An Antiracist Framework for Racial and Ethnic Health Disparities Research

Striking racial and ethnic disparities in childhood health conditions, such as prematurity, obesity, and asthma, have persisted despite decades of research focused on reducing these disparities. Although major advances in the treatment of chronic health conditions are difficult to achieve, an understanding of the underlying biology of disease has led to breakthroughs in the treatment of common childhood diseases such as asthma. It is notable, however, that despite the successes of biology-focused research, racial and ethnic disparities persist across many pediatric health conditions, suggesting that an exclusive focus on biology is a failed strategy for reducing these disparities. To make meaningful progress in improving minority health and disparities, the biomedical framework of health sciences must be recast so that it explicitly incorporates social context,¹ which includes factors such as socioeconomic status, environmental exposures, access to high quality health care, and racism. Because the pediatric field has long understood that contextual factors have profound effects on health, it is best positioned to lead this recasting of health disparities research.

Much health disparities research has been misguided in its framing of race and ethnicity as biological concepts, when socioeconomic and other contextual factors dwarf potential effects of innate biology.^2–4 We have relied on a framework of biomedical research that tends to be uninterested in context and, instead, obsessed with using the latest technology to measure more easily quantifiable biological characteristics, which may not underpin differences in the expression of disease among populations. In addition, observed associations between biological measures and disease among racial or ethnic minority …

Address correspondence to Elizabeth C. Matsui, MD, MHS, Departments of Population Health and Pediatrics, Dell Medical School, The University of Texas at Austin, 1701 Trinity St, Austin, TX 78712. E-mail: ematsui{at}utexas.edu