Adequacy of Existing Surveillance Systems to Monitor Racism, Social Stigma and COVID Inequities: A Detailed Assessment and Recommendations

Decolonization and antiracism: intersecting pathways to global health equity

In this paper, as Black scholars, we address ways that interventions designed to promote equity in health can create pathways for coupling decolonization with antiracism by drawing on the intersection of the health of Africans and African Americans. To frame this intersection, we offer the Public Health Critical Race Praxis (PHCRP) and the PEN-3 Cultural Model as antiracism and decolonization tools that can jointly advance research on colonization and racism globally. We argue that racism is a global reality; PHCRP, an antiracism framework, and PEN-3, a decolonizing framework, can guide interventions to promote equity for Africans and African Americans.

Integrating Racism as a Sentinel Indicator in Public Health Surveillance and Monitoring Systems

Objectives. To evaluate public health surveillance and monitoring systems' (PHSMS) efforts to collect, monitor, track, and analyze racism. Methods. We employed an environmental scan approach. We defined key questions and data to be collected, conducted a literature review, and synthesized the results by using a qualitative description approach. Results. We identified 125 PHSMS; only 3-the Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment and Monitoring System, and California Health Interview Survey-collected and reported data on individual-level racism. Structural racism was not collected in PHSMS; however, we observed evidence for linkages to census and administrative data sets or social media sources to assess structural racism. Conclusions. There is a paucity of PHSMS that measure individual-level racism, and few systems are linked to structural racism measures. Public Health Implications. Adopting a standard practice of racism surveillance can advance equity-centered public health praxis, inform policy, and foster greater accountability among public health practitioners, researchers, and decision-makers. Failure to explicitly address racism and the insufficient capacity to support a robust health equity data infrastructure severely impedes efforts to address and dismantle systemic racism. (Am J Public Health. 2023;113(S1):S80-S84. https://doi.org/10.2105/AJPH.2022.307160).

An Equity-Based Scoring System for Evaluating Surveillance-Related Harm in Public Health Crises

Background

Although surveillance systems used to mitigate disasters serve essential public health functions, communities of color have experienced disproportionate harms (eg, criminalization) as a result of historic and enhanced surveillance.

Methods

To address this, we developed and piloted a novel, equity-based scoring system to evaluate surveillance systems regarding their potential and actual risk of adverse effects on communities made vulnerable through increased exposure to policing, detention/incarceration, deportation, and disruption of access to social services or public resources. To develop the scoring system, we reviewed the literature and surveyed an expert panel on surveillance to identify specific harms (eg, increased policing) that occur through surveillance approaches.

Results

Scores were based on type of information collected (individual and/or neighborhood level) and evidence of sharing information with law enforcement. Scores were 0 (no risk of harm identified), 1 (potential for risk), 2 (evidence of risk), and U (data not publicly accessible). To pilot the scoring system, 44 surveillance systems were identified between June 2020 and October 2020 through an environmental scan of systems directly related to COVID-19 (n=21), behavioral and health-related services (n=11), and racism and racism-related factors (n=12). A score of 0-2 was assigned to 91% (n=40) of the systems; 9% were scored U; 30% (n=13) scored a 0. Half scored a 1 (n=22), indicating a "potential for the types of harm of concern in this analysis." "Evidence of harm," a score of 2, was found for 12% (n=5).

Conclusions

The potential for surveillance systems to compromise the health and well-being of racialized and/or vulnerable populations has been understudied. This project developed and piloted a scoring system to accomplish this equity-based imperative. The nobler pursuits of public health to improve the health for all must be reconciled with these potential harms.

Using COVID-19 Surveillance Systems to Identify and Monitor Disparities: Best Practices and Recommendations

Inadequate attention to racial health equity is a common challenge to effective, reliable monitoring and mitigation of COVID-19 disparities. Efforts to monitor and mitigate COVID-19 disparities continue to be hampered by inadequacies in how surveillance systems collect, tabulate, and report COVID-19-related outcomes. We conducted environmental scans of existing public health surveillance systems and reporting standards, literature reviews, focus groups with surveillance experts, and consultations with the Centers for Disease Control and Prevention (CDC) and an expert panel on surveillance to identify and explore strengths, weaknesses, and gaps in how existing systems monitor COVID-19 and their implications for addressing disparities in related outcomes. We present recommendations based on these reviews and propose a core minimum set of health indicators and best-practice standards for reporting these indicators by COVID-19 surveillance systems to monitor racial/ethnic and other disparities in the pandemic. These recommendations are relevant to monitoring disparities in the ongoing COVID-19 pandemic and may inform monitoring of future epidemics. This discussion is part of an effort by Project REFOCUS to develop syndemic surveillance systems for monitoring the intersecting pandemics of COVID-19 and racism.