Racism and Structural Violence: Interconnected Threats to Health Equity

In 2020, the continuing murder of Black Americans by police officers received widespread media attention and sparked global outrage. Public health responses to these events focused on discrimination by police and structural racism in broader society. However, police violence is but one of many forms of racialized violence propagated by structural racism and anti-Black racism in particular. We aim to expand the current public health dialogue by describing how structural racism and structural violence are deeply interrelated; embedded in institutions, systems, and processes; and threaten health, safety, and well-being across the life course for racialized minority groups. Structural racism and structural violence are threats to health equity and anti-racist public health work.

Engaging Community Networks to Improve Depression Services: A Cluster-Randomized Trial of a Community Engagement and Planning Intervention

This paper explores the effects of a group-randomized controlled trial, Community Partners in Care (CPIC), on the development of interagency networks for collaborative depression care improvement between a community engagement and planning (CEP) intervention and a resources for services (RS) intervention that provided the same content solely via technical assistance to individual programs. Both interventions consisted of a diverse set of service agencies, including health, mental health, substance abuse treatment, social services, and community-trusted organizations such as churches and parks and recreation centers. Participants in the community councils for the CEP intervention reflected a range of agency leaders, staff, and other stakeholders. Network analysis of partnerships among agencies in the CEP versus RS condition, and qualitative analysis of perspectives on interagency network changes from multiple sources, suggested that agencies in the CEP intervention exhibited greater growth in partnership capacity among themselves than did RS agencies. CEP participants also viewed the coalition development intervention both as promoting collaboration in depression services and as a meaningful community capacity building activity. These descriptive results help to identify plausible mechanisms of action for the CPIC interventions and can be used to guide development of future community engagement interventions and evaluations in under-resourced communities.

Racial and Citizenship Disparities in Health Care Among Middle Eastern Americans

OBJECTIVE

To assess differences in health access and utilization among Middle Eastern American adults by White racial identity and citizenship.

METHODS

Data from the 2011 to 2018 National Health Interview Surveys (N=1013) and survey-weighted logistic regression analyses compare Middle Eastern immigrants by race and citizenship on access and utilization of health care in the United States.

RESULTS

White respondents had 71% lower odds of delaying care [adjusted odds ratio (AOR)=0.34; 95% confidence interval (CI)=0.13, 0.71] and 84% lower odds of being rejected by a doctor as a new patient (AOR=0.16; 95% CI=0.03, 0.88) compared to non-White respondents. US citizens had higher odds of visiting the doctor in the past 12 months compared with noncitizens (AOR=1.76; 95% CI=1.25, 2.76).

CONCLUSION

Middle Eastern immigrants who do not identify as White and who are not US citizens are significantly less likely to access and utilize health care compared with those who identify as White and are US citizens.

POLICY IMPLICATIONS

This study shows that racial and citizenship disparities persist among Middle Eastern Americans at a national-level, playing a critical role in access to and use of health care.

Whole Person Care in Under-resourced Communities: Stakeholder Priorities at Long-Term Follow-Up in Community Partners in Care

Objective

Depressed individuals may require help from different agencies to address health and social needs, but how such coordination occurs in under-resourced communities is poorly understood. This study sought to identify priorities of Latino and African American depressed clients, explore whether service providers understand client priorities, and describe how providers address them.

Methods

Between October 2014 and February 2015, we interviewed 104 clients stratified by depression history and 50 representatives of different programs in health and social community agencies who participated in Community Partners in Care, a cluster-randomized trial of coalition-building approaches to delivering depression quality improvement programs. Clients were queried about their most pressing needs; program representatives identified their clients' needs and explained how they addressed them.

Results

Physical and mental health were clients' top priorities, followed by housing, caring for and building relationships with others, and employment. While persistently depressed clients prioritized mental health, those with improved depression prioritized relationships with others. Program representatives identified housing, employment, mental health, and improving relationships with others as clients' top priorities. Needs assessment, client-centered services, and linkages to other agencies were main strategies used to address client needs.

Conclusion

Depressed clients have multiple health and social needs, and program representatives in under-resourced communities understand the complexity of clients' needs. Agencies rely on needs assessment and referrals to meet their clients' needs, which enhances the importance of agency partnership in "whole person" initiatives. Our results illustrate agency capacity to adopt integrated care models that will address clients' multiple needs through multi-sector collaboration and describe potential strategies to help reach the goal of whole person care.

Islamophobia, Health, and Public Health: A Systematic Literature Review

BACKGROUND

In 2017, a "Muslim ban" on immigrants to the United States was coupled with a continued rise in Islamophobia and hate crimes toward Muslims. Islamophobia undermines health equity, yet delineating the effects of Islamophobia globally is challenging as it affects a myriad of groups (geographically, racially, and socially). Additionally, stereotypes equate all Muslims with populations from the Middle East and South Asia. To date, health research pays insufficient attention to Islamophobia, Muslims, and those racialized to be Muslim.

OBJECTIVES

This literature review advances our understanding of racism and health by examining the racialization of religion, by specifically examining Islamophobia as a form of discrimination.

