Introduction

Structural racism refers to the public and private policies, institutional practices, norms, and cultural representations that inherently create unequal freedom, opportunity, value, resources, advantage, restrictions, constraints, or disadvantage for individuals and populations according to their race and ethnicity both across the life course and between generations. Developing a research agenda on structural racism includes consideration of the historical and contemporary policies and other structural factors that explicitly or implicitly affect the health and well-being of individuals, families, and communities, as well as strategies to measure those factors.

The Committee on Population of the National Academies of Sciences, Engineering, and Medicine convened a two-day public workshop on May 16–17, 2022, to identify and discuss the mechanisms through which structural racism operates, with a particular emphasis on health and well-being; to develop an agenda for future research and data collection on structural racism; and to strengthen the evidence base for policy making (see Box I-1 for the workshop’s statement of task and Appendix A for the workshop agenda). The workshop was sponsored by the National Institute on Aging (NIA) and an interdisciplinary steering committee was appointed by the National Academies to plan the structure and content. Invited speakers included investigators from relevant studies, population health researchers, and experts across disciplines with innovative methodologies. Speaker presentations and workshop discussions provided insights into known sources of structural racism and rigorous models of health inequity, revealed novel sources and approaches informed by other disciplines as well

as related fields, and highlighted key research and data priorities for future work on structural racism and health inequity.

FOUNDATION OF THE WORKSHOP

Frank Bandiera (program officer in the Division of Behavioral and Social Research [BSR] at NIA) explained that the first recommendation from the 2019 review of BSR by the National Advisory Council on Aging (NACA) had to do with health disparities. Specifically, the NACA review noted that “the shocking extent of growing SES [socioeconomic status] and regional differences in mortality and life expectancy, as well as persistent racial inequalities, have been documented, and increasing understanding of the sources and approaches to ameliorating these needs [are] to be a major research focus going forward” (National Institute on Aging and National Advisory Council on Aging, 2019, p. 4). The review encouraged researchers to move past the documentation of differences and toward an improved understanding of the sources of the differences and of approaches to ameliorate them.

Bandiera said that as a first step, NIA asked the Committee on Population to host a virtual seminar in May 2020 titled “Persistent and Large

Racial/Ethnic Disparities: Beyond the Role of Socioeconomic Status,”¹ at which several topics were discussed: the role of race and ethnicity in U.S. health disparities; poor health outcomes related to life-course stress from racism, discrimination, and other exposures; and the connection between intergenerational mobility and racial/ethnic disparities, with particular emphasis on immigration. NIA sponsored the Workshop on Structural Racism and Rigorous Models of Social Inequity as a follow-on to the May 2020 seminar, Bandiera explained, with recognition of increasing demand for the following:

1. More rigorous models of social inequity in poor health outcomes to inform policy at the national, state, and local levels;
2. Intersectional research to understand the multidimensional effects of racism on racial/ethnic minority subgroups;
3. Enhanced data infrastructure for developing validated measures of health among racial/ethnic minorities, for implementing effective survey techniques that avoid self-selection bias, for coding historical data to measure racism, and for incorporating longitudinal studies in the analysis of relationships; and
4. Better understanding of the complexity of how racism is expressed.

Hedwig (Hedy) Lee (workshop planning committee chair and professor of sociology at Duke University) pointed out that the term structural racism is now used often in the media, by politicians, and across the population health sciences. She noted that in population health studies there are efforts to measure and model structural racism as a social determinant of health, which continues to expand. Lee reflected on a previous discussion with Kathleen Mullan Harris, professor of sociology at the University of North Carolina at Chapel Hill, about the integration of biological and social information in population health research. Harris cautioned population health scientists to avoid becoming distracted by “new and shiny” data, such as biomarkers, and to avoid producing “simplistic, sound-bite research” that could actually move the field backward.

Lee emphasized that although the study of structural racism might be relatively new for many population health researchers, the concept of structural racism is not—it is foundational in the United States and across the world, as well as the practices of genocide, colonization, and slavery. These practices have been “justified through moral and cultural arguments” that permeate everyday life in ways that are often difficult to observe. Quoting Eduardo Bonilla-Silva (James B. Duke distinguished professor of sociology

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¹https://www.nationalacademies.org/event/05-18-2020/cpop-seminar-seminar-on-persistent-and-large-racial-ethnic-disparities-beyond-the-role-of-socoieconomic-status-ses

at Duke University), Lee noted that racism “is in the air we breathe.” Racism is part of the landscape of the United States—the District of Columbia itself was built by slaves and stolen from Native people. Further, when Thomas Jefferson wrote “all men are created equal,” she continued, Black Americans and Native Americans were excluded.

Lee commented that, given this context, population health researchers cannot overlook insights on structural racism from other disciplines—for example, scholars in the humanities, history, and the social sciences have been documenting structural racism for more than a century. She suggested that population health researchers use these insights to inform the measurement and modeling of structural racism and to create linkages to health across the life course, which will ensure that their work has the potential both to contribute to improved population health and well-being and to reduce disparities.

Lee stressed that no individual scholar, workshop, or discipline can describe, measure, or model structural racism completely. Structural racism research is best approached with collaboration across disciplines. Lee invited speakers and participants to consider the following key question throughout the workshop: how can insights be applied regarding the conceptualization, measurement, and modeling of structural racism to inform decisions about:

1. What new measures of structural racism or data linkages could be used in ongoing or future studies helpful to advance aging research;
2. What mechanisms or data linkages could be used in ongoing or future studies that link structural racism to disparities in health and well-being over time and place; and
3. What study designs could be used to consider how structural factors operate to shape health over the life course?

ORGANIZATION OF THIS PROCEEDINGS

Chapter 1 offers foundational definitions for and discussions of the responsible study of race and structural racism—drawn primarily from the humanities and humanistic social sciences—and highlights the value of understanding the complexity of these concepts and applying them to data collection and analysis in an effort to improve health and well-being and to reduce health disparities. Chapter 2 describes measurement and modeling approaches for the study of structural racism, with specific attention toward the strengths and weaknesses of these approaches for population health and aging research. Chapter 3 summarizes expert insights on data and data infrastructure needs both to measure and model structural racism and to identify and measure the mechanisms that link racism to population

health and well-being over time. Chapter 4 presents key takeaways from the workshop presentations and discussions, with an emphasis on the path forward.

This Proceedings follows the general structure of the workshop and has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. The workshop planning committee’s role was limited to organizing and convening the workshop (see Appendix B for biographical sketches of the workshop discussants and speakers). The views expressed in this proceedings are those of the individual workshop participants and do not necessarily represent the views of the participants as a whole, the planning committee, or the National Academies.

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