Racial Inequality Research Articles

Structural Racism, Mass Incarceration, and Racial and Ethnic Disparities in Severe Maternal Morbidity

Racial and ethnic inequities in the criminal-legal system are an important manifestation of structural racism. However, how these inequities may influence the risk of severe maternal morbidity (SMM) and its persistent racial and ethnic disparities remains underinvestigated. To examine the association between county-level inequity in jail incarceration rates comparing Black and White individuals and SMM risk in California. This population-based cross-sectional study used state-wide data from California on all live hospital births at 20 weeks of gestation or later from January 1, 1997, to December 31, 2018. Data were obtained from hospital discharge and vital statistics records, which were linked with publicly available county-level data. Data analysis was performed from January 2022 to February 2023. Jail incarceration inequity was determined from the ratio of jail incarceration rates of Black individuals to those of White individuals and was categorized as tertile 1 (low), tertile 2 (moderate), tertile 3 (high), with mean cutoffs across all years of 0 to 2.99, 3.00 to 5.22, and greater than 5.22, respectively. This study used race- and ethnicity-stratified mixed-effects logistic regression models with birthing people nested within counties and adjusted for individual- and county-level characteristics to estimate the odds of non-blood transfusion SMM (NT SMM) and SMM including blood transfusion-only cases (SMM; as defined by the Centers for Disease Control and Prevention SMM index) associated with tertiles of incarceration inequity. This study included 10 200 692 births (0.4% American Indian or Alaska Native, 13.4% Asian or Pacific Islander, 5.8% Black, 50.8% Hispanic or Latinx, 29.6% White, and 0.1% multiracial or other [individuals who self-identified with ≥2 racial groups and those who self-identified as "other" race or ethnicity]). In fully adjusted models, residing in counties with high jail incarceration inequity (tertile 3) was associated with higher odds of SMM for Black (odds ratio [OR], 1.14; 95% CI, 1.01-1.29 for NT SMM; OR, 1.20, 95% CI, 1.01-1.42 for SMM), Hispanic or Latinx (OR, 1.24; 95% CI, 1.14-1.34 for NT SMM; OR, 1.20; 95% CI, 1.14-1.27 for SMM), and White (OR, 1.02; 95% CI, 0.93-1.12 for NT SMM; OR, 1.09; 95% CI, 1.02-1.17 for SMM) birthing people, compared with residing in counties with low inequity (tertile 1). The findings of this study highlight the adverse maternal health consequences of structural racism manifesting via the criminal-legal system and underscore the need for community-based alternatives to inequitable punitive practices.

“Everybody that's here, is legal” white employers' racial ideologies in the workplace and justifications for hiring undocumented Latino laborers

AbstractWhite employers routinely hire undocumented Latino immigrant workers based on their perceived racializations about their subservience. Researchers have explored how employers racialize Latinos, yet there is less understanding of how white employers justify breaking immigration labor policies. This study analyzes the justifications of both racialized exploitation and organizational decoupling that supports violations of immigration laws. Using in‐depth interviews with 20 white employers, this study explores employer racializations of Latinos, views of whiteness in the workplace, and justifications to hire undocumented immigrants. White employers praise Latinos for their perceived subservience, favor whites for management, and neutralize their own unlawful actions of hiring undocumented laborers. White employers frame themselves as rational, innocent, and virtuous while reinforcing racial stratification and breaking immigration laws. This study provides insights on employer labor practices with implications for labor mobility, migration reform, and racial inequality in the workplace.

(Un)Doing reflexivity: white researchers on their credibility and legitimacy in the field of ethnic and racial studies

ABSTRACT Positionality and (racialised) positions of power have become crucial topics in the field of ethnic and racial studies, resulting in a growing number of self-reflexive papers on power relations in so-called “cross-ethnic” or “cross-racial” research. However, there has been little comprehensive empirical examination of how researchers navigate questions of positionality when studying ethnic and racial diversity and inequality. This article addresses how white researchers working on these topics aim to establish credibility and legitimacy in the postcolonial context of Flanders, Belgium. Drawing on in-depth interviews, we explore how our respondents (re)construct legitimate motivations for conducting their research, and identify five strategies they use to establish credibility: (a) acknowledging their whiteness; (b) pointing to institutional responsibility, (c) shifting their research focus to white groups or adopting what they consider more “neutral” approaches, (d) claiming experiences with the topic under scrutiny and (e) referring to how ethnic minority groups “approve” their research.

