Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
Abt Associates, Cambridge, Massachusetts.
JAMA. 2021 Dec 21;326(23):2412-2420. doi: 10.1001/jama.2021.17579.
In January 2021, the US Preventive Services Task Force (USPSTF) issued a values statement that acknowledged systemic racism and included a commitment to address racism and health equity in recommendations for clinical preventive services.
To articulate the definitional and conceptual issues around racism and health inequity and to describe how racism and health inequities are currently addressed in preventive health.
An audit was conducted assessing (1) published literature on frameworks or policy and position statements addressing racism, (2) a subset of cancer and cardiovascular topics in USPSTF reports, (3) recent systematic reviews on interventions to reduce health inequities in preventive health or to prevent racism in health care, and (4) health care-relevant professional societies, guideline-making organizations, agencies, and funding bodies to gather information about how they are addressing racism and health equity.
Race as a social category does not have biological underpinnings but has biological consequences through racism. Racism is complex and pervasive, operates at multiple interrelated levels, and exerts negative effects on other social determinants and health and well-being through multiple pathways. In its reports, the USPSTF has addressed racial and ethnic disparities, but not racism explicitly. The systematic reviews to support the USPSTF include interventions that may mitigate health disparities through cultural tailoring of behavioral interventions, but reviews have not explicitly addressed other commonly studied interventions to increase the uptake of preventive services or foster the implementation of preventive services. Many organizations have issued recent statements and commitments around racism in health care, but few have provided substantive guidance on operational steps to address the effects of racism. Where guidance is unavailable regarding the proposed actions, it is principally because work to achieve them is in very early stages. The most directly relevant and immediately useful guidance identified is that from the GRADE working group.
This methods report provides a summary of issues around racism and health inequity, including the status of how these are being addressed in preventive health.
2021 年 1 月，美国预防服务工作组（USPSTF）发布了一份价值声明，承认了系统性种族主义，并承诺在临床预防服务建议中解决种族主义和健康公平问题。
阐明种族主义和健康不公平问题的定义和概念问题，并描述种族主义和健康不公平如何在预防健康中得到解决。
进行了一次审计，评估了（1）关于种族主义的框架或政策和立场声明的已发表文献，（2）USPSTF 报告中癌症和心血管主题的一个子集，（3）最近关于减少预防健康中的健康不公平或预防医疗保健中种族主义的干预措施的系统评价，以及（4）与医疗保健相关的专业协会、指南制定组织、机构和资助机构，以收集有关它们如何解决种族主义和健康公平问题的信息。
种族作为一种社会类别没有生物学基础，但通过种族主义产生生物学后果。种族主义是复杂和普遍存在的，在多个相互关联的层面上运作，并通过多种途径对其他社会决定因素和健康与福祉产生负面影响。在其报告中，USPSTF 已经解决了种族和族裔差异问题，但没有明确解决种族主义问题。支持 USPSTF 的系统评价包括可能通过行为干预措施的文化调整来减轻健康差距的干预措施，但这些评价没有明确解决其他常见研究的干预措施，以增加预防服务的采用或促进预防服务的实施。许多组织最近就医疗保健中的种族主义问题发表了声明和承诺，但很少提供关于解决种族主义影响的操作步骤的实质性指导。在拟议行动方面没有指导的情况下，主要是因为实现这些目标的工作处于非常早期的阶段。确定的最直接相关和最有用的指导来自 GRADE 工作组。
本方法报告总结了种族主义和健康不公平问题，包括在预防健康中解决这些问题的现状。
