Introduction
In September 2021, Evidence for Action (E4A) updated our rolling call for proposals (CFP) with a new emphasis, reflected in its title: “Innovative Research to Advance Racial Equity.” While E4A has always sought to fund research promoting health equity broadly, this updated call explicitly focuses on racial equity. This shift is to acknowledge the widespread structural racism that is entrenched throughout society, which creates barriers to equity for Black, Latinx, Indigenous, Asian, Pacific Islander, and other racial and ethnic groups compared to non-Hispanic white people. Health equity is simply not possible until race and ethnicity no longer predict people’s opportunities, environments, and ability to live a healthy life.
What does this mean for the research we now fund at E4A? While we have not drastically altered our selection criteria (which are outlined in the CFP), we now make intentional efforts to interpret and apply the criteria in ways that center and promote racial equity. First and foremost, the projects we fund under this call should be grounded in a framework that acknowledges the role that racism plays in shaping systems, environments, norms, and institutions, both overtly and subtly. This grounding reflects our commitment to fund research that names racism, not race, as a fundamental driver of health inequities, and provides an orientation to the types of research that we consider innovative, timely, and important under this CFP.
Possible approaches
There are many ways for research to advance racial equity, both in topic and approach. Here are some tangible examples of how proposals can be responsive to this focus:
- The research questions are relevant to disrupting racism. We look for research that is driven by the needs and priorities of people and groups impacted by structural racism, not solely by an academic research agenda or the availability of data. Solutions being tested should be those conceived, created, and/or embraced by the people and communities who are the intended beneficiaries. Solutions should also be aimed at addressing institutional or systems-level “root causes” of race-based inequities, not band-aid approaches that oblige people of color to adapt to or compensate for the harms of structural racism, for example by modifying their personal behavior.
- The research process itself is steeped in equity and authenticity. This often requires diverse research teams where power is shared among those with methodological, subject matter, and practical expertise; establishment of stakeholder or community advisory boards; and the use of survey tools, instruments, and protocols that have been appropriately validated for the specific study populations. Other end-users of research findings, such as program implementors, advocates, and policymakers, should also be engaged as partners early in the process, to help ensure actionability.
- Race and ethnicity variables are properly described and operationalized. A fundamental requirement of research to advance racial equity is the ability to assess whether something has differential impacts among groups based on racial, ethnic, or other identities (also known as heterogeneous treatment effects). We look for research that goes beyond naming race or ethnicity as covariates or strata for analysis, but that also provides sound justification for their use and an explanation of how the variables will be operationalized in the study. Justification should reflect a nuanced understanding of the mechanisms through which racial/ethnic differences influence outcomes, given historical, socio-political, or environmental contexts. Within a structural racism framework, these mechanisms are exclusively social (e.g., reflecting unequal distribution of resources, patterns of discrimination or segregation, etc.). Assumptions about inherent biological predispositions that vary by race/ethnicity are rarely convincing and should not serve as a basis for examining differential impacts of social interventions. In studies of a single racial or ethnic group, there may also be subgroups impacted differently based on socio-economic status, geographic location, language, gender identity, etc. Whenever possible, these groups should be disaggregated accordingly, to further illuminate mechanisms of change and highlight equitable solutions.
- Findings are applicable to specific contexts. Research to advance racial equity does not necessarily need to be broadly generalizable to be important. Because racism operates insidiously through both macro-level systems and everyday transactions, it is often impossible to disentangle and isolate all the immediate drivers of race-based disparities. Rigorous evaluations can account for some observed and unobserved (latent) potential confounders to better support causal inference, but still rely on many assumptions that may not hold when scaled or transferred to other communities, even those with similar observable characteristics. Unmeasured constructs, which could be either protective (e.g., community cohesion, resilience) or harmful (e.g., allostatic load, toxic stress), can influence the extent to which an intervention succeeds or fails in a different context.
Does this mean we do not value generalizability? No – we still prioritize studies where findings are relevant and actionable beyond the study setting. However, researchers must be explicit about the settings, populations, and contexts to which the new knowledge is expected to be applied and the assumptions on which their inferences are based.
Putting evidence into practice
These are just a few of the ways in which we use a racial equity “lens” in evaluating research proposals. Ultimately, our goal is to improve health equity by building evidence on how to reshape systems and structures so that people of all racial and ethnic identities can live a healthy life. Through this new CFP, we seek to fund research that meaningfully contributes to our collective knowledge on how to dismantle structural racism and achieve a Culture of Health.
Resources
- Rhea W. Boyd, Edwin G. Lindo, Lachelle D. Weeks, and Monica L. McLemore, “On Racism: A New Standard for Publishing on Racial Health Inequities” in Health Affairs Blog: https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/.
- Chandra L. Ford and Collins O. Airhihenbuwa, “Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis” in the American Journal of Public Health: https://doi.org/10.2105/AJPH.2009.171058.
- Erin Mackay, Dani Gillespie, Sinsi Hernández-Cancio, “National Partnership for Women and Families Choosing Health Equity Guide for Researchers”: https://www.nationalpartnership.org/our-work/resources/health-care/understanding-decision-points-in-research.pdf.
- "Equitable Evaluation Framework TM", Equitable Evaluation: https://www.equitableeval.org/framework.