Twenty-first-century demographic and social inequalities of heat-related deaths in Brazilian urban areas.

Population exposure to heat waves (HWs) is increasing worldwide due to climate change, significantly affecting society, including public health. Despite its significant vulnerabilities and limited adaptation resources to rising temperatures, South America, particularly Brazil, lacks research on the health impacts of temperature extremes, especially on the role played by socioeconomic factors in the risk of heat-related illness. Here, we present a comprehensive analysis of the effects of HWs on mortality rates in the 14 most populous urban areas, comprising approximately 35% of the country's population. Excess mortality during HWs was estimated through the observed-to-expected ratio (O/E) for total deaths during the events identified. Moreover, the interplay of intersectionality and vulnerability to heat considering demographics and socioeconomic heterogeneities, using gender, age, race, and educational level as proxies, as well as the leading causes of heat-related excess death, were assessed. A significant increase in the frequency was observed from the 1970s (0-3 HWs year-1) to the 2010s (3-11 HWs year-1), with higher tendencies in the northern, northeastern, and central-western regions. Over the 2000-2018 period, 48,075 (40,448-55,279) excessive deaths were attributed to the growing number of HWs (>20 times the number of landslides-related deaths for the same period). Nevertheless, our event-based surveillance analysis did not detect the HW-mortality nexus, reinforcing that extreme heat events are a neglected disaster in Brazil. Among the leading causes of death, diseases of the circulatory and respiratory systems and neoplasms were the most frequent. Critical regional differences were observed, which can be linked to the sharp North-South inequalities in terms of socioeconomic and health indicators, such as life expectancy. Higher heat-related excess mortality was observed for low-educational level people, blacks and browns, older adults, and females. Such findings highlight that the strengthening of primary health care combined with reducing socioeconomic, racial, and gender inequalities represents a crucial step to reducing heat-related deaths.

National analysis of racial disparities in emergent surgery for colorectal cancer

BackgroundRacial disparities in access to preoperative evaluation for colorectal cancer remain unclear. Emergent admission may indicate lack of access to timely care. The present work aimed to evaluate the association of admission type with race among patients undergoing colorectal cancer surgery. MethodsAll adults undergoing resection for colorectal cancer in 2011–2020 National Inpatient Sample were identified. Multivariable regression models were developed to examine the association of admission type with race. Primary outcome was major adverse events (MAE), including mortality and complications. Secondary outcomes included costs and length of stay (LOS). Interaction terms between year, admission type, and race were used to analyze trends. ResultsOf 722,736 patients, 67.6 % had Elective and 32.4 % Emergent admission. Black (AOR 1.38 [95 % CI 1.33–1.44]), Hispanic (1.45 [1.38–1.53]), and Asian/Pacific Islander or Native American (1.25 [1.18–1.32]) race were associated with significantly increased odds of Emergent operation relative to White. Over the study period, non-White patients consistently comprised over 5 % greater proportion of the Emergent cohort compared to Elective. Furthermore, Emergent admission was associated with 3-fold increase in mortality and complications, 5-day increment in LOS, and $10,100 increase in costs. MAE rates among Emergent patients remained greater than Elective with a widening gap over time. Non-White patients experienced significantly increased MAE regardless of admission type. ConclusionNon-White race was associated with increased odds of emergent colorectal cancer resection. Given the persistent disparity over the past decade, systematic approaches to alleviate racial inequities in colorectal cancer screening and improve access to timely surgical treatment are warranted.

