Aging Fast & Slow

From enduring the consequences of forced displacement and cultural disruption to grappling with inadequate resources and discriminatory policies, Native American communities have faced multifaceted challenges that have deeply impacted their ability to receive equitable and effective healthcare. Join us in this enlightening episode as we engage with Dr. Emily Haozous, a distinguished Research Scientist at the Pacific Institute for Research and Evaluation. Through the lens of her research, Haozous delves into the historical and systemic conditions that have limited healthcare access for these communities, uncovering deeply rooted challenges and disparities. Her pioneering contributions shed light on these critical issues, striving to bridge gaps in understanding and advocating for impactful change within these healthcare systems. References Haozous EA, Trott Jaramillo E, Willging CE. Getting to know: American Indian elder health seeking in an under-funded healthcare system. Qualitative Research in Health. December 2021. Haozous EA, Lee J, Soto C. Urban American Indian and Alaska Native Data Sovereignty: Ethical Issues. American Indian and Alaska Native Mental Health Research. 2021. Jaramillo ET, Haozous EA, Willging CE. The Community as the Unit of Healing: Conceptualizing Social Determinants of Health and Well-Being for Older American Indian Adults. Gerontologist. May 2022.

Structural racism has attracted increasing interest as an explanation for racial disparities in health. But structural racism has often been measured using single-indicator proxies such as housing discrimination. This approach leaves important aspects of structural racism unaccounted for. We kick off season 3 with social epidemiologist and associate professor at the Johns Hopkins Bloomberg School of Public Health, Dr. Lori Dean. Dean is leading the way in exploring new definitions and methods to measure structural racism. Dean discusses her groundbreaking research delving into the influence of individual- and neighborhood-level social and economic factors on health disparities and outcomes for those managing chronic illnesses. Reference Dean, LT, Thorpe RJ. What Structural Racism Is (or Is Not) and How to Measure It: Clarity for Public Health and Medical Researchers. American Journal of Epidemiology. August 2022 

Structural racism is more than private prejudices held by individuals. It is embedded in institutional policies and practices that unfairly minoritize and disadvantage certain groups while advantaging others. Addressing structural racism then requires not only changing individual attitudes, but also identifying and changing those policies and institutions that foster a racial hierarchy. We are joined by trailblazer Dr. Zinzi Bailey, a social epidemiologist and Assistant Professor at the University of Miami Miller School of Medicine and the Sylvester Comprehensive Cancer Center. Drawing upon her extensive experience in quantitative and qualitative methods of assessing social determinants of health inequities, Dr. Bailey discusses how she uses this information to dismantle structural racism. References Adkins-Jackson PB, Chantarat T, Bailey ZD, and Ponce NA. Measuring Structural Racism: A Guide for Epidemiologists and Other Health Researchers. American Journal of Epidemiology. September 2021 Bailey ZD, Feldman JM, Bassett MT. How Structural Racism Works — Racist Policies as a Root Cause of U.S. Racial Health Inequities. The New England Journal of Medicine. February 2021 Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. The Lancet. April 2017

Time may be a social determinant of health that is influenced by racism across the life course. Unfortunately, time as a social resource is often not considered in most studies of health disparities. Dr. Gilbert Gee, Chair of the Department of Community Health Sciences at the Fielding School of Public Health, UCLA, joins us to examine racism through the lens of time, showing us how historically it has been stolen from racial and ethnic minorities. By more deeply considering time, researchers such as Gee are advancing our understanding of racial inequities in health. Join us for this candid, thought-provoking take on history and race that may make you reconsider your understanding of time and health equity. References Gee GC, Ford CL. Structural Racism and Health Inequities, Old Issues, New Directions. April 2011 Gee GC, Hing A, Mohammed S, Tabor DC, Williams DR. Racism and the Life Course: Taking Time Seriously. American Journal of Public Health. January 2019 Gee GC, Hicken MT. Structural Racism: The Rules and Relations of Inequity. Ethnicity and Disease. May 2021

Blacks have the highest infant mortality rate of any racial or ethnic group in the United States. And the disparities are stark. Black pregnant people in the U.S. experience preterm birth at rates approximately 2 times that of White pregnant people and Black infants are twice as likely to die within the first year. In this episode, we are joined by University of Minnesota health equity researchers Drs. Rachel Hardeman and Tongtan (Bert) Chantarat who are working to change that pattern and advance reproductive health equity. By exploring replicable and theoretically sound measures of structural racism, these researchers hope to reveal evidence of its harm to maternal-child health and thereby identify pathways for intervention.   References 1.     Hardeman RR, Homan PA, Chantarat T, Davis BA, Brown TH. Improving The Measurement Of Structural Racism To Achieve Antiracist Health Policy, Health Affairs. February 2022 2.     Chantarat T, Van Riper DC, Hardeman RR, Multidimensional structural racism predicts birth outcomesfor Black and White Minnesotans, Health Services Research. June 2022 3.     Multidimensional Measurement of Structural Racism: Learnings from an Interview with Dr. Tongtan (Bert) Chantarat, Evidence for Action Blog. August 2022 4.     Hardeman RR, Chantarat T, Smith ML, et al. Association of Residence in High–Police Contact Neighborhoods With Preterm Birth Among Black and White Individuals in Minneapolis, JAMA Network Open. December 2021

Structural racism is a core cause of health inequities. Providing evidence of that relationship requires a reliable method to measure structural racism. Frequently, measurements of racism are too simplistic and feed the false narrative that race, rather than racism, is the cause of racial health inequities. In this episode, Dr. Roland J. Thorpe, Jr., a gerontologist and social epidemiologist at the Johns Hopkins Bloomberg School of Public Health, joins podcast hosts Drs. Szanton and Crews to discuss a framework for assessing structural racial discrimination across contexts, geography, and the life course with the aim of dismantling structural racism and advancing health equity. References: Thorpe RJ, Szanton SL, LaFave SE. Structural Racial Discrimination and Structural Resilience: Measurement Precedes Change. The Journals of Gerontology. February 2022 LaFave SE, Bandeen-Roche K, Gee G, Thorpe RJ, Li Q, Crews D, Samuel L, Cooke A, Hladek M, Szanton SL. Quantifying Older Black Americans’ Exposure to Structural Racial Discrimination: How Can We Measure the Water In Which We Swim? Journal of Urban Health. April 2022 Dean LT, Thorpe RJ. What Structural Racism Is (or Is Not) and How to Measure It: Clarity for Public Health and Medical Researchers. American Journal of Epidemiology. September 2022