SEARCH METHODS

Per PRISMA guidelines, we conducted a search in October 2017 using PubMed-MEDLINE and a combination of terms. We identified additional articles using other search engines. For inclusion, articles needed to include a descriptor of discrimination, contain an identifier of Muslim or Muslim-like identity (i.e., groups commonly perceived as Muslim, including Arabs, Middle Easterners, North Africans, and South Asians), include a health outcome, be in English, and be published between 1990 and 2017.

SELECTION CRITERIA

We identified 111 unique peer-reviewed articles. We excluded articles that did not meet the following criteria: (1) examined Islamophobia, discrimination, or racism among a Muslim or Muslim-like population; (2) included a health outcome or discussion of health disparities; and (3) was conducted in North America, Europe, Australia, or New Zealand. This yielded 53 articles.

RESULTS

The majority of studies (n = 34; 64%) were quantitative. The remaining studies were qualitative (n = 7; 13%), mixed methods (n = 2; 4%), or reviews (n = 10; 19%). Most studies were based in the United States (n = 31; 58%). Nearly half of the reviewed studies examined mental health (n = 24; 45%), and one fourth examined physical health or health behaviors (n = 13; 25%). Others focused on both physical and mental health (n = 10; 19%) or health care seeking (n = 7; 13%). Studies showed associations between Islamophobia and poor mental health, suboptimal health behaviors, and unfavorable health care-seeking behaviors.

CONCLUSIONS

This study elucidates the associations between Islamophobia, health, and socioecological determinants of health. Future studies should examine the intersectional nature of Islamophobia and include validated measures, representative samples, subgroup analyses, and comparison groups. More methodologically rigorous studies of Islamophobia and health are needed. Public Health Implications. Addressing the discrimination-related poor health that Muslims and racialized Muslim-like subgroups experience is central to the goals of health equity and assurance of the fundamental right to health.

Social Determinants of Health, Violent Radicalization, and Terrorism: A Public Health Perspective

Background: Terrorism-related deaths are at an all-time high as there were 32,685 and 29,376 terrorism-related deaths in 2014 and 2015, respectively. Terrorism is defined as the use of violence and intimidation in the pursuit of political aims. Terrorism is detrimental for mental health, premature mortality, and economic losses and undermines the central tenets of public health to improve the health and well-being of populations. Despite the impact terrorism has on avoidable morbidity and mortality, population health research largely overlooks social determinants of terrorism and risk factors that contribute to terrorist activities.

Methods: Drawing from what is known about commonly studied social determinants of health topics, including the relationships between structural and interpersonal discrimination, social cohesion, and gang violence and health, we present a public health framework, rooted in the social determinants of health, for identifying potential factors influencing terrorism and violent radicalization.

Results: Social determinants of health provide unique insight into how interpersonal and structural factors can influence risk for violent radicalization and terrorist activity. Each of the topics we review provides an entry point for existing public health and behavioral science knowledge to be used in preventing and understanding violent radicalization and terrorism. For example, anti-Muslim sentiment has promoted discrimination against Muslims, while also serving to marginalize and stigmatize Muslim communities. These conditions limit the social resources, like social cohesion, that Muslims have access to and make political violence more appealing to some.

Conclusions: Public health can contribute much to the ongoing debate around terrorism. The field must take a more prevention-focused approach to the problem of terrorism. Failure to do so only perpetuates approaches that have not been successful.

Feedback from the Field

Background: Maintaining a healthy weight can reduce risks of excessive weight gain during pregnancy and help prevent maternal and child obesity. Low-income women are high-risk for excessive weight gain during pregnancy. Nutrition counseling can help improve dietary habits, however, it is often provided by paraprofessionals who lack formal training in dietetics. There is a need for a brief dietary assessment form for paraprofessionals serving low-income perinatal women. Purpose: The purpose of this study was to provide feedback on the feasibility of the Perinatal Food Group Recall (PFGR) form among Comprehensive Perinatal Health Workers (CPHWs) serving low-income pregnant and post-partum mothers. Methods: Nine CPHWs at four clinics were asked to complete their regular dietary assessment form and then administer the PFGR. Key informant interviews with the nine paraprofessionals were conducted to obtain their feedback on the form. Results: The findings suggest that the form provides a feasible and easyto-administer dietary assessment tool for use by practitioners without formal dietetics training who serve clinics in low-income communities with heavy client flow. Conclusion: The form can facilitate the provision of nutrition counseling among low-income mothers and build capacity among community health workers.

Black Lives Matter: A Commentary on Racism and Public Health

The recent nonindictments of police officers who killed unarmed Black men have incited popular and scholarly discussions on racial injustices in our legal system, racialized police violence, and police (mis)conduct. What is glaringly absent is a public health perspective in response to these events. We aim to fill this gap and expand the current dialogue beyond these isolated incidents to a broader discussion of racism in America and how it affects the health and well-being of people of color. Our goal is not only to reiterate how salient structural racism is in our society, but how critical antiracist work is to the core goals and values of public health.