A call for reform: Education’s role in strengthening democracy

This essay maintains that the ideal American democracy necessitates a fair, equitable, and just education system. This fair system would subsequently create an educated electorate to then select their representatives, vote on policy amendments or changes, and remain informed on issues that affect all aspects of life in this representative democracy. It pays special attention to the racial inequities that continue to exist due to an unjust taxation and funding system, corrupt political bodies, and the urban-suburban divide. Relying on the Founding Fathers, Dr. Martin Luther King, Jr, and contemporary sociologists and economists, this essay identifies key factors which continue to divide the American educational system. The essay contends that such inequities, political actions aimed at the elimination of content or curriculum, and the continued underfunding of American school systems puts the long-term viability of our democracy in peril.

Racial inequities in HIV incidence among men who have sex with men prior to and amidst an Ending the HIV Epidemic initiative.

The aim of this study was to examine trends in HIV incidence among men who have sex with men (MSM) relative to the scale up of Ending the HIV Epidemic (EHE) initiatives, including biomedical prevention strategies, and to describe racial inequities over time. A cross-sectional study, matching annual cohorts of New York City (NYC) Sexual Health Clinic (SHC) patients from 2010 to 2018 to the citywide HIV registry to identify seroconversions during 1 year of follow-up, through 2019. We examined HIV incidence for each annual cohort of MSM using diagnoses within 1 year after last negative HIV test. We calculated incidence rates and rate ratios (IRR) pooled across 3-year intervals (2010-2012, 2013-2015, 2016-2018) by race/ethnicity, age, neighborhood poverty level, recent STI diagnosis, and condom use during anal sex. There were 36 156 study visits among MSM attending NYC SHCs, including 37% among White MSM and 63% among MSM of color. From 2010 to 2018, HIV incidence decreased overall from 2.82 to 0.82/100 person-years, and among all race/ethnicity, age, poverty, STI, and condom use subgroups. For 2010-2012 vs. 2016-2018, adjusted IRRs (95% CI) increased for Black MSM [1.8 (1.3-2.6) vs. 6.0 (3.5-10.2)], Latino MSM [1.4 (1.0-2.0) vs. 4.0 (2.3-6.8)], and MSM of other races [1.0 (0.6-1.7) vs. 2.5 (1.3-4.9)] compared with White MSM. Black and Latino MSM seroconverted at significantly higher rates than White MSM in the same age groups and neighborhood poverty level. Despite decreases in HIV incidence among MSM, racial inequities were exacerbated over time. Addressing structural factors that impact racial inequities in risk of HIV should undergird EHE initiatives.

An Exploration into People with Disabilities’ Access to Sex, Sexuality, and Sex Education in South Africa

IntroductionThe needs of people living with disabilities regarding sex and sexual health remain largely neglected. Knowledge and resources about disabled sexuality have emerged mainly from the global north and have centered on heteronormative ideas about sex, gender, and sexuality.MethodsAn affirmative, sex positive, queer, and intersectional exploration was undertaken of the experiences and needs a group of adults with disabilities living in Gauteng, South Africa in relation to accessing information about sex, sexuality, and sexual health. Interviews were conducted with people of diverse disabilities, language groups, and cultural backgrounds. Interviews were analyzed using thematic analysis.ResultsThe participants revealed that sexual encounters, relationships, and dating were infused with negative experiences related to lack of understanding about sex, internalized ableism, exploitation, and physical, sexual, and emotional abuse resulting from societal stigma and ignorance regarding disability. Participants offered suggestions for how their needs could be addressed.ConclusionOur study concludes that the denial of sexual rights is a central element of the broader forms of social exclusion that people with disabilities. In South Africa, many of these forms of exclusion have been compounded by the legacy of apartheid, and the persistence of racial inequality, taboos about sex, and stigmas associated with disability.

The stark implications of abolishing child welfare: An alternative path towards support and safety

AbstractScholars and advocates are at odds about how to achieve higher levels of child safety and permanency. Calls for change include the recent upEND focus on eradication of child welfare services to a radical refocusing of the present system towards prevention/early intervention. To clarify the implications of reform over abolition, we seek to portray a future in which the abolition of child welfare has occurred, in juxtaposition to maintaining four core elements of established child maltreatment programmes around the world: (1) receiving and responding to community signals about the risk to children; (2) assessment of need coupled with a proportionate response; (3) rights protections to ensure fairness when placement outside the family is required; and (4) procedures for accountability and quality improvement. For each of these functions, we outline abolitionist advocates' positions and implications for children and parents. Across these elements, we delineate how assigning these responsibilities to communities, as suggested by upEND, would likely (1) exaggerate racial and economic inequities and (2) create structural barriers that would increase harm to children. We suggest several evidence‐informed enhancements to practice, research and policy that would mitigate these inequities while also increasing safety and permanency.

