Psychology Researchers Call for Changes to Better Address Racial Health Disparities
A group of psychology researchers is calling on the field of psychological science to change the way it approaches research related to health and racial health disparities. Specifically, the researchers are proposing a shift in how psychology research approaches race and racism, in order to address the fact that Black people in the United States face far worse health outcomes than White people.
The proposal is the subject of a new paper published in the journal Translational Issues in Psychological Science. The paper, “Bringing Psychological Science to Bear on Racial Health Disparities: The Promise of Centering Black Health Through a Critical Race Framework,” was authored by Vanessa Volpe, an assistant professor of psychology at NC State; Danyelle Dawson at the University of Illinois, Urbana-Champaign; Danny Rahal at the University of California, Los Angeles; Keadija Wiley at the University of North Carolina at Greensboro; and Sianneh Vesslee at Ursinus College.
We recently had the opportunity to talk with Volpe about the impetus for the proposal, how it could work, and why it’s important.
The Abstract: I know that a lot of studies show there are significant racial health disparities between Black and White people in the U.S. Can you give me a couple of examples?
Vanessa Volpe: According to the most recent data report released by the Center for Disease Control’s Office of Minority Health and Health Equity, we see some of the strongest disparities between Black and White health in the United States in cardiovascular health and maternal and child health. Rates of premature death from stroke and coronary heart disease are significantly higher among Black people compared to White people. The infant mortality rate for Black women is more than double that for White women and although the preterm birth rate for Black infants has declined, it is still approximately 60% higher. Other government agencies also have accessible ways to explore statistics on racial health disparities – including an easy-to-use health disparities widget produced by Healthy People 2020 and HDPulse, a source of data which includes interactive maps and each state’s “report card” on disparities produced by the National Institute of Minority Health and Health Disparities.
In North Carolina, mirroring the rest of the nation, Black individuals have higher rates of premature death and a higher age-adjusted mortality rate than White individuals. A lot of people tend to think that these types of racial disparities are due to differences in socioeconomic resources. However, research doesn’t find that to be the case. Certainly such resources matter, but when they are accounted for statistically, they don’t remove evidence of a disparity.
TA: Psychologists aren’t medical doctors. So, what does this have to do with psychology?
Volpe: The link between physical and mental well-being is well established. Broadly, psychology is concerned with human beings’ individual and social thoughts, feelings and behaviors in various environmental contexts. We often think about medicine as being concerned with the parts and functions of human beings’ physical bodies when they get sick. But this artificial “mind” (psychology) and “body” (medicine) split has been delegitimized since the World Health Organization expanded the definition of health substantially in 1948 to “a state of complete physical, mental and social well-being and note merely the absence of disease or infirmity.” The ways in which our bodies react physiologically (medicine) are shaped by the way we interpret and react to our subjective experiences (psychology), and vice versa.
Psychologists have the understanding of cognition, memory, coping, decision-making, social influence, intergroup relations, etc. that is necessary to understand and reduce racial health disparities. For example, stress is both a psychological and physical phenomena. You feel stress in your body – your heart might beat faster, you might start sweating – why? Because you have interpreted something in your environment as challenging or threatening. That interpretation is psychological. Psychology explains the social, cognitive and emotional processes by which our bodies react. And the ways in which our bodies react, in both the short-term and long-term and in adaptive and maladaptive ways, dictate our health. By combining psychology’s understanding of stress with psychology’s understanding of intergroup relations – the ways in which social groups compete for resources, weaponize language to dehumanize others and maintain superiority, and justify discrimination – you have a vast foundation from which to understand the causes, mechanisms, consequences and solutions to racial health disparities in the United States.
TA: In this new paper, you and your co-authors argue that psychology research on this subject has been hampered by its “ahistorical, acontextual, risk-based, and individual approach.” What does that mean?
Volpe: An ahistorical approach to understanding racial health disparities means that we have not acknowledged the sociopolitical history of race in the United States explicitly in our work. But it’s impossible to eliminate racial health disparities if we cannot agree and explicitly state in each of our papers that race is a historical construct that has a certain meaning and history in America.
This is tied to the importance of contextualizing our research – once we understand and explicitly note the history of the construct of race, we need to move beyond that step to acknowledge its sociopolitical purpose. When the history of race as a social construct in America is fully understood, we will see that the construct has had and still has a purpose – race was created in order to gain power and resources for White people. This is not equitable, of course, but must be acknowledged if we are to dismantle that purpose and achieve health equity. We can’t fight against something we refuse to fully admit. Race is the child of racism, not the parent.
When we say that research has been hampered by a risk-based approach, we mean that research has failed to acknowledge the ways in which Black individuals and communities thrive and has refused to invest in putting resources and power in the hands of Black individuals and communities to heal. Instead, in trying to “help,” psychology has created a narrative of Black individuals and communities as helpless, uneducated, unhealthy and powerless. In this way, the research, interventions, and programming that seemingly aim to “help” Black individuals and communities continues to be owned, operated and governed by White people in power.
