Racial Inequality Research Articles

Responding to employee-based race inequalities in National Health Service (England): accountability and the Workforce Race Equality Standard

PurposeThis paper examines the efforts of National Health Service (England) (NHSE) to respond to employee-based racial inequalities via its Workforce Race Equality Standard (WRES). The WRES constitutes a hybridised accountability initiative with characteristics of the moral and imposed regimes of accountability.Design/methodology/approachThe study conceptualises the notion of responsive race accountability with recourse to Favotto et al.’s (2022) moral accountability model and critical race theory (CRT), and through it, examines the enactment of WRES at 40 NHSE trusts using qualitative content analysis.FindingsDespite the progressive nature of the WRES that seeks to nurture corrective actions, results suggest that trusts tend to adopt an instrumental approach to the exercise. Whilst there is some evidence of good practice, the instrumental approach prevails across both the metric reporting that trusts engage in to guide their actions, and the planned actions for progress. These planned actions not only often fail to coalesce with the trust-specific data but also include generic NHSE or equality, diversity and inclusion initiatives and mimetic adoptions of best practice guidance that only superficially address racial concerns.Social implicationsWhilst the WRES is a laudable voluntary achievement, its moral imperative does not appear to have translated into a moral accountability within individual trusts.Originality/valueResponding to calls for more research at the accounting-race nexus, this study uniquely draws on CRT to conceptualise and examine race accountability.

ACOG Committee Statement No. 10: Racial and Ethnic Inequities in Obstetrics and Gynecology.

Disparate health outcomes and unequal access to care have long plagued many communities in the United States. Individual demographic characteristics, such as geography, income, education, and race, have been identified as critical factors when seeking to address inequitable health outcomes. To provide the best care possible, obstetrician-gynecologists should be keenly aware of the existence of and contributors to health inequities and be engaged in the work needed to eliminate racial and ethnic health inequities. Obstetrician-gynecologists should improve their understanding of the etiologies of health inequities by participating in lifelong learning to understand the roles clinician bias and personally mediated, systemic, and structural racism play in creating and perpetuating adverse health outcomes and health care experiences.

54468 Racial and socioeconomic inequities in atopic dermatitis care: A study of price and pharmacy deserts for recommended skincare products

54468 Racial and socioeconomic inequities in atopic dermatitis care: A study of price and pharmacy deserts for recommended skincare products

Optional Exam Retakes Reduce Anxiety but may Exacerbate Score Disparities Between Students with Different Social Identities.

Use of high-stakes exams in a course has been associated with gender, racial, and socioeconomic inequities. We investigated whether offering students the opportunity to retake an exam makes high-stakes exams more equitable. Following the control value theory of achievement emotions, we hypothesized that exam retakes would increase students' perceived control over their performance and decrease the value of a single exam attempt, thereby maximizing exam performance. We collected data on exam scores and experiences with retakes from three large introductory biology courses and assessed the effect of optional exam retakes on gender, racial/ethnic, and socioeconomic disparities in exam scores. We found that Black/African American students and those who worked more than 20 h a week were less likely to retake exams. While exam retakes significantly improved student scores, they slightly increased racial/ethnic and socioeconomic disparities in scores partly because of these differences in participation rates. Most students reported that retake opportunities reduced their anxiety on the initial exam attempt. Together our results suggest that optional exam retakes could be a useful tool to improve student performance and reduce anxiety associated with high-stakes exams. However, barriers to participation must be examined and reduced for retakes to reduce disparities in scores.

COVID-19 vaccine uptake inequality among older adults: A multidimensional demographic analysis

Age, race, ethnicity, and sex are important determinants of coronavirus disease of 2019 (COVID-19) outcomes. Older adults (65 years and older) are at the highest risk of COVID-19 morbidity and mortality. Analyzing their vaccine uptake by subclassifying demographics is rare and can assist vaccination policies. This study investigates COVID-19 dose 1and 2vaccine uptakes among them by race, ethnicity, and sex. Immunization registry data were used to calculate temporal changes in older adults' COVID-19 vaccine uptake by race, ethnicity, race-sex, and ethnicity-sex in Kentucky's most populous county, Jefferson County, during the first 6 quarters of the COVID-19 vaccination program. By May 2022, the county's Asian residents had the highest dose 1 and 2 vaccination rates (97.0% and 80.4%), then White residents (90.0% and 80.2%). Black residents had one of the lowest COVID-19 vaccination rates (87.3% and 77.3%). The rate among Hispanic residents (82.0% and 66.4%) was considerably lower than non-Hispanic residents (90.2% and 80.1%). The rates were consistently lower in males. Racial, ethnic, and sex-based COVID-19 vaccine inequalities were largely maintained during the study period. Vaccine rollout practices and promotional programs should aim to boost the uptake of the COVID-19 vaccination among racial minority and male older adults.