Health Care Professional Distress and Mental Health: A Call to the Continuing Professional Development Community.

COVID-19 unleashed a maelstrom of distress on health care professionals. The pandemic contributed to a host of stressors for workers because of the need for rapid acquisition of new knowledge and skills to provide best treatment while simultaneously dealing with personal safety, limited resources, staffing shortages, and access to care issues. Concurrently, problems with systemic racial inequality and discrimination became more apparent secondary to difficulties with accessing health care for minorities and other marginalized groups. These problems contributed to many health care professionals experiencing severe moral injury and burnout as they struggled to uphold core values and do their jobs professionally. Some left or disengaged. Others died. As continuing professional development leaders focused on all health professionals, we must act deliberately to address health care professionals' distress and mental health. We must incorporate wellness and mental health as organizing principles in all we do. We must adopt a new mental model that recognizes the importance of learners' biopsychosocial functioning and commit to learners' wellness by developing activities that embrace a biopsychosocial point of view. As educators and influencers, we must demonstrate that the Institute for Healthcare Improvement's fourth aim to improve clinician well-being and safety (2014) and fifth aim to address health equity and the social determinants of health (2021) matter. It is crucial that continuing professional development leaders globally use their resources and relationships to accomplish this imperative call for action.

Urban sprawl and racial inequality in intergenerational mobility

Abstract Persistent racial inequality in socioeconomic status within urban areas has been a significant concern in both the US and European countries. Differences across racial groups in intergenerational mobility (IM) have been identified as a key source of this persistence. However, efforts to understand racial inequality in IM have rarely considered the role of urban sprawl. This article argues that urban sprawl affects differences in IM between racial groups directly and indirectly through racial segregation, racial bias, and social capital. We analyze data from 874 metropolitan counties in the US using structural equation models to test these direct and indirect effects of sprawl on racial inequality in IM. We found that urban sprawl was negatively associated with racial inequality in IM. The direct effect, which we partially attribute to higher racial disparities in social capital in more compact counties, was statistically significant. For the indirect effects, racial segregation had the largest mediating effects between urban sprawl and racial inequality in IM, followed by economic connectedness (EC) and racial bias. The net indirect effect of sprawl on racial inequality in IM was negative because negative indirect effects through racial segregation and EC outweigh positive indirect effects through racial bias. Our findings demonstrate the significant role of urban form in racial inequality in IM.

Mapping Pockets of Survival

In our Shadwell food history walk, part of a larger ‘Food Lives’ initiative, we employed counter-mapping techniques to shed light on overlooked post-war migrant cafés, revealing their essential role in facilitating food security and community. These spaces, often central in marginalised individuals’ navigation through urban life, epitomise racialised resistance and survival. Their significance, especially the almost invisible contributions of women and men of colour, stands in contrast to dominant historical narratives. The spatial food heritage of Cable Street emphasises the longstanding influence of racially marginalised migrant communities, countering racism and racial inequalities. Drawing parallels to present-day East End eateries, often criticised yet serving as cultural hubs, the project underscores the enduring ‘sticky emotions’ tied to food, racial dynamics, and colonial legacies.

Kantian Cosmopolitanism and the Challenge of its Racist Prejudices

In the years 1788, Kant develops a conception of racial inequality in which he not only affirms the superiority of the « European » white race over other races, but also appears to approve of the enslavement of Black people. Kant’s theory of racial inequality baffles many, considering that in the moral philosophy he develops during the same period, he makes no compromises on the inviolability of human dignity. The aim of this text is not to deny Kant’s racism between 1764 and 1790, which is evident in his courses on physical geography and anthropology, but rather to demonstrate that Kant’s primary objective, which he never loses sight of in his various writings on race, is to explain the unity in diversity of the human species. While Kant’s theory of racial inequalities leaves no doubt about his racism between 1764 and 1790, it is inaccurate to claim that he remained constant in his views on non-European peoples. From 1795 onwards, in the Project for a Perpetual Peace and later in The Metaphysics of Morals (1797), Kant reevaluates his appreciation of non-European peoples, develops a more egalitarian conception of rights and race, and condemns European colonization.

