed over a period of 22 years to assess the long-term effects of their fathers' incarceration. ResultsOverall, 1264 families were followed in our analysis. From this number, outcomes were available for 689 sons 22 years later. Our findings indicate that incarceration was more prevalent among Black fathers who were younger and had lower educational attainment. Additionally, a father's incarceration was linked to lower educational levels and younger maternal age. Crucially, we found associations between a father's incarceration and mental health issues (such as anxiety and depression) in their children by the age of 22. ConclusionThe significantly higher risk of incarceration faced by Black men not only poses a direct health risk to themselves but also has profound intergenerational consequences for their children. The impacts extend across various domains, including the risk of incarceration, educational attainment, and mental health of their sons. These insights underscore the urgency for policy interventions aimed at dismantling the systemic barriers that perpetuate the cycle of incarceration and its long-lasting effects on the Black community.

Co-designing a Health Journey Mapping resource for culturally safe health care with and for First Nations people.

Background Many healthcare professionals and services strive to improve cultural safety of care for Australia's First Nations people. However, they work within established systems and structures that do not reliably meet diverse health care needs nor reflect culturally safe paradigms. Journey mapping approaches can improve understanding of patient/client healthcare priorities and care delivery challenges from healthcare professionals' perspectives leading to improved responses that address discriminatory practices and institutional racism. This project aimed to review accessibility and usability of the existing Managing Two Worlds Together (MTWT) patient journey mapping tools and resources, and develop new Health Journey Mapping (HJM) tools and resources. Method Four repeated cycles of collaborative participatory action research were undertaken using repeated cycles of look and listen, think and discuss, take action together. A literature search and survey were conducted to review accessibility and usability of MTWT tools and resources. First Nations patients and families, and First Nations and non-First Nations researchers, hospital and university educators and healthcare professionals (end users), reviewed and tested HJM prototypes, shaping design, format and focus. Results The MTWT tool and resources have been used across multiple health care, research and education settings. However, many users experienced initial difficulty engaging with the tool and offered suggested improvements in design and usability. End user feedback on HJM prototypes identified the need for three distinct mapping tools for three different purposes: clinical care, detailed care planning and strategic mapping, to be accompanied by comprehensive resource materials, instructional guides, videos and case study examples. These were linked to continuous quality improvement and accreditation standards to enhance uptake in healthcare settings. Conclusion The new HJM tools and resources effectively map diverse journeys and assist recognition and application of strengths-based, holistic and culturally safe approaches to health care.

The Effect of Neurodevelopmental Disorders on the Prognosis of Children Undergoing Heart Transplantation: A Retrospective Analysis of the National Inpatient Sample 2011–2019

Background: Many international governing bodies recommend against heart transplantation in patients with severe cognitive-behavioral disabilities, however no clear criteria are offered to define severity. Patients with neurodevelopmental disorders may face systematic discrimination when being evaluated for transplant. We set out to investigate whether children with neurodevelopmental disorders that undergo heart transplantation have poorer in-hospital outcomes compared to neurotypical children. Methods: A retrospective analysis of the National Inpatient Sample database was conducted to identify pediatric patients with neurodevelopmental disorders who underwent heart transplantation from 2011–2019. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to investigate the association between the documented presence of a neurodevelopmental disorder and in-hospital outcomes in children undergoing heart transplantation. Results: We identified a weighted sample of 3770 pediatric cardiac transplant patients, of whom 245 (6.5%) had a documented diagnosis of neurodevelopmental disorder. There was no significant difference in the odds of major adverse cardiovascular events (all-cause mortality, stroke complications or myocardial infarction), surgical complications, infection, venous thromboembolic events, delirium/restraint use, or cardiac dysrhythmia. Patients with neurodevelopmental disorders had lower overall length of stay (44.0 days interquartile range (IQR): 16.0–90.0 vs. 57.08 days IQR: 22.0–112.0, p < 0.050), and cost of stay ($956,031 IQR: 548,559.0–1,801,412.0 vs. $1,074,793 IQR: 599,089.8–2,129,086.0, p < 0.050). Patients with neurodevelopmental disorders had significantly lower odds of acute transplant complications (adjusted odds ratio (aOR): 0.39, 95% confidence interval (CI): 0.21–0.74, p < 0.050) vascular complications (aOR: 0.36, 95% CI: 0.19–0.66, p < 0.050) and acute kidney injury (AKI) (aOR: 0.52, 95% CI: 0.33–0.83, p < 0.050). Conclusions: These data suggest that patients with neurodevelopmental disorders have overall similar if not potentially improved post-transplant outcomes in the acute setting compared to neurotypical patients, possibly secondary to selection bias in the patient selection process.

