Interrogating for Equity: Laying the foundation for a health equity analytical framework

For epidemiologists to do our jobs, it is necessary to name and study forces that determine health outcomes. Racism and colonialism are fundamental drivers of health in the US, but are seldom directly named or analyzed in epidemiologic analysis. Because science is not neutral but subject to the same assumptions that perpetuate racist harms, we must take precautions against replicating these harms through analyses that fail to account for the effects of racism. To do analysis appropriately requires a deep and nuanced understanding of both race and racism in the time and place of the lives of the people whose health we study. This requires engaging with history and social theory, to fully understand and integrate the historical and institutional root causes of persistent health inequalities. Epidemiology is a young, rapidly-evolving field that affords us the opportunity to craft and pilot new methods, and to borrow methodologies and frameworks from other disciplines to strengthen the validity and truth of our work. In this project I undertake such innovation, by melding causal diagrams with social theory and historical context to push epidemiology toward an overdue engagement with structural drivers of inequity (most notably, racism). I provide diagrammed examples of a conceptual framework for operationalizing race as a proxy for racism in considering how systemic racism contributes to specific health outcomes of interest, as suggestions for improving upon epidemiology and other forms of science, to serve as tools to advance health equity and anti-racism