Teaching & Learning Guide for: Institutional interactions and racial inequality in policing: How everyday encounters bridge individuals, organizations, and institutions

Teaching & Learning Guide for: Institutional interactions and racial inequality in policing: How everyday encounters bridge individuals, organizations, and institutions

An Incomplete Recognition: An Analysis of Political Science Department Statements after the Murder of George Floyd

As a discipline centered on power, political science provides an important window into potential responses to episodes of heightened attention to long-standing racial violence and inequality in the United States. During the summer of 2020, political science departments, like many other entities, issued public statements in response to the brutal murder of George Floyd and the long and ongoing history of deadly violence against Black people at the hands of law enforcement. This paper examines these statements, providing a descriptive analysis of themes raised and types of commitments to action. Rhetorical responses to racism constitute important sites for understanding how discursive power is deployed. Ultimately, we observe that proposed solutions contained in statements are not commensurate with the structural understanding of racism encapsulated in statements. These statements suggest that the status quo prevails even among those who study power. We document limited commitments to addressing racism in political statements.

The whiteness of ‘sex discrimination’: theorising white feminist ideology in politics

The year 2025 will mark 50 years since the prohibition of gender discrimination in employment in Europe. Feminist narratives of this time have often been ones of progress, despite Black feminist critique of how such legislation effaced racially minoritised women’s experiences. Why was gender equality legislation designed to mainly benefit white privileged women? What discourses were involved? Meanwhile, while the term ‘white feminism’ has recently been popularised, there has been relatively little investigation of what it comprises in politics in Europe. Drawing on cross-disciplinary empirical research on UK gender equality legislation involving analysis of parliamentary debate, archival research and oral history, this article contributes to theorisation of the tenets of white feminism, namely, as a political ideology wherein gender is constructed as the most important marker of social inequality and, specifically, as being more important than racial inequality. Ultimately, such specification aims to make white feminism in politics impossible to render neutral.

Isolating the Drivers of Racial Inequities in Prostate Cancer Treatment.

Black individuals in the United States are less likely than White individuals to receive curative therapies despite a 2-fold higher risk of prostate cancer death. While research has described treatment inequities, few studies have investigated underlying causes. We analyzed a cohort of 40,137 Medicare beneficiaries (66 and older) linked to the Surveillance Epidemiology and End Results (SEER) cancer registry who had clinically significant, non-metastatic (cT1-4N0M0, grade group 2-5) prostate cancer (diagnosed 2010-2015). Using the Kitagawa-Oaxaca-Blinder decomposition, we assessed the contributions of patient health and health care delivery on the racial difference in localized prostate cancer treatments (radical prostatectomy or radiation). Patient health consisted of comorbid diagnoses, tumor characteristics, SEER site, diagnosis year, and age. Health care delivery was captured as a prediction model with these health variables as predictors of treatment, reflecting current treatment patterns. A total of 72.1% and 78.6% of Black and White patients received definitive treatment, respectively, a difference of 6.5 percentage points. An estimated 15% [95% confidence interval (CI): 6-24] of this treatment difference was explained by measured differences in patient health, leaving the remaining estimated 85% (95% CI: 74-94) attributable to a potentially broad range of health care delivery factors. Limitations included insufficient data to explore how specific health care delivery factors, including structural racism and social determinants, impact differential treatment. Our results show the inadequacy of patient health differences as an explanation of the treatment inequity. Investing in studies and interventions that support equitable health care delivery for Black individuals with prostate cancer will contribute to improved outcomes.

