June 2022: U of M to study multilevel structural racism on whole person health across the lifecourse
The University of Minnesota is one of two sites awarded NIH funding to study the impact of various levels of discrimination on health outcomes and to develop interventions that will promote health equity
Kate Dodge | Media Relations Manager
MINNEAPOLIS/ST. PAUL (06/20/2022) — The University of Minnesota and the University of Georgia have launched a prospective study to understand how structural racism experienced at the individual, neighborhood, institutional and societal/policy levels affect whole person health. This includes mental, physical, behavioral and social health.
“Prior studies have shown individual level associations between discrimination and negative health outcomes, but less is known about how experiencing multiple levels of structural racism affect whole person health for families and individuals across the lifecourse,” said study principal investigator Jerica Berge, Ph.D., MPH, a professor in the Medical School on the Twin Cities campus. “Findings from this study will allow for developing interventions that can simultaneously intervene at multiple levels of structural racism to promote health equity.”
A lifecourse is a culturally defined sequence of age categories that people are normally expected to pass through as they progress from birth to death.
The study is built on a prospective longitudinal cohort study of 631 racially and ethnically diverse families (i.e., African American/Black, Hispanic, Native American, Immigrant/Refugee and white) that spans the lifecourse, from childhood to adulthood/parenthood in Minneapolis and St. Paul. In Georgia, 300 more families from rural settings will be enrolled to better understand experiences of structural racism in urban and rural settings with diverse families.
Co-investigators in this project include MPC Members Rachel Hardeman, Ph.D., MPH, associate professor in the School of Public Health; Alicia Kunin-Batson, Ph.D., LP, assistant professor in the Medical School; Angie Fertig, Ph.D., research scientist in the Humphrey School of Public Affairs; David Van Riper, M.A., Minnesota Population Center; and University of Georgia faculty Allan Tate, Ph.D., MPH and Grace Bagwell Adams, Ph.D., MPA.
The parent R01 already has three time-points of mixed-methods data (i.e., ecological momentary assessment and Geographic Information System survey), that includes discrimination and neighborhood segregation measures and physical, mental and behavioral health outcomes. In addition, cardiometabolic and stress biomarker data (i.e., heart rate, blood pressure, waist circumference, hair cortisol) and multi-level measures of structural racism (i.e., individual, neighborhood, institutional, societal/policy) will be added at two time points, 18 months apart.
Researcher Bert Chantarat found that structural racism is harming the health of Black babies no matter where they live in Minnesota.
In Minnesota, babies of U.S.-born Black pregnant people suffer twice the rate of low-birth weight and other adverse birth issues as their white counterparts. Minnesota Population Center researchers recently examined the role structural racism plays in harmful birth outcome disparities and found it’s an extensive problem statewide.
Tongtan (Bert) Chantarat led the study published in Health Services Research. The study was co-authored by Rachel Hardeman, associate professor and Blue Cross Endowed Professor of Health and Racial Equity, and director of the Center for Antiracism Research for Health Equity at , and David Van Riper of the Minnesota Population Center.
Prior research has examined racial birth disparities in geographic areas using single-dimensional measures of structural racism, such as housing segregation or income inequity. However, analysis using only a single measure can fail to reveal harmful structural racism or the combined effects of multiple factors in a community.
To account for the various influences, the researchers used an analytical approach they developed called the Multidimensional Measure of Structural Racism (MMSR). The MMSR roots out structural racism by measuring a community’s level of residential segregation, educational inequity, employment inequity, income inequity, homeownership inequity, criminal justice inequity, and how those factors interact.
To understand how structural racism harms pregnant people and their babies, the researchers deployed the MMSR using 2017 demographic data from the American Community Survey, incarceration information from Vera Institute of Justice, and 2018 birth outcomes data for nearly 50,000 babies from the Minnesota Department of Health.