Finally, the individual-level-only approach means that psychology, because of its focus on people and social groups, tends to see individuals themselves as the intervention point. Supporting individuals exposed to racism is an important initiative, but it is a Band-Aid and needs to be acknowledged as such. Racial health disparities are created because of racism. Racism is a White creation and a White problem and it has tangible benefits for White people. If I frame the problem as racism, a system of White power, then I can better understand how the individual person who is suffering the consequences of that system downstream may be affected and my approach becomes necessarily more system-level. As a field, we do not want to be in the business of blaming Black people for their inability to be healthy when embedded in a hostile system of dehumanization and violence. That blame misattributes the problem and directs attention away from solving it.
TA: The paper says that those approaches have limited psychology’s ability to reduce racial health disparities. Is it the role of research to reduce disparities, or is it the role of research to better understand disparities so that interventions can be developed to address the problem?
Volpe: I see the role of research as both. Research has generally been seen as a way to better understand phenomena, and scientists often write about the implications of their work for practice, policy and intervention in their papers. Often, the actual problem-solving and implementation may be an oversight in more basic psychological science research or earlier in psychologists’ careers because of the ways in which numbers of publications and grants are rewarded.
However, in my view, growing numbers of psychologists acknowledge the importance of research in which putting something into action is a component (e.g., community-based participatory research, action research, citizen science models). In this way, research has taken on a more expansive definition, and one which allows psychologists to reduce health disparities through research. I would argue that it is the responsibility of psychologists to be engaged in work that can be put into practice, even though it often takes more time and involvement from stakeholders from multiple sectors. The world is grappling with so many challenges that psychologists can help solve, but psychological knowledge that has no translational potential wastes resources and keeps valuable information sequestered behind paywalls.
TA: You and your co-authors urge the adoption of a Critical Race Theory framework for future psychology research efforts. What is Critical Race Theory, and what is a Critical Race Theory framework?
Volpe: Critical Race Theory (CRT) was developed in the 1980s in American law schools as a framework for understanding how racism is rooted in the systems of America, with a focus on power relations. Broadly, a CRT framework in psychological science would entail understanding racial health disparities as a downstream impact of racism, which is a system of power which is institutional in nature and pervades all aspects of society, including law, employment, housing, education, etc. Instead of focusing on individuals as racist, CRT argues for a shift of focus to the systems of America itself as fundamentally racist. CRT is concerned with not only placing the primacy of emphasis on racism but also suggesting that through illuminating this emphasis the goal is to restructure power and achieve liberation.
TA: How could this be incorporated into research efforts? And how would this improve outcomes?
Volpe: In the paper we outline three overarching ways that psychological science can improve, one of which focuses on how CRT can guide research efforts. A clear example to follow is Public Health Critical Race Praxis, which is a public health research process proposed by Chandra Ford and Collins Airhihenbuwa, which incorporates CRT tenets. This leads the researcher through the steps of the research process from start to finish, with an emphasis on power and racism as the upstream target for racial health disparities. Research on racial health disparities and/or on health, conducted with members of marginalized racial/ethnic groups in the United States, should be familiar with this approach. Additional recommendations that flow from CRT include making sure that variables that highlight racism at the larger societal, system and community levels are included in research studies, explicitly defining the sociopolitical context of the study and racism, and considering intersectionality of identities and social positions directly in research design. Beyond research endeavors, whether it be in practice or policy, psychological science should invest in community capacity-building initiatives, utilize counterstorytelling approaches, and work to actively keep power within Black communities. Counterstorytelling approaches are methods, programs and opportunities that prioritize the lived experiences and stories of Black individuals and communities that counter stereotypes about Black people. Psychological science’s role should be to help Black individuals and communities maintain or regain power over their own resources and narratives.
TA: Are there any potential drawbacks to adopting this approach?
Volpe: Adopting this approach will by no means be easy, but I can’t imagine any drawbacks.
TA: Are you aware of any research efforts that have already taken this approach?
Volpe: Public health researchers have taken steps to restructure the way they think about racial health disparities (see the Public Health Critical Race Praxis mentioned above), and the medical establishment is becoming increasingly concerned with understanding racism at larger levels beyond the individual, as is clear from the recent Ethnicity and Disease and NIMHD call for papers that help define structural racism and its implications for health. Psychological science has been slower to catch up, but increased acceptance of community-based participatory research efforts has been valuable. And more tangible resources for critical and community-based research, via the patient-centered outcomes research institute and translational sciences institutes, are helping to shape new possibilities for this work.
TA: What are the next steps, as you see them, in terms of how to incorporate CRT into this field?
Volpe: In line with recognizing that racism is not solely an individual-level phenomena, we must also recognize that incorporating CRT into psychological science will take efforts not just from individual researchers but from funding agencies, editorial boards of scholarly journals and employment/tenure structures. These efforts will require institutional policies that allow psychological scientists to work actionably and collaboratively with partners in multiple disciplines.