Beyond ‘Lulz' and ‘Keyboard warriors': exploring the relationship between trolling and radicalization

ABSTRACT Despite the similar psychological profiles of internet trolls and radicalized political actors, as well as the historical connections between trolling and the alt-right, little research has studied how trolling corresponds with the process of radicalization. Our study examines this relationship between trolling and radicalization by interrogating two pieces of folk wisdom about internet trolls, that they only care about ‘the lulz’ and that they are merely ‘keyboard warriors.’ Using the issue of racial inequality in the United States as a case study, we ask whether someone’s enjoyment of trolling is affected by their attitudes about racial inequality as well as whether those who enjoy trolling are more likely to engage in politically motivated activist and radical activities related to their views about race. Based on a nationally representative survey (N = 739), our study finds that those who enjoy the discursive act of trolling also intend to participate in other forms of political engagement, including both activist and radical activities. Overall, our findings reveal significant overlaps between trolling, activism, and radical activities when it comes to the topic of racial inequality, demonstrating the value of considering discursive acts like trolling within the broader context of studying the adoption of extremist ideologies and actions.

Uncovering the Transformative Labor in Black Women's Community Work

Despite efforts by scholars to visibilize Black women's community work, we still lack a framework that captures the nuances in the work arrangements of Black women serving and advocating for their communities. Our paper introduces a new conceptual framework, the Continuum of Transformative and Reproductive Labor (CTRL), to recognize this hidden multiform labor of racialized women. The CTRL places community work that reproduces oppressive social structures on a spectrum opposite what we call transformative labor—labor that disrupts systems of oppression. The CTRL framework distinguishes social reproductive and transformative community work along four dimensions, (1) the type of power each produces, (2) workers’ autonomy and leadership, (3) workers’ motivation, and (4) how the work is valued. We explore the utility of the CTRL framework for analyzing multiple types of community work Black women perform by highlighting historical and contemporary cases in two different labor contexts. Ultimately, we make a key contribution to feminist social work; Recognizing the community as a site of social reproductive labor, we create a new framework to acknowledge Black women's labor in the community as distinct in its capacity to transform social systems by resisting the reproduction of racial and gender inequality.

Situating implementation science (IS) in res(IS)tance: a conceptual frame toward the integration of scholarship from the black radical tradition.

This manuscript undertakes a disciplinary self-critique of the field of implementation science, a field which attempts to bridge the gap between evidence-based interventions and their practical application. Despite the heightened emphasis on health equity and racial disparities, the field's current discourse is limited by key epistemic shortcomings. First, even though prevalence of implementation gaps between racialized groups in the United States necessitates a comprehensive understanding of the systems perpetuating these disparities, the field does not operate with a general explanation for disparities not as a failure of systems, but a system historically and structural designed to produce disparities. Second, the field has attempted to address disparities without adequate dialog with a broad tradition of anti-racist and anti-colonial sociology, history and epistemology, and therefore risks a decontextualized analysis of disparities and under-informed approaches to achieving equity. Fortunately, scholarship from the Black radical tradition (BRT), such as the Public Health Critical Race Praxis (PHCRP), Critical Race Theory (CRT), and more broadly conceptual frameworks from post-modern, anti-colonial, Black feminist studies and social epistemology can offer to implementation science frameworks that center power dynamics and racialized oppression. This epistemic re-alignment of implementation research to "center at the margins" can enable the field of implementation science to more critically examine and dismantle systems that perpetuate racial inequalities in access to and utilization of health interventions. For example, normalization and dynamic fit, which are thought to be key mechanisms of implementation, are revealed in the light of this tradition of scholarship to be potentially problematic acquiescence to oppressive systems. Drawing from the concept of resistance anchored in the scholarship of the Black radical tradition as well as contemporary social epistemology such as the work of José Medina and Maria Fricker about epistemic justice, the authors further advance that implementation science could make more substantial contributions to the dismantling of racialized systems and actively work toward health justice through the transdisciplinary lens of resistance. This is a call to action for integrating implementation science with critical philosophical and theoretical perspectives rooted in Black studies and related insights, which have been acquired through the struggle for social justice, to inform the design of implementation strategies and research projects that improve health services and health outcomes for health disparity populations.