Copyright STAT
The long, drawn out process of science can mean that work is published in a very different world than when it was conceived. That helps to explain how research on the health impact of structural racism that was led by the National Institutes of Health came to be published on Friday, even as the Trump administration has cancelled and challenged the value of such work. The work on the paper, which attempts to quantify the impacts of structural racism on cardiovascular disease across the United States, was started several years ago, when there was a “a real eagerness to engage in this conversation,” said Zachary Dyer, a family medicine physician and a co-author. But now, it is being published in a very different political environment as the Trump administration has attacked work it deems related to “diversity, equity, and inclusion.” Several of the paper’s authors are scientists at the NIH, whose director has in recent months discredited research on structural racism as “ideological” and “unscientific.” Advertisement The paper’s corresponding author could not be reached, because of the ongoing government shutdown. When asked to help facilitate an interview with the authors of the paper, an NIH spokesperson said, “We cannot comment or facilitate interviews due to ongoing litigation.” They declined to specify which cases they were referencing, but a number of lawsuits seeking to reinstate terminated grants related to DEI are working their way through the courts. “This paper was developed during a period when science itself has been under attack in America. Public health agencies have faced budget cuts, political interference, and growing uncertainty about their ability to communicate openly. These conditions have slowed research and delayed the release of work that is critical to understanding and protecting community health,” said Charles Rogers, director of the Men’s Health Inequities Research Lab and another co-author. “The timing is especially troubling. Our study exposes how structural racism harms heart health, yet the very institutions meant to prevent and respond to those harms are being weakened. When science is silenced or delayed, people suffer.” The paper, published in JAMA Health Forum, analyzed neighborhoods by census tracts using a measure of structural racism developed by Dyer that includes factors related to education, employment, housing, and poverty, among others. The researchers found that areas with the highest measure of structural racism had disproportionately elevated rates of high blood pressure, obesity, and diabetes. Advertisement “The people who live in that neighborhood, regardless of their race, are experiencing those outcomes,” said Dyer. “If you are living in a neighborhood that is affected by structural racism, or has the negative effects of structural racism, your health, on average, is more challenging.” Structural racism, which is defined as a system of policies, institutions, and practices that perpetuate racial discrimination, has been difficult for scholars to quantify, because of the bevy of factors that are at play. “We can’t set up a monitor for racism like we would with air pollution,” said Lance Waller, a biostatistician at Emory University who has worked with geographical analyses and was not involved with the paper. Because the index in the paper uses indirect measures of structural racism, there may be better alternatives, said Zinzi Bailey, a social epidemiologist at the University of Minnesota who studies structural racism. “It relies on indirect, proxy measures downstream of racialized policies, strategies, and practices and has been validated against composite measures of primarily socioeconomic disadvantage with minimal consideration of racism,” she said. Outside researchers stressed the importance of this work, at a moment when research on health disparities is under fire. The lack of rigorous measurements to study structural racism are, in part, the result of a historical lack of investment in that work. Creating such measures has become even more difficult now, as federal sources of data have in some cases been taken down or altered. While there may not be a single “perfect paper,” Bailey said, “that does not detract from the need for people to be studying this work and to be putting it out there and for people within our national research infrastructure to be putting this work out. This is extremely important work.” The NIH did not respond to questions regarding the paper’s findings that structural racism “should be considered when developing health equity–oriented, place-based interventions.” Advertisement Papers published by intramural scientists at the NIH are reviewed by the agency before publication. The authors declined to say whether the agency had requested changes to the manuscript. “Being able to work with NIH colleagues and be able to maybe have a little more of the freedom that they don’t have by existing outside of that, I think is a strength of the team of researchers,” Dyer said. “But beyond that, I don’t think I could say much about their perspective.” The authors included an unusual disclaimer at the end of the paper, stating that “the contributions of the NIH authors are considered works of the US government. The findings and conclusions presented in this paper are those of the authors and do not necessarily reflect the views of the NIH or the US Department of Health and Human Services.” Despite the political climate, the authors said they and others will continue this work. “Calling this kind of research ‘unscientific’ or ‘ideological’ ignores both the evidence and the lived experiences of millions of people. The data are clear: Neighborhoods with higher levels of structural racism have worse cardiovascular health. Refusing to study that truth does not make it go away; it only deepens the harm,” Rogers said. “Studying structural racism is not about politics. It is about protecting lives, improving communities, and making sure health equity is more than just a slogan.”