Towards unsettling the racial nation-state: affective interventions in an Australian literature classroom

ABSTRACT As the adoption of the Immigration Restriction Act 1901 (otherwise known as the White Australia policy) reveals, whiteness has always been fundamental to the Australian nation-state. White sovereignty is constitutive of the Australian nation, making it a racial state. But the devastating impact of whiteness on those deemed ‘not-white’ remains largely unacknowledged. Drawing on framing of affective economies and an empirical study tracing how secondary school students in a Literature class negotiate their identities amidst structures of colonialism, I explore the affective dynamics of these negotiations with attention to how emotions align some bodies with particular communities and situate some outside of nation. Within a pedagogic intervention aiming to disrupt canonical assumptions, I collected written responses, recorded group discussions from all class members, and interviewed a selection of these students. Data analysis demonstrates that many in the class were oriented to whiteness as ‘Australianness’ at the expense of other possible cultural identities offered by their biographies, often resulting in emotions of shame or disorientation. It invites us to think beyond national borders to avert the deleterious effects ‘nation-ness’ can have on those it excludes and to work towards implementing pedagogic interventions that might unsettle the racial nation-state.

Canadian social workers’ attitudes toward immigrants with different legal statuses in Canada

Summary This study contributes to the ongoing efforts to address systemic inequality within social work by examining Canadian social workers’ attitudes toward immigrants who are permanent residents (PR), refugees, temporary residents (TR), or undocumented immigrants. Using a cross-sectional design with a convenience sample (n = 653), we explore how social workers’ attitudes toward immigrants vary in relation to (a) respondents’ demographics, (b) contact with immigrants, (c) perceptions of equal opportunities among immigrants, (d) perceptions of deservingness for immigrants with different legal statuses, and (e) the impact of the COVID-19 pandemic on these attitudes. Findings While Canadian social workers generally express positive attitudes toward immigrants, there is a slightly stronger endorsement for PR and refugees to access public services compared to nonstatus (NS) immigrants and TR. Social workers who identify as conservative or have limited contact with immigrants are more likely to perceive NS immigrants as potential criminal threats or burdens on the healthcare system. Significantly, a majority of respondents feel that their social work training inadequately prepares them to work effectively with immigrants. Applications Canadian social workers advocate for principles of diversity, inclusion, and commitment to social justice. However, perceptions regarding which immigrants deserve access to social services vary based on legal status, suggesting a limitation in social workers’ professional mandate. The study discusses implications for social work education and training, emphasizing the need to address and unsettle systemic racism within the profession.

"I want to lift my people up": Exploring the psychological correlates of racial themes within the life stories of midlife Black Americans.

This study explores how middle-aged Black Americans talk about race, without prompting, while telling their life stories. Drawing upon a dataset of lengthy Life Story Interviews (N = 70), we first employed a keyword search to identify race-relevant interview scenes for each participant. Next, we conducted a thematic analysis of these scenes to identify salient racial narrative themes. Finally, we coded race-relevant scenes to examine the psychological correlates of racial narrative themes. We identified 460 total racially themed Life Story Interview scenes, with the number of racially themed scenes ranging from 1 to 17 across participants' interviews. Racial narrative themes included Community of Care, Black Cultural Identity, Multiculturalism, Activism, Encounter with Racism, Systemic Racism, and Racial Reckoning. Quantitative analyses highlight a relationship between racial narrative themes and psychological measures of wisdom and generativity. This study offers insight into the ways that race manifests in the life stories of Black Americans and highlights the importance of considering race in the study of narrative identity, and personality, more broadly.

Examining adverse childhood experiences and Black youth's engagement in a hospital-based violence intervention program using administrative data.

Stemming from poverty and systemic racism, Black youth are disproportionately represented in hospital-based violence intervention programs (HVIPs) due to greater violence exposure. HVIPs are a critical intervention that have been shown to reduce rates of reinjury in urban hospitals and trauma centers across the United States; however, they are plagued by low enrollment and engagement rates. Few studies have examined factors related to engagement, particularly among Black youth. Guided by Trauma Theory and Critical Race Theory, this study uses a retrospective cohort design. Between-group differences of adverse childhood experiences (ACEs) among engaged youth compared to nonengaged youth who were violently injured and recruited for a HVIP were examined using chi-square and logistic regression. ACEs were approximated using a novel approach with administrative data. Results indicated that the total ACE score was not significantly associated with engagement status. Individual ACEs were tested across age groups. This study highlights a novel approach to understanding ACEs among a hard-to-reach population and illuminates the significant level of ACEs faced by violence-exposed Black youth at young ages. Considering theory, Black families may be more reluctant to engage due to fear and past harms in social service systems stemming from systemic racism. Though ACEs did not predict engagement in this study, considering the high rates of ACEs experienced by Black youth and their families in the context of systemic racism suggests that HVIPs should acknowledge historical harms and foster trauma-informed and healing-centered interactions during recruitment and later stages of engagement.