The study found:
- Three distinct patterns of structural racism within Minnesota communities: Type A communities have high education, income, and criminal justice inequities, and moderately high residential segregation and homeownership inequity, but low employment inequity. Type B areas have high education, employment, and homeownership inequities, but moderately high levels of residential segregation, income, and criminal justice inequities. Type C neighborhoods have high income inequity, are moderately high on residential segregation, and employment, homeownership, and criminal justice inequities, but are low on education inequity.
- The risks of preterm birth, low birth weight and small-for-gestational-age instances for U.S.-born Black pregnant Minnesotans were always higher than for their white counterparts regardless of the type of communities in which they lived during pregnancy.
- The risks among U.S.-born Black pregnant people did not vary significantly across the area types.
- When structural racism was viewed in its totality, it had statistically equivalent harms on Black babies no matter where they lived in Minnesota.
“If you look at structural racism from just one angle at a time, you miss the full impact on health,” said Chantarat. “For example, if you only look at income inequality, you might think, ‘Oh, this area in Minnesota has low income inequity, so it must be an OK place for U.S.-born Black pregnant people to live!’ But that just isn’t the case. When you look at the full picture of structural racism, there is no place in Minnesota where the birth outcomes of Black pregnant people are equal to their white peers.”
The authors said the results affirm that structural racism is multidimensional, which means antiracist solutions need to be multidimensional, too, such as implementing policies that raise employment, income, and home-ownership among Black residents. The researchers call on policy makers to take their findings into account as they work to improve the health of Black Minnesotans through systemic reform.
Original version published by the School of Public Health on April 26, 2022 by Charlie Plain.
April 2022: Announcing the New MPC Associate Director
We are excited to announce Dr. Kathryn Grace has been appointed as the next MPC Associate Director. Dr. Grace, a former first generation college student, is an Associate Professor in the Department of Geography, Environment, and Society. Dr. Grace’s education is grounded in theoretical mathematics, biostatistics and (spatial) statistics, providing her a solid quantitative research foundation. Her own experiences as a Medicaid recipient and low-income parent undergird her interests in the health challenges facing low-income women and families in unstable situations. She relies on a range of scientific approaches, including qualitative field work, to center the lived experiences of poor women in research on climate change impacts. As an interdisciplinary scholar with a focus on building collaborative research teams, she has an extensive background in bringing alternative perspectives both to research issues and work environments. Dr. Grace has worked to establish collaborative and interdisciplinary research projects in a number of institutes around the world, including at the Max Planck Institute for Demographic Research in Germany, the Stockholm University Demography Unit, the Institut National d’Etudes Demographiques in France, the Vienna Institute for Demography, and the University of Ouagadougou, Burkina Faso. She has an impressive track record of publishing in domain specific and interdisciplinary journals, including Nature Climate Change, Demography, Population and Development Review, and Proceedings of the National Academies of Sciences. Beginning with leading a NASA Early Career Grant in 2012, she continues to secure external funding, including awards from NIH, NASA, the Gates Foundation, and NSF, as well as international funding organizations. Please welcome Kathryn as she assumes this new leadership role!
February 2022: Measurement of Structural Racism Barnraising
Join us on March 14th and 15th for Improving the Measurement of Structural Racism Barnraising co-hosted by the Minnesota Population Center (MPC) and Center for Antiracism Research for Health Equity (CARHE) Barnraising.
Structural racism is complex and multidimensional, but too often measurements of racism are simplistic and one dimensional. This enables the continued false narrative that race, rather than racism, is the cause of racial inequities. This workshop will bring together researchers and data users from across the country to dynamic conversations on how to create and utilize multidimensional measures of structural racism.
December 2021: Over-policing linked to higher odds of preterm birth
Associate Professor Rachel Hardeman found that U.S.-born Black birthing people living in areas with high police contact experienced a 100% higher chance of preterm birth compared to residents in low-contact areas.
CHARLIE PLAIN | DECEMBER 8, 2021
This article is derived from an original version posted on the School of Public Health’s website. Content was added to highlight the Minnesota Population Center’s contributions to the study.
New research from members of the Minnesota Population Center (MPC) and the University of Minnesota School of Public Health (SPH) links the stress of living in an over-policed neighborhood with higher odds of preterm birth for both Black and white birthing people — but most severely for Black residents. Preterm birth, defined as birth before 37 weeks of gestation, raises the risk of long-term health problems for babies.
