NIMHD Seminar Looks at Past for Future of Health Disparities
The historical role of science and scientists in creating and perpetuating racism and racial health inequities was the topic of a recent NIMHD seminar that featured Dr. Consuelo Wilkins, senior vice president and senior associate dean for health equity and inclusive excellence at Vanderbilt University. “Although race is a sociopolitical construct, scientific researchers are still treating it as a biological justification for health inequities,” she said in opening remarks.
Wilkins went on to discuss the continuing pervasiveness of racial and ethnic health disparities and the social and structural determinants that underlie them.
“In the last 20 years, disparities have narrowed very little,” she said, noting how essential it is for researchers not to be “color blind” and to acknowledge race when studying health data. It is important because race does influence health outcomes, not necessarily by biology or genetics, but by differences in life experiences and conditions due to systemic racism.
Wilkins outlined how health leaders can address racial inequities, including reversing unjust practices and policies, making decisions based on diverse perspectives and connecting with frontline health care staff.
Wilkins suggested that early-career scientists not yet enmeshed in old practices are poised to create positive disruption in health disparities research by questioning the status quo.
For example, young scientists were instrumental in the call to remove race as a factor when calculating estimated glomerular filtration rate (eGFR) to diagnose stages of kidney disease, a condition disproportionately affecting people in racial and ethnic minority populations such as African Americans.
Using race, a social construct, as a proxy for genetics, a biological factor, to calculate eGFR does not take into account the genetic diversity within racial and ethnic minority populations or the fact that many individuals identify as multiracial or multiethnic.
The scientific community can also take steps to promote racial equity in research, including improving transparency in clinical research enrollment and addressing exclusionary research practices; making investigators accountable for meeting scientifically valid diversity standards in their test groups, which should reflect the populations most affected by the disease being studied; investing in sustained, reciprocal relationships with communities that have been marginalized; and developing evidence-based guidance to inform inclusive research participation.
Wilkins emphasized the importance of community engagement and incorporating the perspectives of the population being studied.“Researchers usually set out presuming they have to educate the community they are studying, when it is actually the researchers themselves that may lack a meaningful understanding of what makes the community tick,” she said.
Wilkins also discussed the importance of systems-level change in creating and integrating inclusive policies and initiatives to achieve health equity. She described how most health disparities researchers are trained to work at the individual level, studying individual health behaviors and responses to interventions. But the future of health disparities research requires investigators to explore upstream factors. She called on researchers to collaborate across fields and scientific departments to examine the higher-level social, cultural and environmental factors that disparately influence the health of racial and ethnic minority populations.
The lecture was NIMHD’s Black History Month seminar.