A Few Doctors Will See Some of You: The Critical Role of Underrepresented in Medicine (URiM) Family Physicians in the Care of Medicaid Beneficiaries.

Despite being key to better health outcomes for patients from racial and ethnic minority groups, the proportion of underrepresented in medicine (URiM) physicians remains low in the US health care system. This study linked a nationally representative sample of family physicians (FPs) with Medicaid claims data to explore the relative contributions to care of Medicaid populations by FP race and ethnicity. This descriptive cross-sectional study used 2016 Medicaid claims data from the Transformed Medicaid Statistical Information System and from 2016-2017 American Board of Family Medicine certification questionnaire responses to examine the diversity and Medicaid participation of FPs. We explored the diversity of FP Medicaid patient panels and whether they saw ≥150 beneficiaries in 2016. Using logistic regression models, we controlled for FP demographics, practice characteristics, and characteristics of the communities in which they practiced. Of 13,096 FPs, Latine, Hispanic, or of Spanish Origin (LHS) FPs and non-LHS Black FPs saw more Medicaid beneficiaries compared with non-LHS White and non-LHS Asian FPs. The patient panels of URiM FPs had a much greater proportion of Medicaid beneficiaries from racial and ethnic minority groups. Overall, non-LHS Black and LHS FPs had greater odds of seeing ≥150 Medicaid beneficiaries in 2016. These findings clearly show the critical role URiM FPs play in caring for Medicaid beneficiaries, suggesting physician race and ethnicity are correlated with Medicaid participation. Diversity in the health care workforce is essential for addressing racial health inequities. Policies need to address problems in pathways to medical education, including failures to recruit, nurture, and retain URiM students.

Mining the Sun: Coal-to-solar transitions and energetic place-making in Appalachia

A striking effort is under way to use energy investment, a key feature of US federal climate policy, to build solar farms on former mining lands and in legacy mining communities in central Appalachia. Focusing on community solar initiatives, we consider the geosociality of energy transitions from the perspective of communities where many people have considerable knowledge of energy systems and how they work. We note that the politics of place-making in the context of environmental sacrifice and capital abandonment enables negotiations around energy that often seek to bridge deep social contradictions. We highlight how solar energy’s diffuse networks of power, both social and electrical, privilege forms of temporal labor that are alliance-building, compositionist, para-ethnographic and intimately concerned with the capacity to build relations. Vernacular energy expertise can play a major role in creating novel forms of political sociality. In West Virginia, this both builds on and significantly shifts the emphasis of long legacies of energetic place-making. We expect the ongoing development of community-led solar investment to contribute to substantially important diversifying effects in West Virginian communities, especially when these efforts can more explicitly address the state’s extreme geographical, race, and class-based inequalities.

Research on Social Stratification in Brazil

ABSTRACTBrazil, as the most unequal and populous country in Latin America, demands a closer examination of its patterns and trends of social stratification. With an emphasis on recent contributions, the paper reviews the literature on four major areas of stratification research: race relations and inequality, educational stratification, intergenerational mobility, and income inequality. The literature on racial stratification focuses on the following subjects: racial classification, discrimination, marital selectivity, educational stratification, and intergenerational mobility. In addition, educational stratification literature concerning trends and patterns is reviewed with special attention to studies advanced by sociologists of social stratification. Intergenerational mobility studies are also presented and discussed. Finally, studies on income and wealth inequality are reviewed. In all these areas the contribution of sociologists is highlighted, and trends and patterns of stratification are presented.

Highly Sensitized Kidney Transplant Outcomes After the 2014 Kidney Allocation System Change.

