New York vaccination rates study proves validity of new tool for measuring structural racism

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The structural racist beliefs, policies and behaviors that favor whites over people of color and American Indians are a deeply pervasive problem in our society, but previously very difficult to measure. Recently, researchers at the University of Minnesota School of Public Health successfully tested a new method of measuring structural racism as a multidimensional determinant of health, the Multidimensional Measure of Structural Racism (MMSR). Using COVID-19 vaccination rates among New York City communities as a case study, they found that using a multidimensional method gives more insight into the root cause of health inequalities than using multiple one-dimensional measures.

Progress towards racial and health equity cannot be made if academics and policymakers cannot measure the causes of inequalities, understand their deleterious effects and track changes over time, explains doctoral student Bert Chantarat. The MMSR helps researchers do this.

Led by Chantarat, Rachel Hardeman, Blue Cross Endowed Professor of Health and Racial Equity and Director of the SPHCenter for Antiracism Research for Health Equity, and David Van Riper of the Minnesota Population Center, the study was recently published in the LancetsEClinicalMedicine.

Most methods of measuring structural racism focus on a single dimension of structural racism, such as education, employment or involvement in criminal justice. The MMSR tool created by Chantarat, Van Riper and Hardeman measures five aspects of structural racism as well as Black-White residential segregation, inequalities in education, employment, income and home ownership to create profiles of the area or group measured.

The idea is that if you examine health inequalities through the multidimensional classes of structural racism, you will always see their connection, Chantrat says. However, if you selectively examine inequalities by a specific form of structural racism, you cannot do so because the one-dimensional measures you use cannot capture how various forms of structural racism reinforce each other to cause bad. health.

Researchers used the MMSR to analyze vaccination completion rates in New York City areas during the first phase (December 2020 to February 2021) of the effort when health officials carefully narrowed down who could receive vaccines based on their health and job, not where they lived. Chantarat and his colleagues separated New York City neighborhoods into three classes based on MMSR measurements:

Class A: Racial segregation with high racial inequalities in education, employment, home ownership and income. Class B: Racial diversity with low inequalities in education, employment and home ownership; moderate income inequality between black and white residents. Class C: moderately segregated with less inequality in home ownership and income; higher inequalities in education and employment than in class A.

When the researchers compared the numbers, they found that people living in class A neighborhoods had significantly higher rates of completing the two-dose vaccination protocol compared to people living in class B and C neighborhoods. When researchers analyzed immunization data only across individual dimensions of structural racism, they found that differences in completion rates were only seen between areas with income inequality between blacks and blacks. White was high and low.

The researchers say that in the common scientific practice of first identifying racial inequalities and then dissecting the root causes of those inequalities, the use of one-dimensional measures can potentially lead researchers to inaccurate conclusions that there is no is no inequalities and deter them from trying to investigate the damaging effects of structural racism working below the surface.

Next, the researchers plan to use the MMSR to investigate persistent health inequalities in Minnesota. They hope to understand how various dimensions of structural racism interact to cause ill health for people of color and Native Americans, and that this new idea will lead to the design of effective policy interventions. They will also collaborate with researchers from across the United States to apply this new method to understand patterns of health inequity in other areas.

The development of the MMSR was made possible by early investments from the Minnesota Population Center and a recent grant from the Robert J. Jones Urban Research and Outreach-Engagement Center.

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