Click here to download a PDF of Recommendations for Measuring Structural Racism in Chicago

Background:
On September 7, 2016, Health & Medicine Policy Research Group staff attended a meeting jointly hosted by the Center for Community Health Equity (a joint DePaul-Rush center) and Health & Medicine’s Health Equity Initiative, to help advise the Chicago Department of Public Health’s (CDPH) Department of Epidemiology on how to both accurately and reliably measure experiences of racism in Chicago. Health & Medicine would like to thank CDPH for their earnest inquiry and engagement on difficult questions about a long-term foundational problem in the United States context: racism, an impediment to our shared goal of achieving health equity.

The September 7th meeting followed a series of smaller meetings in which Health & Medicine staff met with CDPH to discuss the results of questions pertaining to experiences of racial discrimination included in a recent Healthy Chicago Survey. This survey provides local Behavioral Risk Factor Surveillance System (BRFSS) data comparable across Chicago community areas, to which CDPH added some questions. Health & Medicine and CDPH share the concern that a specific series of questions in the Healthy Chicago Survey are not accurately measuring experiences of racial discrimination. This shared concern and the CDPH epidemiology staff’s increased inquiry into this issue together provide opportunities to develop better measures of racism and to expand anti-racist public health practice in Chicago.

As past American Public Health Association President Dr. Camara Jones has said, we must first put racism on the agenda in order to work to eliminate it, which seems to be the intention with this area of inquiry. We hope that the recommendations and notes herein help advance CDPH’s work toward accurately measuring racism, and ultimately aiding in the process of confronting structural racism and advancing toward achievement of health equity in Chicago—both monumental undertakings.

Recommendations and Action Steps:
1: CDPH is encouraged to remove measures of experiences of racial discrimination from the Healthy Chicago Survey. Several methodological problems with using the scale within the Healthy Chicago Survey have been identified by both CDPH and external partners. Pages three and six of the PDF have more detailed rationale. We recommend more robust measurement methods below.

2: CDPH should instead utilize an approach of mixed qualitative methods. This approach is likely to provide actionable information that may guide future data collection at a city-wide level. This method may reveal more accurate individual level racial discrimination measures and potential ideas for measuring structural racism as well. Page three of the PDF includes more exploration of this topic.

3: CDPH should develop ways to measure structural racism, vis-à-vis a structural determinants of health inequities approach that includes measuring governance processes, economic policy, and public and social policies. We suggest a methodological shift toward measuring the impacts of structural racism on health inequities, with a reduced focus on measuring the degree of racism at the interpersonal level. Given that there is already documented and objective evidence of racism at different levels—internalized, interpersonal, institutionalized, and structural—CDPH should focus on structural racism, as it is the most preventive level. To this end, CDPH staff might begin with the questions provided by Dr. Camara Jones during her presentation on the APHA webinar regarding measuring racism to help guide public policy decisions and actions. Page seven of the document has more information.

4: CDPH should utilize structural measures of racism in policing, as a goal in the violence prevention section of Health Chicago 2.0 requires structural measures and both structural (policy) and institution level interventions. For reference, the most pertinent goal in Healthy Chicago 2.0 is stated as, “Reduce mass incarceration and inequitable police attention in communities of color” and the most relevant associated objective is: “Decrease discriminatory treatment in the criminal justice system”. More resources for inquiry pertinent to this recommendation are found on pages five and six of the PDF.

5: CDPH is encouraged to contextualize its use of “race” categories whenever sharing information about inequities in charts, graphs, maps, or in text. Within the current context and history of racism in the US, this may help audiences understand these inequities as resulting in significant part from racism at different levels—internalized, interpersonal, institutionalized, and structural. Two Health & Medicine staff members are collaborating with others to develop a Contextualizing the use of “race” in public health statement that may be helpful in this regard. Among other reasons, this is essential for debunking the myth of biological “races” for various audiences, helping dismantle the ideology that underpins racism.

Other recommendations:

• If CDPH decides to use a survey tool for this (against the recommendation herein), review and consider using the reactions to “race” module (mentioned in the 9/7/16 “Quantifying Racism” webinar)
• If CDPH has not yet connected with Dr. Nancy Krieger on this subject, Health & Medicine staff would like to participate in the discussion to hear her feedback and suggestions for moving forward
• Set and publish goals, objectives, and strategies for improving the diversity and inclusiveness of Healthy Chicago 2.0 committees
• Develop and share a timeline for this project to improve measures of racism to advance accountability to both the general public and outside partners who are advising CDPH

Concluding Note:
Health & Medicine is enthusiastic about CDPH’s commitment to better measure racism in Chicago and regularly engage with external partners to work toward accurate measures. We share these notes as feedback on this process and hope that they offer useful resources and recommendations. We look forward to continued partnership on helping measure racism as a means of targeting resources and policies, and measuring progress on dismantling structural racism, a prerequisite to our shared goal of achieving health equity in Chicago and a socially just society. Our notes associated with the above recommendations are found in the appendix, on pages 3-7 of the PDF.

Contributors:

Sekile Nzinga-Johnson, PhD, MSW, Senior Director of Programs
Wesley Epplin, MPH, Director of Health Equity
Tiffany Ford, MPH, Policy Analyst
Renae Alvarez, MPH, Policy Analyst

Editors:

Margie Schaps, MPH, Executive Director
Morven Higgins, Development & Communications Manager

Read the full document here: Recommendations for Measuring Structural Racism in Chicago