Excerpts

Public Health Challenges in Vulnerable Communities  

"The author (CW) has illustrated that public housing communities can suffer from immense and unique public health challenges – environmental racism, deteriorating housing quality, displacement, poor air quality, and abject failures in government agency performance (C. Williams, Birungi, et al., 2022). A shift from racial homogeneity can spur research innovation to study and improve the health of highly vulnerable populations that shoulder the burden of inequalities in the public health economy."

Critique of Critical Race Theory in Public Health Research  

"Researchers have also encouraged greater focus on racial subgroups over homogeneous groups (CDC, 1998). This study does not take that position. The supra-construct of race implied in this framing remains a major problem for health disparities research, as discussed. It may be a position that is somewhat consistent with CRT because CRT encourages 'deeper understandings of concepts, relationships, and personal biases' (Ford et al., 2010). However, the CRT assumption based on the primacy of race is a fundamental feature of its school of thought. In our study, we assume that race is an anachronistic hold-over that 'developed largely to justify the highly profitable African slave trade and the systems of slavery in the Americas' (Fullilove, 1998). Our study premise is that the centuries-old social construction of race has devolved as to be too attenuated and crude for public health research. It weakens research quality, encourages poor practices, and retards scientific progress."

Disadvantages of Broad Racial Categorizations for Subpopulations  

"In addition to other drawbacks, this large and undefined group disadvantages White subpopulations with disproportionate health burdens (Bhopal & Donaldson, 1998). The US White population is equivalent to the population of Brazil (approximately 218,000,000) – the seventh largest country in the world (Country Comparisons - Population, n.d.)."

Need for Alternative Frameworks to Address Health Disparities  

"Rather than a single trait or combination of traits, some researchers have called for narrative-based categorization, an anti-racist community-based participatory research (CBPR) model, and effectuation of the public health economy (Adkins-Jackson et al., 2023; Hsu et al., 2019; C. Williams, Birungi, et al., 2022)."

Limitations of Race as a Proxy for Health Determinants  

"Proponents for the use of race in research have often regarded race as a proxy for several constructs – income, culture, biology, and racism (C. P. Jones, 2000; T. A. LaVeist, 2005). In Jones and colleagues' highly cited work positing a theory on three levels of racism, they purported that race is a 'rough proxy for socioeconomic status, culture, and genes, but it precisely captures the social classification of people in a race-conscious society such as the United States... That is, the variable “race” is not a biological construct that reflects innate differences, but a social construct that precisely captures the impacts of racism' (C. P. Jones, 2000). While Jones’ position is that 'race is a contextual variable, not a characteristic of the person,' she acknowledges several issues with race while seeking to defend race as an indicator of 'the distribution of risks and opportunities in our race-conscious society' (C. P. Jones, 2001)."

Impact of Racial Nomenclature on Research Quality  

"This study sides with critics in arguing that race variables inherently weaken research quality and impedes scientific advancement (Fanelli & Ioannidis, 2013). Conceptual and operational definitions of race in research are highly attenuated, for reasons that we explain throughout this study."

Scientific Utility of Race in Health Research  

"The scientific utility of race is experiencing increasing debate within the research community (Burchard et al., 2003; Feero et al., 2024; Garvey et al., 2022; D. S. Jones et al., 2024; Martinez et al., 2022; National Academies of Sciences, 2023). While Critical Race theorists have sought to more centrally situate race in health research, critics have questioned the importance of racial data altogether (Butler et al., 2018; Ford & Airhihenbuwa, 2018; Gannon, 2016; Garvey et al., 2022; Ioannidis et al., 2021; Witzig, 1996)."

Assumptions Supporting Race in Public Health Research  

"The inclusion of racial variables is understood to benefit public health by aiding in determining causes of disease - risk factors, genetics, and the role of the environment (Bhopal & Donaldson, 1998; Lin & Kelsey, 2000). Support for race and ethnicity in public health research has been premised on four major assumptions: 1) that race and ethnicity are easily attainable and consistently defined, 2) that there exists shared interpretability among study populations and the general public, 3) that research participation and response rates are similar across groups, and 4) that race is a stable variable among research participants across data sets and periods of assessment (CDC, 1998)."