“Too Clean, Too White”: Resistance to the Racial Politics of Hygiene in Helena María Viramontes’s Under the Feet of Jesus

Abstract The central characters of Helena María Viramontes’s 1996 novel about Mexican American farm workers, Under the Feet of Jesus, are plagued by dirt and grime wherever they go. Subsequently, these characters frequently face racial discourses of hygiene—popular forms of communication (advertisements, public health education, etc.) that associate cleanliness with whiteness and wealth, and dirtiness with poverty and nonwhite identity. Through their encounters with dirt, cleaning products, and racial discourses of hygiene, Viramontes’s characters demonstrate how ideas about cleanliness inform US racial formation. In particular, the novel’s engagement with the American ideals of white cleanliness foisted on the central teenage farm worker, Estrella, and her family reveals how personal hygiene is weaponized as a tool of neoliberalism to obscure the material conditions of laborers and the systemic environmental racism they face. In the novel, individual hygiene is presented, most often by white or white-coded characters, as the path toward environmental, racial, and economic justice in ways that distract from the structural roots of the environmental injustices nonwhite farm workers face daily. Through white color imagery and active engagement with dirty materiality, Under the Feet of Jesus challenges racial discourses of hygiene and demonstrates systemic and restorative ways of thinking about public health and the value of communal care.

African Americans’ Willingness to Extend Legitimacy to the Police: Connections to Identities and Experiences in the Post-George Floyd Era

Abstract Numerous benefits materialize when people extend legitimacy to institutions; consequently, many investigations of the legitimacy of the police have been reported. However, several critical issues remain unanswered. My paper’s purpose is to revisit the question of willingness to grant police legitimacy, focusing on a nationally representative sample of African Americans. I test hypotheses connecting police legitimacy with experiences with unfair treatment by legal authorities, ingroup attachments, attitudes toward systemic racism, and engagement with Black Lives Matter. My findings reveal significant connections between experience with discrimination, ingroup attachments, and beliefs about systemic racism but little relationship between BLM attitudes and police legitimacy.

Feasibility and acceptability of measuring prenatal stress in daily life using smartphone-based ecological momentary assessment and wearable physiological monitors.

High levels of stress during pregnancy can have lasting effects on maternal and offspring health, which disproportionately impacts families facing financial strain, systemic racism, and other forms of social oppression. Developing ways to monitor daily life stress during pregnancy is important for reducing stress-related health disparities. We evaluated the feasibility and acceptability of using mobile health (mHealth) technology (i.e., wearable biosensors, smartphone-based ecological momentary assessment) to measure prenatal stress in daily life. Fifty pregnant women (67% receiving public assistance; 70% Black, 6% Multiracial, 24% White) completed 10 days of ambulatory assessment, in which they answered smartphone-based surveys six times a day and wore a chest-band device (movisens EcgMove4) to monitor their heart rate, heart rate variability, and activity level. Feasibility and acceptability were evaluated using behavioral meta-data and participant feedback. Findings supported the feasibility and acceptability of mHealth methods: Participants answered approximately 75% of the surveys per day and wore the device for approximately 10hours per day. Perceived burden was low. Notably, participants with higher reported stressors and financial strain reported lower burden associated with the protocol than participants with fewer life stressors, highlighting the feasibility of mHealth technology for monitoring prenatal stress among pregnant populations living with higher levels of contextual stressors. Findings support the use of mHealth technology to measure prenatal stress in real-world, daily life settings, which shows promise for informing scalable, technology-assisted interventions that may help to reduce health disparities by enabling more accessible and comprehensive care during pregnancy.

Racially minoritised students’ strategies for navigating and resisting racism in higher education

ABSTRACT For years now racially minoritised people have entered UK Higher Education (HE) at higher rates than their white peers and, in recent years, recognition of race inequality in the sector has been growing. Despite this, institutional racism and whiteness continue to underpin UK HE. A growing body of work centres the experiences of racially minoritised students and considers how they experience racism and whiteness in HE. Less scholarly attention has been paid to how students respond to and resist racism and whiteness. As such, this article draws attention to racially minoritised students’ agency and the strategies they develop and deploy to navigate and resist racism in HE. In so doing, it challenges deficit discourses that suggest that racially minoritised students lack the capital required to survive in the academy. Second, through exploring students’ agency and resistance, it reveals the weight of institutional whiteness in HE.

