Cited by 415Health disparities and outcomesRacial and Ethnic Identity ResearchPublic Health and Social Inequalities

The DOI matches its Crossref record; 116 of the 116 references it cites were found in a registry or an index; 2 of the 275 sources its claims cite were checked for support.

Reducing Racial Inequities in Health: Using What We Already Know to Take Action

Open access
Williams, David R., Cooper, Lisa A.·2019·International Journal of Environmental Research and Public Health

Abstract

This paper provides an overview of the scientific evidence pointing to critically needed steps to reduce racial inequities in health. First, it argues that communities of opportunity should be developed to minimize some of the adverse impacts of systemic racism. These are communities that provide early childhood development resources, implement policies to reduce childhood poverty, provide work and income support opportunities for adults, and ensure healthy housing and neighborhood conditions. Second, the healthcare system needs new emphases on ensuring access to high quality care for all, strengthening preventive health care approaches, addressing patients’ social needs as part of healthcare delivery, and diversifying the healthcare work force to more closely reflect the demographic composition of the patient population. Finally, new research is needed to identify the optimal strategies to build political will and support to address social inequities in health. This will include initiatives to raise awareness levels of the pervasiveness of inequities in health, build empathy and support for addressing inequities, enhance the capacity of individuals and communities to actively participate in intervention efforts and implement large scale efforts to reduce racial prejudice, ideologies, and stereotypes in the larger culture that undergird policy preferences that initiate and sustain inequities.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that eliminating racial health inequities requires coordinated action on communities of opportunity, health care delivery, and political will/awareness. It synthesizes evidence for specific policies and interventions, from early childhood programs and income supports to provider bias reduction and social-needs integration.

Key findings

  • The paper organizes needed action into three strategies: creating communities of opportunity, building more health into medical care delivery, and raising awareness/building political will to address inequities.
  • Early childhood and income-support evidence includes Perry Preschool, where at age 40 the intervention group had higher income, high school completion, college graduation, health insurance coverage, and home ownership and lower crime, out-of-wedlock births, and welfare assistance; Abecedarian treatment males had systolic blood pressure of 126 mm Hg versus 143 mm Hg in controls, and none versus one in four controls met metabolic syndrome criteria; early childhood programs were reported to return $3 to $17 per dollar invested.
  • In 2017, child poverty rates were 33% for American Indian children, 33% for African American children, 26% for Hispanic children, 11% for Asian and Pacific Islander children, and 11% for white children. A $1 minimum wage increase above the federal minimum was associated with a 1%–2% decrease in low birth weight and a 4% decrease in post-neonatal mortality; if all states in 2014 had increased their minimum wage by $1, the researchers estimated 2,790 fewer low birth weight births and 518 fewer post-neonatal deaths.
  • The Delaware colorectal cancer program increased colonoscopy screening by 54% for blacks and 29% for whites and eliminated the racial screening gap; CRC incidence declined 34% for African Americans and 26% for whites, and mortality declined 42% for blacks and 13% for whites, with annual program costs of $7 million versus $8.5 million in savings. Kidney transplantation disparities increased: 2-year cumulative incidence of live donor kidney transplantation in 1995 was 7.0% for white, 3.4% for black, 6.8% for Hispanic, and 5.1% for Asian patients; in 2014 it was 11.4% for white, 2.9% for black, 5.9% for Hispanic, and 5.6% for Asian patients.

Methods

  • Design: narrative review/overview of scientific evidence, not a new empirical study.
  • Data/sample: published research, national data, and program evaluations cited in the paper; no new primary data were collected.
  • Analysis: the paper synthesizes evidence around three intervention strategies—communities of opportunity, health care delivery reform, and awareness/political will—and cites specific studies and examples to support each.

Limitations

  • Stated: the authors note that much remains to be learned about optimal timing and sequencing of interventions, scaling up promising local studies, and effective mass-media communication strategies; research on raising awareness of racial inequities is described as limited with significant gaps.
  • Evident: as a narrative review, it does not report a systematic search strategy, inclusion criteria, or quantitative synthesis.
  • Evident: many cited interventions are small/local studies, natural experiments, or program evaluations, and the paper does not formally assess risk of bias across the evidence base.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/ijerph16040606

Cites

116 of 116 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

238 Not checked yet · 21 Own interpretation · 5 No basis given · 2 Supported

Verify all 273 references — free account

Show all 157 claims

  • It may state two separate claims as one. 99
  • Probably not a substantial claim. 15
109 of 109
  • The paper relies on this without support.

