Measurement of Race for Health Equity: Challenges and Opportunities
Dr. Kyler James Sherman-Wilkins, Assistant Professor of Sociology, Faculty Affiliate in the Gerontology Program and Founder and Director of the Health Equity Research Collective (HERC) at Missouri State University.
As a health researcher who studies health differences among different racial groups, I often think about the importance of accurate data and measurements. I firmly believe that if we don’t measure something, we can’t improve it. One reason why we haven’t made much progress in reducing health gaps between different races is because we haven’t been very precise in how we measure race.
On its face, it may seem strange that race is such a difficult demographic variable to capture. After all, race is such a salient factor in our society and most Americans feel that they have a solid grasp on what race is. I believe that many Americans, including some public health workers, don’t fully grasp the concept of race and its complexities when it comes to measuring it. This lack of understanding has serious implications, as it perpetuates and worsens health inequalities among different racial groups.
The Difficulty of Measuring Race is Rooted in the Fact that Race is not a Biological Reality
Sociologists have long discussed that race is a social construct, which means that categories like “Black” and “White” don’t have a biological basis. Scientists today generally agree that racial categories, determined by the results of the Human Genome Project, are weak and problematic when it comes to representing human ancestry. Instead of being fixed categories, race is influenced by social and political factors.
For example, the U.S. Census Bureau’s frequent changing of racial categories across decennial censuses. These changes are not rooted in any advancement in how we come to understand what race is and is not. Rather, these changes are made from institutional pressures and policy goals. In a 2016 article, historians Brian Gratton and Emily Klancher Merchant argued that categorizing Mexican Americans as non-white was motivated by nativist opposition to increased migration from Mexico. The argument is that it would be easier to stem migratory flows from Mexico if the population was not considered White. Most recently, we have seen a proposal by the Biden administration to change how Latinos, Middle Easterners, and North Africans are counted in federal statistics. While this change is not necessarily problematic; it highlights the ongoing challenge of measuring race since it has never had a solid foundation in objective reality. The concept of race was developed to classify people and justify atrocities like American slavery. Given this troubling history, those interested in achieving racial health equity face the question of what it truly means in terms of health disparities when someone identifies as “Black,” “White,” or “Mixed Race.”
Difficulties in Defining and Measuring Race Provides an Opportunity
Though there are valid and legitimate criticisms of how we currently measure race, it is important to not let the perfect be the enemy of the good. When we look at the entire population, even though the way we categorize race may be oversimplified and not very precise, it can still be helpful in understanding how health outcomes differ across the United States. Additionally, there are new and innovative approaches to capturing the complexities of race and its impact on health. One example is the groundbreaking research conducted by Harvard sociologist Ellis Monk. He has developed a unique method of measuring race by considering self-reported skin tone (such as very light, light, medium, dark, and very dark) instead of relying on basic ‘Black’ and ‘White’ categories. This allows for a better understanding of the diverse variations among individuals and how social factors contribute to health disparities. The work of Monk and others reveals interesting findings that have strong implications for health and health policy. For example, in a recent article Monk and his team discovered that people with darker skin tones reported more experiences of discrimination, leading to higher levels of stress, which is linked to poorer health outcomes. Although measuring skin tone might not replace self-reported racial categories anytime soon, paying attention to skin tone could provide valuable insights for addressing health disparities more effectively.
In sum, we have to balance ease of data collection, with the utility of the data that we are collecting. Moreover, when collecting novel data, we must also be mindful of what is standard in the field of public health. If local agencies use a different method to measure race than state and national samples, it becomes difficult to compare their data. It’s important for all agencies to use the same measurement approach to ensure meaningful comparisons. The challenge is not to arrive at perfect measure of race. That is indeed impossible. Rather, we must do a better job of understanding what we are measuring and what we can and cannot say about the world based on that measure. Do the categories of ‘White’ and ‘Black’ mean anything outside of the context of our society’s current definition and view of race? Does being ‘Black’ automatically mean having a higher risk of poor health, or is it due to racist structures and systems that distribute resources unequally based on created racial hierarchy? How can we better measure race to really address our most marginalized populations? It is crucial to carefully consider these questions in order to make genuine efforts towards ending racial disparities and achieving health equity.
Dr. Kyler James Sherman-Wilkins (he/him/his) is an Assistant Professor of Sociology, Faculty Affiliate in the Gerontology Program and Founder and Director of the Health Equity Research Collective (HERC) at Missouri State University. A social demographer and life course sociologist by training, Sherman-Wilkins’ research centers around the social and structural determinants of health and health inequities, particularly as it pertains to cognitive health, across the life course. He sits on numerous Boards for local, State, and National organizations including the NAACP-Springfield Chapter, The GLO Center, Health Equity Collaborative, Missouri Foundation for Health, PROMO, Missouri Council on Aging, and the Population Reference Bureau. Kyler received his B.S. degree in Human Development and Family Studies at Cornell University and both his M.A. and Ph.D. degrees at The Pennsylvania State University. He lives with his husband, Luis, and their two dogs, Berta and Alfie.