Transforming Health Equity Research in Integrated Primary Care: Antiracism as a Disruptive Innovation

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Increased media attention regarding COVID-related health disparities combined with horrific institutionalized violence against Black Americans have revitalized the call to action to address systemic racism in health care. Among the consequences of systemic racism in health care are significant health disparities in prevalence, diagnosis, and treatment of comorbid physical and mental health conditions. Despite decades of studies acknowledging health disparities based on race and an increased awareness of the social determinants of health, we seem to be lightyears away from significant change. There are shockingly few evidence-based interventions to change racism attitudes, behaviors, and practices at the provider and organizational-systems level. New paradigms are needed to intervene on, and not just document, racism in health care systems. We propose to develop and test a transformative paradigm for translating basic behavioral and social science into new anti-racism interventions for primary care settings. The paradigm is the first of its kind to integrate community-based participatory research, systems science, diffusion of innovation theory, and item response theory, leveraging an established framework of early phase translational behavioral and social science to rigorously define new anti-racism interventions within complex health systems and rigorously develop measures to assess impact. Anti-racism is a disruptive innovation in integrated primary care systems in the United States, one that can be rigorously mapped using community-engaged systems science methods. This map identifies “inflection points” likely to result in the most impactful intervention targets, and then established pathways can be used to translate fundamental behavioral and social science discoveries into new interventions at these points. Systems science modeling can then simulate potential interventions and produce mathematical standards for intervention efficacy in future trials. This transformative paradigm will also detail innovative methods to develop efficient and effective measurement tools to rigorously monitor outcomes. This transformative paradigm of antiracism as a disruptive innovation will not only revolutionize health equity interventions in integrated primary care systems but will provide a foundation for improving health care racism in other systems.