Introduction: Kidney Allocation System (KAS) was implemented by United Network for Organ Sharing in 2014 to reduce allocation disparities. Research Questions: Outcomes of highly sensitized patients (calculated panel reactive antibody (cPRA) ≥ 97%) before and after KAS were compared to low-risk recipients (cPRA <10%) in the post-KAS era were examined. The impact on racial disparities was determined. Design: This was a retrospective study of national registry data. Two cohorts of adult candidates waitlisted for deceased donor transplantation during 3-year periods before and after KAS were identified. Results: Highly sensitized patients (N = 1238 and 4687) received a deceased donor kidney transplant between January 1, 2011 and December 31, 2013 and between January 1, 2015 and December, 31, 2017. Racial disparity for highly sensitized patients improved, yet remained significant (P < 0.001), with Black patients comprising 40% and 41% of the highly sensitized candidates and 28% and 34% of the recipients pre- and post-KAS. While posttransplant death-censored graft failure for highly sensitized recipients was similar overall, post-KAS was associated with improved graft survival in the first year after transplant (HR 0.56, 95% CI 0.40-0.78). When compared to contemporaneous lowrisk recipients, both death-censored and all-cause graft failure were similar for highly sensitized recipients and was associated with increased risk for death-censored graft failure beyond the first year (HR 1.39, 95% CI 1.11-1.73). Conclusion: The allocation system led to an increase in transplantation in highly sensitized candidates without compromising outcomes. Although KAS has led to more balanced transplant rates between highly sensitized Black and White patients, racial inequalities persist.

Confronting the Legacy of Eugenics and Ableism: Towards Anti-Ableist Bioscience Education.

Society and education are inherently ableist. Disabled people are routinely excluded from education, or have poorer outcomes within educational systems. Improving educational experiences and outcomes for people of color has required educators to design antiracist curricula that explicitly address racial inequality. Here, we explore parallel antiableist approaches to bioscience education in an essay coauthored by a disabled bioscience student and able-bodied faculty member in bioscience. Our work is underpinned by Critical Disability Theory and draws on disability and pedagogical scholarship as well as our own experiences. The biosciences has a unique need to confront its history in the discredited pseudoscience of eugenics, which has led to discrimination and human rights abuses against disabled people. We provide a brief history of the relationship between biological sciences research and eugenics and explore how this legacy impacts bioscience education today. We then present a recommended structure for antiableist biology education. Our approach goes beyond providing disability access, to a model that educates all students about disability issues and empowers them to challenge ableist narratives and practices.

Neighborhood environments underpin screen time intervention success in children: Evidence from a study of greenspace and community programming across 130 US communities

The goal of this study was to understand how neighborhood greenspace access may support or hinder the effectiveness of community programs and policies (CPPs) aimed at reducing racial and ethnic inequities in screen time among 4598 US children. We found higher CPP intensity was significantly associated with fewer screen time behaviors in high greenspace neighborhoods, but not neighborhoods with low or moderate greenspace. Moreover, there were significant differences in greenspace access by neighborhood-level race and ethnicity. Implementing CPPs without regard for racial and ethnic greenspace inequities may be an underlying cause in the perpetuation of inequities in childhood screen time.

Group Conflict, Racial Inequality, and Stratification

Group Conflict, Racial Inequality, and Stratification

Advancing culturally responsive-sustaining computer science through K-12 teacher professional development strategies

To address racial and gender inequality in K-12 computer science (CS) education, there needs to be a multi-pronged approach. In addition to curricula that are culturally responsive and sustaining inclusive, K-12 CS teachers need to be equipped to implement the curriculum, pedagogy, and instruction to mitigate the racial and gender gaps in classrooms. Key results showed significant improvements in teachers’ confidence in carrying out culturally responsive-sustaining practices upon the completion of PD to improve teachers’ pedagogy within K-12 classrooms. A three-month follow-up showed that teachers integrated the CRCS practices to different degrees. Furthermore, examples of how the framework was integrated are shared. The PD and associated findings were made available as proposed scalable and replicable models for in-service CS teacher PD across the nation.

Расовое профилирование в Японии: всегда чужой

Racial inequality and discriminatory practices continue to disrupt the lives of millions of people and limit their opportunities, significantly reducing their quality of life. Despite the adopted international and national documents, the issue is far from resolved. Racial profiling has long been under international scrutiny and is a major concern. This is a special type of discrimination that flourishes in developed countries, in which law enforcement agencies are directly involved. The police practice of racial profiling, in which people are targeted or criminalized based on factors such as nationality, skin color or ethnic origin rather than objective evidence or illegal behavior, has become a persistent problem in Japan. Japan is an ethnically homogeneous state, so the situation with racial profiling is particularly acute, but Japanese authorities in the vast majority of cases ignore or hush up this problem, giving the green light to the further development of ethnic discrimination and creating a negative attitude towards foreigners in Japanese society.