"This might be cliché, but it was a sense of family": Gang involvement among Indigenous young adults and their search for attachment, community, and hope.

Indigenous communities in Canada continue to feel the ongoing impacts of colonialism, including socio-economic disadvantage, high rates of violent victimization, systemic racism and discrimination, overrepresentation in the criminal justice system, and intergenerational trauma. Based on in-depth interviews with 10 gang-involved Indigenous young adults, using attachment theory as a guiding framework, we explore how colonialism continues to negatively impact the attachment these young people have to their families, communities, and social institutions, and leads to their gang involvement which perpetuates violence and trauma. Yet, they exhibit hope for a better future. Drawing on participant experiences we suggest key points at which provision of supports and resources can assist with increasing attachments and facilitating gang desistance. We share these insights while acknowledging the continued structural, embedded violence many Indigenous youth experience today that necessitates a commitment to decolonization at all levels of Canadian society.

AOA Critical Issues Symposium: Promoting Health Equity.

Promoting equitable health care is to ensure that everyone has access to high-quality medical services and appropriate treatment options. The definition of health equity often can be misinterpreted, and there are challenges in fully understanding the disparities and costs of health care and when measuring the outcomes of treatment. However, these topics play an important role in promoting health equity. The COVID-19 pandemic has made us more aware of profound health-care disparities and systemic racism, which, in turn, has prompted many academic medical centers and health-care systems to increase their efforts surrounding diversity, equity, and inclusion. Therefore, it is important to understand the problems that some patients have in accessing care, promote health care that is culturally competent, create policies and standard operating procedures (at the federal, state, regional, or institutional level), and be innovative to provide cost-effective care for the underserved population. All of these efforts can assist in promoting equitable care and thus result in a more just and healthier society.

Addressing Systemic Racism and Racialized Violence to Reduce Firearm Injury and Mortality Inequities

This JAMA Forum discusses systemic racism and racialized violence, promising approaches to address inequities in firearm violence, and ways to treat the trauma of gun violence.

Using Critical Race Theory in Social Work Education to Prepare Antiracist Practitioners: A Systematized Review

ABSTRACT Growing concerns arise over the effectiveness of cultural competency and humility in addressing systemic racism in social work. Scholars advocate for the incorporation of critical race theory (CRT) into social work education; however, its polarization creates uncertainty. This systematized review synthesizes the contemporary use of CRT in social work curricula. Comprehensive searches were conducted and sixteen peer-reviewed studies met the inclusion criteria, representing BSW, MSW, and PhD education. Three roles for CRT within social work were identified: (a) understanding systemic racism, (b) an alternative model to cultural competence, and (c) the inclusion of CRT into the social work curriculum or specific courses. Benefits and barriers are also identified. To align with social work values, social work should consider the integration of CRT across the curriculum.

Conceptualizing White-Ability Saviorism: A Necessary Reckoning With Ableism in Urban Teacher Education

White saviorism is a well-documented phenomenon in the education literature. Particularly, researchers have made connections between white saviorism and teacher preparation for urban contexts serving Students of Color negatively impacted by legacies of systemic racism. Scholars are increasingly taking an intersectional lens to understand the ways in which racism and ableism intersect, yet much of the literature on white saviorism does not critically examine the role of ableism. In this meta-ethnography, we review extant qualitative research on urban teacher preparation in an effort to extend the analysis to include a robust examination of ableism and deepen our understandings of white supremacy in these spaces. To this end, we conceptualize white-ability saviorism as a more comprehensive and precise way to understand the dynamics at play in urban teacher preparation that contribute to white supremacy and perpetuate educational inequities for urban Communities of Color.

Sidestepping Class: A Marxist Critique of Race Formation Theory

ABSTRACT This article critically examines the racial formation theory proposed by Omi and Winant from a Marxist perspective. It contends that the theory overlooks the class dimension of the social construction of race and the dynamics of racial formation in the United States. The article traces the historical role of class in the process of racial formation and shows how race and racism are linked to the evolution of capitalism in American society. It argues that the colonial ruling class created race and used racism as a tool to fragment the labouring class along racial and ethnic lines, preventing them from uniting against the colonial capitalist system. The invention of race set the stage for the persistence and reinforcement of race formation and racism by the subsequent American ruling class from post-independence to the present day. This article also challenges the idea of a racial state and asserts that it is a false concept that fails to capture the reality of racism and its solutions. It concludes that the theory is inadequate, biased, and ineffective in addressing and resolving the issues of race and racism in the social and everyday lives of the oppressed minorities in the United States.