Critical Race Theory’s Principles in Public Health  

"Although the CRT literature is highly context-dependent and not a theory in the traditional sense of a concretized theory of change, there are at least four generally accepted principles: race consciousness, contemporary mechanisms, centering in the margins, and praxis (Ford et al., 2010). Race consciousness seeks to centrally and contextually place race and racism discourse - whether historical, legal, educational, public health, and research (Ford et al., 2010)."

Criticisms of Critical Race Theory’s Application  

"Critics have argued against CRT on several fronts: does not contain the 'intellectual architecture' to be considered social theory, lack of clear mechanistic racial theory, overemphasis and underdevelopment of systemic racism and white supremacy as root causes, lack of methodological translation, allows too much intellectual variety, lack of Latinx inclusion, and non-agreement among CRT adherents (Anguiano & Castañeda, 2014; Cabrera, 2019; Treviño et al., 2008)."

Weaknesses of Race as a Research Variable  

"Similar to Jones, Thomas LaVeist holds a complex view of race in public health research - acknowledging conceptual and methodological challenges. LaVeist’s physiognomy model of race and health of cause and effect posits three pathways for explaining racial health disparities behavioral, cultural or ethnic, social or structural (T. A. LaVeist, 1994). He identified inherent weaknesses of race: poor proxy ('it seems logical that if race is a proxy for other factors such as biology or culture, then a need exists to find more creative ways to measure these other factors'), lack of practical translation ('Moreover, from a statistical standpoint the simple inclusion of a race dummy variable in a regression model is inadequate if the objective is to develop interventions to affect race differences in a dependent variable'), inadequate for population validity ('In practice, justified examples for using race as a criterion in sample selection are rare'), and measurement error ('there are measurement problems with race that have not been adequately addressed')(T. A. LaVeist, 1994)."

Need for Structured Critical Appraisal Tools  

"No such tool appears in the public health literature. The Critical Race (CR) Framework is a vital step to advance evidence-based reasoning and critical appraisal for health disparities research. This dissertation study developed a web-based training and tool to aid public health experts in evaluating health studies in four inviolable areas of critical appraisal - reliability, validity, internal validity, and external validity."

Poor Conceptual Clarity in Racial Analysis  

"Studies involving racial analysis show poor conceptual clarity, non-delineation between ethnicity and race, and minimal discussion of quality of racial data collection tools (Martinez et al., 2022). It was not known the extent to which the development of a bias tool and training would be acceptable, feasible, and appropriate."

Impact of Race on Research Interpretability  

"Academic journals are culpable in widespread practices that assume data are representative and interpretable when they are not. An example is instructive. Xiao and colleagues published a systematic review and meta-analysis of 122 COVID-19 clinical studies between October 2019 and February 2022 to investigate female and racial/ethnic minority enrollment in trials (Xiao et al., 2023). ... The major sources of bias arising from racial social construction are not discussed and not accounted for in data analysis."

Policy Implications of Improved Critical Appraisal  

"The successful development of a CR Framework would likely lead to new funding expectations on racial data collection and analysis to ensure quality research. Following full post-study testing, we anticipate that new policies and standards in data collection, grant funding, and scientific advancement will account for a paradigmatic shift in critical race analysis."

Behavioral Health Research and Racial Generalizations  

"Studies that make conclusions based on racial generalizations in behavioral health have limited scientific value and generalizability (Kaufman & Cooper, 2001). Further, research that does not account for the inherent threat of racial variables is likely to have lower quality."

Measurement Error in Racial Data  

"Measurement error is the difference between a measured observation and its true value. ... Within the context of this study, random error means the chance that some racial data can be inaccurate. An example of systematic error might be a tool that forces a single racial identity for all study participants that causes underreporting of multiracial identities."

Need for Narrative-Based Categorizations  

"Some researchers have called for narrative-based categorization, an anti-racist community-based participatory research (CBPR) model, and effectuation of the public health economy (AdkinsJackson et al., 2023; Hsu et al., 2019; C. Williams, Birungi, et al., 2022)."

Challenges with Race in Statistical Models  

"When independent variables have measurement error, they can cause attenuation bias toward zero or the null (Gokmen et al., 2022). Tabachnick and colleagues regard the lack of measurement error, 'a clear impossibility in most social and behavioral research' (Tabachnick et al., 2007)."

Historical Context of Race as a Social Construct  

"In our study, we assume that race is an anachronistic hold-over that 'developed largely to justify the highly profitable African slave trade and the systems of slavery in the Americas' (Fullilove, 1998)."