Medical Mistrust Among Black Patients with Serious Illness: A Mixed Methods Study.

Medical mistrust among Black patients has been used to explain the existence of well-documented racial inequities at the end of life that negatively impact this group. However, there are few studies that describe patient perspectives around the impact of racism and discriminatory experiences on mistrust within the context of serious illness. To better characterize experiences of racism and discrimination among patients with serious illness and its association with medical mistrust. Seventy-two Black participants with serious illness hospitalized at an academic county hospital. This is a convergent mixed methods study using data from participant-completed surveys and existing semi-structured interviews eliciting participants' perspectives around their experiences with medical racism, communication, and decision-making. The experience of medical racism and its association with Group-Based Medical Mistrust (GBMM) scale scores, a validated measure of medical mistrust. Of the 72 Black participants, 35% participated in interviews. Participants were mostly men who had significant socioeconomic disadvantage, including low levels of wealth, income, and educational attainment. There were reported high levels of race-based mistrust in the overall GBMM scale score (mean [SD], 36.6 [9.9]), as well as high scores within the suspicion (14.2 [5.0]), group disparities in healthcare (9.9 [2.8]), and lack of support (9.1 [2.7]) subscales. Three qualitative themes aligned with the GBMM subscales. Participants expressed skepticism of healthcare workers (HCWs) and modern medicine, recounted personal experiences of discrimination in the medical setting, and were frustrated with poor communication from HCWs. This study found high levels of mistrust among Black patients with serious illness. Suspicion of HCWs, disparities in healthcare by race, and a lack of support from HCWs were overarching themes that influenced medical mistrust. Critical, race-conscious approaches are needed to create strategies and frameworks to improve the trustworthiness of healthcare institutions and workers.

Community-engaged randomised controlled trial to disseminate COVID-19 vaccine-related information and increase uptake among Black individuals in two US cities with rheumatic conditions.

Inequities in COVID-19 infection and vaccine uptake among historically marginalised racial and ethnic groups in the USA persist. Individuals with rheumatic conditions, especially those who are immunocompromised, are especially vulnerable to severe infection, with significant racialised inequities in infection outcomes and in vaccine uptake. Structural racism, historical injustices and misinformation engender racial and ethnic inequities in vaccine uptake. The Popular Opinion Lleader (POL) model, a community-based intervention that trains trusted community leaders to disseminate health information to their social network members (eg, friends, family and neighbours), has been shown to reduce stigma and improve care-seeking behaviours. This is a community-based cluster randomised controlled trial led by a team of community and academic partners to compare the efficacy of training POLs with rheumatic or musculoskeletal conditions using a curriculum embedded with a racial justice vs a biomedical framework to increase COVID-19 vaccine uptake and reduce vaccine hesitancy. This trial began recruitment in February 2024 in Boston, Massachusetts and Chicago, Illinois, USA. Eligible POLs are English-speaking adults who identify as Black and/or of African descent, have a diagnosis of a rheumatic or musculoskeletal condition and have received >=1 COVID-19 vaccine after 31 August 2022. POLs will be randomised to a 6-module virtual educational training; the COVID-19 and vaccine-related content will be the same for both groups however the framing for arm 1 will be with a racial justice lens and for arm 2, a biomedical preventative care-focused lens. Following the training, POLs will disseminate the information they learned to 12-16 social network members who have not received the most recent COVID-19 vaccine, over 4 weeks. The trial's primary outcome is social network member COVID-19 vaccine uptake, which will be compared between intervention arms. This trial has ethical approval in the USA. This has been approved by the Mass General Brigham Institutional Review Board (IRB, 2023P000686), the Northwestern University IRB (STU00219053), the Boston University/Boston Medical Center IRB (H-43857) and the Boston Children's Hospital IRB (P00045404). Results will be published in a publicly accessible peer-reviewed journal. NCT05822219.