    Obesity is a risk factor for several chronic conditions.

    “Obesity is a risk factor for several chronic conditions”
  • The paper relies on this without support.

    Low birth weight is a leading cause of mortality among newborns and is associated with an increased risk of health problems in infancy, childhood and adulthood.

    “Low birth weight is a leading cause of mortality among newborns and is associated with an increased risk of health problems in infancy, childhood and adulthood.”
  • The paper relies on this without support.

    The military is a more race-blind environment than the larger society.

    “The military is a more race-blind environment than the larger society”
  • The paper relies on this without support.

    Virtually every health-enhancing resource is linked to where one lives in the U.S.

    “virtually every health-enhancing resource is linked to where one lives in the U.S.”
  • The paper relies on this without support.

    Much of medical care in the U.S. is focused on treating disease after it has occurred.

    “Much of medical care in the U.S. is focused on treating disease after it has occurred.”
  • The paper relies on this without support.

    Implicit bias is likely the most common form of bias among healthcare providers.

    “Although implicit bias is likely the most common form of bias among healthcare providers, explicit bias also persists in society and efforts are needed to minimize its occurrence as well.”
  • The paper relies on this without support.

    Explicit bias persists in society.

    “explicit bias also persists in society”
  • The paper relies on this without support.

    Hospitals are often the largest employer in many communities.

    “Hospitals are often the largest employer in many communities.”
  • The paper relies on this without support.

    A broad range of affirmative action policies have been implemented in the last 50 years to increase the participation and success of women and minorities in education and occupational contexts.

    “A broad range of affirmative action policies have been implemented in the last 50 years to increase the participation and success of women and minorities in education and occupational contexts.”
  • The paper relies on this without support.

    The Purpose Built Communities model is being replicated in multiple communities across the U.S.

    “The purpose built model is being replicated in multiple communities across the U.S.”
  • The paper relies on this without support.

    Raising awareness of racial inequities, building political support, and increasing empathy are necessary to reduce racial inequities in health.

    “There are three interrelated communication challenges: we need to raise awareness of inequities, build political support, and increase empathy for addressing social inequities in health.”
  • The paper relies on this without support.

    Findings from studies in other countries and on other stigmatized groups are applicable to reducing racial inequities in health in the U.S.

    “Similarly, an RCT in Japan showed that it was possible to get Japanese university students to increase their empathy toward a stigmatized outgroup (Japanese-Brazilians residing in Japan who had lost their jobs because of an economic recession) [135].”
  • The paper relies on this without support.

    Interventions that reduce prejudice or increase empathy in small or local studies can be scaled to reduce racial inequities in health.

    “Major investments in research are needed to identify how to best close the empathy gap in real world contexts and to expeditiously bring to scale interventions that are proven to be effective.”
13 of 13

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

1 of 1

Citations

Cites

Show all 114 references

Research works printed but not linked: 2

  1. Smedley, B.D., Stith, A.Y., and Nelson, A.R. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, National Academy Press.
  2. Fingar, K.R., Hambrick, M.M., Heslin, K.C., and Moore, J.E. (2019, January 04). Healthcare Cost and Utilization Project Statistical Briefs: Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Morbidity, 2006–2015: Statistical Brief #243, Available online: https://www.ncbi.nlm.nih.gov/books/NBK532465/#sb243.s1.

Cited by

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Metadata

Authors
Williams, D. R., & Cooper, L. A.
Affiliations
  • Harvard University (US)
  • Johns Hopkins University (US)
Corresponding author
Williams, David R.
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2019-02-19
Volume
16
Issue
4
Pages
606
ISSN
1660-4601 (ISSN-L)
OpenAlex
W2917886734
Cited by
415
References
114
Citations by year
2026: 25 · 2025: 47 · 2024: 80 · 2023: 68 · 2022: 73 · 2021: 73 · 2020: 41 · 2019: 7
FWCI
10.32
Type
journal article
Language
en
Open access
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
W.K. Kellogg Foundation (P0131281)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
racial disparities in health, systemic racism, early childhood development, child poverty, healthy housing, neighborhood conditions, preventive medicine, health workforce diversity, social determinants of health, political will, racial prejudice, stereotypes, health equity policy
MeSH terms
Delivery of Health Care, Ethnicity, Humans, Health Knowledge, Attitudes, Practice, Quality of Health Care, Research Design, Community Networks, Healthcare Disparities, Racism

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