Researchers from Mayo Clinic and the University of Minnesota have published a paper in the Journal of Clinical and Translational Science, which provides a new framework describing how racism affects heart health among people of color in Minnesota. The researchers are focused on reversing these disparities.

This framework will help scientists explore and measure how chronic exposure to racism, not race, influences health outcomes," says Sean Phelan, Ph.D., a Mayo Clinic health services researcher and senior author of the paper.  "This will help enable researchers to design interventions that address the root causes of these disparities and improve heart health for people of color everywhere."

The researchers are part of the Center for Chronic Disease Reduction and Equity Promotion Across Minnesota (C2DREAM). This research center aims to reduce cardiovascular health disparities in collaboration with Minnesota community leaders and community health organizations.

Taking a broader view to reduce inequities

Historically, research on racism and health has focused on interpersonal racism. The C2DREAM framework takes a broader view, examining how oppressive systems of power, structural and institutional racism, and interpersonal racism work together to influence the social determinants of health and health outcomes. Social determinants of health are nonmedical factors that affect health; the Centers for Disease Control and Prevention describes them as "the conditions in which people are born, grow, work, live and age."

"Our social structures and policies deny or grant access to opportunities throughout a person's life in ways that can affect health," says Kene Orakwue, first author of the paper and a predoctoral student in Health Services Research, Policy & Administration at the University of Minnesota School of Public Health. "I believe these social structures must be intentionally interrogated in order to reduce inequities."

People who experience chronic racism may be affected by factors such as intergenerational trauma, reduced access to healthcare, differential treatment in healthcare settings and psychological distress. All these things negatively affect heart health and can have a cumulative effect over the course of a person's life.

Shaping research to disrupt racism

C2DREAM's goal is to find ways to disrupt racism's effect on heart health. The C2DREAM framework provides a roadmap for researchers, including a shared set of measures for different types of racism.

"In order to change something, we have to be able to measure it," says Felicity Enders, Ph.D., associate director of the Mayo Clinic Center for Clinical and Translational Science and a C2DREAM co-investigator.

The C2DREAM framework guides critical thinking, exposing the multidimensional relationship between racism and heart health and showing researchers how to measure racism's effects on many levels. In doing so, the framework also shows researchers how to measure the real impact of interventions.

For example, says Dr. Enders, a study involving immigrant communities might look at structural barriers to heart health, such as access to culturally appropriate healthy food; institutional barriers, such as access to language interpreters during telehealth appointments; and interpersonal barriers, such as cultural understanding between doctor and patient.

C2DREAM researchers are already using the framework to guide their work. All C2DREAM-funded studies collect common measures of inequity, such as data on housing segregation and income disparities. This makes it easier to compare, share and combine data across studies. It also leads to a more comprehensive understanding of how racism affects heart health — and how to disrupt those effects — across the state of Minnesota.

Refining measures of racism

The researchers see the C2DREAM framework as only a starting point. Future research will focus on refining measures of structural, institutional and interpersonal racism and expanding the framework to include the effects of cultural and internalized racism.

Learn more about C2DREAM

C2DREAM is a regional effort spanning Minnesota that includes Mayo Clinic and Mayo Clinic Health System, the University of Minnesota, Hennepin Healthcare, Native American Community Clinic and the Rand Corp. It brings together researchers and community stakeholders from various disciplines, drawing on evidence-based medical expertise and local and cultural knowledge. C2DREAM is funded by a P50 grant from the National Institute on Minority Health and Health Disparities. Visit the C2DREAM website to learn more about its ongoing research projects and events.

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