Racism and perinatal health inequities research: where we have been and where we should go.
Racism and perinatal health inequities research: where we have been and where we should go.
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DOI：
10.1016/j.ajog.2022.05.033
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发表时间：
2022-10
影响因子：
9.8
通讯作者：
中科院分区：
文献类型：
--
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世纪以来，尽管临床技术进步和公共卫生实践的变化降低了总体发病率，但围产期健康结果中的种族和族裔不平等现象仍然存在。种族是一种社会结构，而不是一种固有的生物或遗传现实;因此，健康结果方面的种族差异是结构性种族主义的后果，或者是健康机会沿着种族化的界线不公平分配的后果。妇产科的临床医生和科学家有责任努力消除黑人、棕色人种和土著生育者的健康不平等，履行这一责任需要高质量研究提供可操作的证据。为了产生这种可操作的证据，研究界必须重新调整范式，实践和基础设施，着眼于生殖正义和反种族主义。这份特别报告提供了一系列关键建议，作为转变围产期健康研究以实现健康公平的路线图。这些建议是基于2021年孕产妇胎儿医学学会第41届年度妊娠会议科学研究研讨会上提出的专家意见和证据。建议分为三大类-改变研究范式，改革研究实践和改造研究基础设施-并扎根于临床，公共卫生和社会学奖学金在健康公平的进步和缺点的历史基础。改变研究范式需要利用结构性种族主义的多学科视角;促进确定结构性种族主义干扰的生物学途径的机械研究;并利用将种族主义视为围产期不良结局因素的概念模型。改变实践方法，促进和参与多学科团队，并制定标准化的数据收集指南，将确保范式转变集中在历史上被边缘化的黑人，棕色和土著生育者的声音。最后，需要改变基础设施，使之融入以社区为中心的方法，以实现范式和实践的转变。打破筒仓和支持真正的社区伙伴关系，以及调整机构，资金和学术出版目标与围产期健康公平的战略重点的机构政策，是至关重要的。实现健康公平需要改变支持种族主义生态系统的结构，黑人，棕色人种和土著生育者必须在生育之前，期间和之后导航。这些结构延伸到临床医生日常工作的医疗保健系统之外，但不能将其排除在研究工作之外，以创建实现围产期健康公平所需的可操作证据。
For over a century, substantial racial and ethnic inequities in perinatal health outcomes have persisted despite technical clinical advances and changes in public health practice that lowered the overall incidence of morbidity. Race is a social construct and not an inherent biological or genetic reality; therefore, racial differences in health outcomes represent the consequences of structural racism, or the inequitable distribution of opportunities for health along racialized lines. Clinicians and scientists in obstetrics and gynecology have a responsibility to work to eliminate health inequities for Black, Brown, and Indigenous birthing people, and fulfilling this responsibility requires actionable evidence from high quality research. In order to generate this actionable evidence, the research community must realign paradigms, praxis, and infrastructure with an eye toward reproductive justice and anti-racism. This special report offers a set of key recommendations as a roadmap to transform perinatal health research to achieve health equity. The recommendations are based on expert opinion and evidence presented at the Society for Maternal Fetal Medicine’s 41st Annual Pregnancy Meeting State of the Science Research Symposium in 2021. Recommendations fall into three broad categories – changing research paradigms, reforming research praxis, and transforming research infrastructure – and are grounded in an historical foundation of the advances and shortcomings of clinical, public health, and sociological scholarship in health equity. Changing the research paradigm requires leveraging a multi-disciplinary perspective on structural racism; promoting mechanistic research that identifies the biologic pathways perturbed by structural racism; and utilizing conceptual models that account for racism as a factor in adverse perinatal outcomes. Changing praxis approaches to promote and engage multidisciplinary teams and develop standardized guidelines for data collection will ensure that paradigm shifts center the historically marginalized voices of Black, Brown and Indigenous birthing people. Finally, infrastructure changes that embed community-centered approaches are required to make shifts in paradigm and praxis possible. Institutional policies that break down silos and support true community partnership, as well as alignment of institutional, funding, and academic publishing objectives with strategic priorities for perinatal health equity, are paramount. Achieving health equity requires shifting the structures that support the ecosystem of racism that Black, Brown, and Indigenous birthing people must navigate before, during, and after childbearing. These structures extend beyond the healthcare system in which clinicians operate day-to-day, but they cannot be excluded from research endeavors in order to create the actionable evidence needed to achieve perinatal health equity.
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影响因子：
37.8
作者：
Churchwell, Keith;Elkind, Mitchell S. V.;Williams, Olajide
通讯作者：
Williams, Olajide
DOI：
10.1111/j.1479-828x.2000.tb03344.x
发表时间：
2000-08-01
影响因子：
1.7
作者：
Austin, MP;Leader, L
通讯作者：
Leader, L
影响因子：
2.3
作者：
Chambers, Brittany D.;Arega, Helen A.;McLemore, Monica R.
通讯作者：
McLemore, Monica R.
影响因子：
--
作者：
Eichelberger, Kacey Y;Alson, Julianna G;Doll, Kemi M
通讯作者：
Doll, Kemi M
影响因子：
2.7
作者：
Alson JG;Robinson WR;Pittman L;Doll KM
通讯作者：
Doll KM