Designing Interventions Addressing Structural Racism to Reduce Kidney Health Disparities: A Report from a National Institute of Diabetes and Digestive and Kidney Diseases Workshop

Abstract

Structural racism embodies the many ways in which society fosters racial discrimination through "mutually reinforcing inequitable systems" that limit access to resources and opportunities that can promote health and well-being among marginalized communities. To achieve health equity, and kidney health equity more specifically, structural racism must be eliminated. In February 2022, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened the "Designing Interventions that Address Structural Racism to Reduce Kidney Health Disparities" workshop which was aimed at describing the mechanisms through which structural racism contributes to health and healthcare disparities for people along the continuum of kidney disease; and identifying actionable opportunities for interventional research focused on dismantling or addressing the effects of structural racism. Participants identified six domains as key targets for interventions and future research: 1) apply an anti-racism lens, 2) promote structural interventions, 3) target multiple levels, 4) promote effective community and stakeholder engagement, 5) improve data collection, and 6) advance health equity through new healthcare models. There exists an urgent need for research to develop, implement and evaluate interventions that address the unjust systems, policies, and laws that generate and perpetuate inequities in kidney health.

Effect of a Novel Multicomponent Intervention to Improve Patient Access to Kidney Transplant and Living Kidney Donation

“…Trial findings may not be generalizable to other health care systems because dialysis practice patterns, patient case-mix, access to multidisciplinary care, and resources available to improve access to kidney transplant may vary across geographical regions . Finally, this intervention did not address inequities in access to transplantation, a key priority in health care …”

Residential Structural Racism and Prevalence of Chronic Health Conditions

“…5,12,13,17,[20][21][22] Efforts to elucidate potential targets for interventions designed to mitigate residential neighborhood health inequities are nascent. 23 We examined the association of global and discrete indicators of structural racism with residential neighborhood prevalence of CKD, hypertension, and diabetes--chronic health conditions for which racial and ethnic disparities have long been described.…”

Federal Regulations and Dialysis-Related Disparities

“…End-stage renal disease (ESRD) or kidney disease (ESKD) represents one of the most visible health conditions beset with racial, ethnic, and socioeconomic disparities, alongside a substantially high cost of care per patient . Health disparities typically describe group differences in the prevalence, incidence, or outcomes of a health condition or differences in quality of care that would not exist in an equitable and just society . Usually those injustices are due to conscious and unconscious biases embedded in laws, policies, and/or practices that inform how structures and systems allocate health- and life-affirming resources and opportunities .…”

“…Health disparities typically describe group differences in the prevalence, incidence, or outcomes of a health condition or differences in quality of care that would not exist in an equitable and just society . Usually those injustices are due to conscious and unconscious biases embedded in laws, policies, and/or practices that inform how structures and systems allocate health- and life-affirming resources and opportunities . System-level bias based on racial and ethnic identities is commonly termed structural racism , but these same structures and systems can also have embedded group biases based on sex, gender identity, ability, religion, socioeconomic status, and more …”