The study, led by Rachel Hardeman, MPC Member, associate professor, and director of the SPH Center for Antiracism Research and Health Equity (CARHE), was published in the Journal of the American Medical Association (JAMA) Open Network. Hardeman is a national expert in racial reproductive health disparities, including the role of over-policing in Black birth disparities. The work was co-authored by MPC members and trainee alumni, including Tongtan Chantarat, Morrison Luke Smith, J’Mag Karbeah, and David C. Van Riper as well as Dara D. Mendez from University of Pittsburgh Graduate School of Public Health.
A growing body of research reveals the physiological harms of police encounters, particularly for Black people. This study adds to that research, showing how racist policing practices hurt birthing people and their babies.
“Racism is a fundamental cause of health inequity, which means we have to apply antiracism to institutions that affect the fundamentals of our lives and communities,” said Hardeman. “Our research focused on residents of Minneapolis and found that U.S.-born Black birthing people and their babies were hit the hardest by over-policing, which is a form of structural racism.”
Hardeman’s study team examined medical record data of 745 white, 121 U.S.-born Black, and 193 non–U.S.-born Black Minneapolis residents who gave birth to single babies at a large health system between Jan. 1 and Dec. 31, 2016. The researchers then looked at where the residents lived in Minneapolis and determined if they were in neighborhoods that had high police contact, defined as areas within the highest statistical quarter of police activity in the city.
The research found:
- In high police-contact neighborhoods, all birthing people had higher odds of preterm birth, indicating that the stress of over-policing is harmful regardless of race.
- White birthing people living in high police contact neighborhoods experienced a 90% higher chance of preterm birth compared to residents in low-contact areas.
- U.S.-born Black birthing people in high-contact areas experienced a 100% higher chance of preterm birth compared to residents in low-contact areas.
- Foreign-born Black birthing people in high-contact areas showed only a 10% higher chance for preterm birth. This is explained by what researchers call the “immigrant paradox,” which states that Black immigrants who didn’t grow up weathering structural racism have far better health outcomes than Black individuals who were born and raised in America.
- The researchers also found that Black neighborhoods are disproportionately over-policed compared to white neighborhoods.
“Our results show that over-policing is bad for everyone, but that the burden is not shared equally,” said Hardeman. “The difference between U.S.-born and non-U.S.-born Black birthing people also reveals that racism — and not race — creates health inequities between Black people and their white counterparts.”
If the cause of higher preterm birth rates among U.S. and non-U.S.-born Black birthing people was purely biological due to their race, both groups would have had similar results. Instead, the research shows that non-U.S.–born Black birthing people have far healthier pregnancies and babies than their U.S.-born counterparts, proving that the difference is whether or not they experienced long-term exposure to over-policing structural racism.
“Racism is a fixable problem,” said Hardeman. “Community health needs to be a priority for public safety reform, and the voices and needs of Black, Indigenous, and people of color need to be prioritized.”
Funding for this study was provided from the Institute for Diversity, Equity, and Advocacy at the University of Minnesota. Additional support by the Minnesota Population Center, which is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant No: P2C HD041023). Medical record data was provided by the University of Minnesota’s Best Practices Informatics Consulting Group.
This work benefited from the MPC Short-Term Research Assistant program, which provides the services of a qualified research assistant to MPC members free of charge. One of the co-authors, Morrison Luke Smith, started on the project while serving as the short-term research assistant. Learn more about the program and how to become an MPC member.
About the Center for Antiracist Research for and Health Equity
The SPH Center for Antiracism Research for Health Equity (CARHE), supported by Blue Cross and Blue Shield of Minnesota, uses revolutionary antiracist research techniques to explore how systems, policies, social structures and historical influences create the conditions for health inequities. In its pursuit to address and uproot structural racism’s impact on health and healthcare, CARHE produces antiracist research findings, changes the narrative around race and racism, produces equitable policy solutions, and influences community interventions.