Limitations of Existing Bias Tools  

"A single bias tool developed in the medical education field appears in the literature (Garvey et al., 2022). A more structured tool to include conceptualization, analysis, and interpretation is needed to assist public health researchers to identify weaknesses in health studies."

Impact of Racial Variables on Public Health Practice  

"Public Health Practice. The implication of this study is that practices dependent on racial generalizations constitute poor practice. As discussed further in Chapter 2, the assumption of racial homogeneity is all too common despite the breadth of diversity within and across races."

Need for Rigorous Data Collection Standards  

"Federal standards on race data collection warrant intensified and sustained scrutiny. Policies may be unjustified where racialized research undermines scientific quality."

Critique of Race as a Biological Construct  

"While Jones’ position is that 'race is a contextual variable, not a characteristic of the person,' she acknowledges several issues with race while seeking to defend race as an indicator of 'the distribution of risks and opportunities in our race-conscious society' (C. P. Jones, 2001)."

Redundancy in Biomedical Research Due to Race  

"High redundancy has been shown in biomedical research (Lund et al., 2022). Disaggregation of racial data can lead to place- and attribute-based populations that vary in severity of health needs and disparities."

Public Health Critical Race Praxis (PHCRP)  

"When Ford and colleagues introduced CRT in public health research, PHCRP built upon the foundational principles of CRT: public health, centering, critical consciousness, experiential knowledge, ordinariness, praxis, primacy, race consciousness, and the social construction of minoritized populations (Ford et al., 2010)."

Inadequacy of Race for Scientific Rigor  

"Race variables appear frequently in public health research (T. A. LaVeist, 2005; Ross et al., 2020). Yet, the scientific basis for use of race in health research has been a long-standing contentious issue (Gannon, 2016; Ioannidis et al., 2021; Lin & Kelsey, 2000; Witzig, 1996). Its common use is attributed to research norms rather than scientific rigor (Lin & Kelsey, 2000; Witzig, 1996)."

Critique of Race as a Proxy for Genetic Ancestry  

"In response to NASEM, journal editors published ten percepts in March 2024 for authors and peer journal reviewers to consider when race and ethnicity are used as proxies for genetic ancestry groups that: 1) include accurate and respectful terminology, 2) avoidance of race and ethnicity as genetic proxies, 3) expressed rationale for population groups, 4) methodologies for data collection, 5) operationalization of populations, 6) inclusion of all genetic ancestry groups, 7) how populations of interest influence data interpretability, 8) limitations of generalizability with stratified analysis, 9) limitations with use of legacy datasets, and 10) avoidance of race and ethnicity as proxies for genetic ancestry (Feero et al., 2024)."

Need for Contextual Analysis Over Racial Categories  

"Racial nomenclature forms a type of research bias toward favoring the legitimacy of race in science, except that researchers often fail to explain the construct of race that it is intending to capture (Kaufman & Cooper, 2001)."

Impact of Race on Internal Validity  

"Poor reliability and validity weaken internal validity. Strong internal and external validity are essential for determining the rigor, accuracy, and utility for health disparities studies (McDermott, 2011)."

Call for Abandoning Race in Public Health Research  

"‘I believe it is time to abandon race as a variable in public health research. Following the illusion of race cannot provide the information we need to resolve the health problems of populations’ (Fullilove, 1998)."

Role of Journals in Perpetuating Racial Bias  

"Due to this study and much of health disparities research overlooking the scientific rigor necessary for race variables, the Critical Race Framework study is encouraging a major sea change in critical appraisal of research quality, including among top health and medical sciences journals."

Importance of Expert Engagement in Tool Development  

"Consistent with the literature, experts were consistently engaged in the development of our critical appraisal tool (Downes et al., 2016)."

Challenges with Race Data Collection Tools  

"Race data collection tools should show reliability and validity. Threats to internal validity due to poor construction of race should be assessed and minimized to the greatest extent possible."

Limitations of Current Research Practices  

"The persistence of racial nomenclature in public health research is detrimental to the field. ... Health studies are defined by poor conceptual clarity of the race variable, lack of delineation between ethnicity and race, and limited discussion of how race was measured (Martinez et al., 2022)."

Future Directions for CR Framework Application  

"Future research should seek to study individual perceptions and practices that influence outcomes of CR Framework application and to reduce barriers to ensure that minimum sample sizes can be met for additional testing."