Deconstructing Inequities — Transparent Values in Measurement and Analytic Choices

Abstract

In response to these injustices and to spur systemic change across sectors, a growing number of state and local governments have declared racism a public health crisis. 5 These declarations are an important first step in the advancement of racial and health equity-a movement on social, political, and economic fronts that requires expanding the power of groups who are most affected by systemic racism and other structural inequities so that they can organize both people and resources, set agendas, shift narratives, and influence decisions and the people who make them. 6 Another important step, as we in the public health field know, is accurate measurement of progress necessary to hold ourselves collectively accountable and to ensure lasting change. Public Health Critical Race Praxis (PHCRP), an application of critical race theory, provides guiding principles for the examination and analysis of myriad health equity challenges. 7 PHCRP foregrounds race as a social construct and requires explication of how racism, as a display of power over others, shapes and pervades determinants of health and equity. In doing so, PHCRP calls for researchers to reflect on the questions they pose and the disciplinary knowledge they apply. Rather than incorporating only the perspectives of scientists, PHCRP also requires the centering of lived experience. As the movement for racial justice grows, researchers will create or adapt various metrics and methods for capturing the differences in health determinants and outcomes among racial and ethnic groups. Amid the data deluge that may result, PHCRP encourages due consideration of conceptual and methodologic decisions that reflect the norms and values of researchers and how those norms and values are, or are not, made explicit. What may seem like "objective" methodologic choices can have important implications for resource allocation and policy decisions. It is worth highlighting some of these considerations and the ways in which measurement and analytic choices can affect what is being examined and concluded about health and equity. These considerations have certainly been pondered before, but application of them does not appear to be standard practice. We see this failure of widespread uptake as a manifestation of structural racism. The Me aning of He alth Inequities The complex concepts of health equity, inequity, inequality, and disparities have been defined in myriad ways. Although some scholars have asserted that inequities are inequalities deemed to be unnecessary, avoidable, unfair, or unjust, interpretations of fairness, justice, necessity, and social acceptability are value-laden and likely to The New England Journal of Medicine Downloaded from nejm.org on June 17, 2021. For personal use only. No other uses without permission.