Community level factors and racial inequities in delivery hospitalizations involving severe maternal morbidity in the United States, 2016–2019

The objective of this study was to evaluate the racial and ethnic disparities in delivery hospitalizations involving severe maternal morbidity (SMM) by location of residence and community income. We used the 2016 to 2019 Healthcare Cost and Utilization Project National Inpatient Sample. International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations with SMM. Using logistic regression models, we examined the association between race and ethnicity and delivery hospitalizations involving SMM. In adjusted analyses, the models were stratified by location of residence and community income and adjusted for patient and hospital characteristics. In rural areas, non-Hispanic Black women (AOR 1.50; 95% CI 1.25–1.79) and women of other races (AOR 1.32; 95% CI 1.03–1.69) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. In micropolitan areas, non-Hispanic Black women (AOR 1.88; 95% CI 1.79–1.97), non-Hispanic Asian/Pacific Islander women (AOR 1.54; 95% CI 1.16–2.05), and women of other races (AOR 1.31; 95% CI 1.03–1.67) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. Non-Hispanic Black women also had increased odds of experiencing a delivery hospitalization involving SMM in communities with the lowest income (quartile 1) (AOR 1.59; 95% CI 1.49–1.66), middle income (quartiles 2 and 3) (AOR 1.81; 95% CI 1.72–1.91), and highest income (AOR 2.09; 95% CI 1.90–2.29) when compared to non-Hispanic White women. We found that location of residence and community income are associated with racial and ethnic differences in SMM in the United States. These factors, outside of individual factors assessed in previous studies, provide a better understanding of some of the structural and systemic factors that may contribute to SMM.

Discrimination and Racial Inequities in Self-reported Mental Health Among Immigrants and Canadian-Born Individuals in a Large, Nationally Representative Canadian Survey.

We examined the link between discrimination and self-rated mental health (SRMH) among immigrants and Canadian-born individuals, stratified according to an individual's identification as racialized or white. Using data from Canada's General Social Survey (2014) (weighted N = 27,575,000) with a novel oversample of immigrants, we estimated the association of perceived discrimination with SRMH separately among immigrants and Canadian-born individuals and stratified by racialized status. Among immigrants, we also investigated whether age-at-arrival attenuated or strengthened associations. The prevalence of discrimination was higher among racialized compared to white immigrants (18.9% versus 11.8%), and among racialized compared to white non-immigrants (20.0% versus 10.5%). In the adjusted model with immigrants, where white immigrants not reporting discrimination were the referent group, both white (adjusted prevalence odds ratio [aPOR] 6.11, 95% confidence interval [CI] 3.08, 12.12) and racialized immigrants (aPOR 2.28, 95% CI 1.29, 4.04) who experienced discrimination reported poorer SRMH. The associations were weaker among immigrants who immigrated in adulthood. In the adjusted model with non-immigrants, compared to unexposed white respondents, Canadian-born white respondents who experienced discrimination reported poorer SRMH (aPOR 3.62, 95% CI 2.99, 4.40) while no statistically significant association was detected among racialized respondents (aPOR 2.24, 95% CI 0.90, 5.58). Racialized respondents experienced significant levels of discrimination compared to white respondents irrespective of immigrant status. Discrimination was associated with poor SRMH among all immigrants, with some evidence of a stronger association for white immigrants and immigrants who migrated at a younger age. For Canadian-born individuals, discrimination was associated with poor SRMH among white respondents only.

Desigualdades raciais para além do paradigma

The so-called “paradigm of racial inequalities”, inaugurated by Carlos Hasenbalg, answered decisive questions about the permanence of disparities between blacks and whites in Brazil and guided new agendas, research designs and forms of analysis of racial inequalities. This article builds some critical notes on the way in which racial inequalities are thematized based on this paradigm, especially the focus on the market as a sphere of observation, and points out the potential for retaking this research object by the contemporary sociology of racial relations, renewed by perspective of intersectionalities and the emergence of new themes.

Sociologia histórica e interpretação do racismo no Brasil

This article examines the contributions of so-called historical or processual sociology to the analysis of racism in Brazil, based on four central concepts: revolution, reproduction, formation and event. The central argument is that the processual analysis of events, in the different approaches selected, offers some alternatives for tackling the main obstacle faced in the field of the sociology of racism: jointly explaining the formation of racial inequalities and their social production in the interaction and sociability between agents. It is suggested that the specific objective of historical sociology in this field of research is the racialization of the social experience of time, that is, the constitution of racialized temporalities.