Racial Health Equity and Social Needs Interventions

Abstract

ImportanceSocial needs interventions aim to improve health outcomes and mitigate inequities by addressing health-related social needs, such as lack of transportation or food insecurity. However, it is not clear whether these studies are reducing racial or ethnic inequities.ObjectiveTo understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity.Evidence ReviewSources included a scoping review of systematic searches of PubMed and the Cochrane Library from January 1, 1995, through November 29, 2021, expert suggestions, and hand searches of key citations. Eligible studies evaluated interventions addressing social needs; reported behavioral, health, or utilization outcomes or harms; and were conducted in multiracial or multiethnic populations. Two reviewers independently assessed titles, abstracts, and full text for inclusion. The team developed a framework to assess whether the study was “conceptually thoughtful” for understanding root causes of racial health inequities (ie, noted that race or ethnicity are markers of exposure to racism) and whether analyses were “analytically informative” for advancing racial health equity research (ie, examined differential intervention impacts by race or ethnicity).FindingsOf 152 studies conducted in multiracial or multiethnic populations, 44 studies included race or ethnicity in their analyses; of these, only 4 (9%) were conceptually thoughtful. Twenty-one studies (14%) were analytically informative. Seven of 21 analytically informative studies reported differences in outcomes by race or ethnicity, whereas 14 found no differences. Among the 7 that found differential outcomes, 4 found the interventions were associated with improved outcomes for minoritized racial or ethnic populations or reduced inequities between minoritized and White populations. No studies were powered to detect differences.Conclusions and RelevanceIn this review of a scoping review, studies of social needs interventions in multiracial or multiethnic populations were rarely conceptually thoughtful for understanding root causes of racial health inequities and infrequently conducted informative analyses on intervention effectiveness by race or ethnicity. Future work should use a theoretically sound conceptualization of how race (as a proxy for racism) affects social drivers of health and use this understanding to ensure social needs interventions benefit minoritized racial and ethnic groups facing social and structural barriers to health.

Prevalence and Correlates of Unmet Medical and Social Needs in Virginia’s Medicaid Managed Long Term Services and Supports Program

“…For example, in the AHC pilot, individuals in racial minority groups were more likely to be eligible for navigation of social needs than white enrollees but less likely to opt into navigation for these needs and to report having their social needs addressed. This may suggest, similar to our findings, that a lack of trust in both the social and medical system and a lack of resources in predominantly minority communities may hamper the ability of MLTSS programs to serve members of color 33,34 …”

“…This may suggest, similar to our findings, that a lack of trust in both the social and medical system and a lack of resources in predominantly minority communities may hamper the ability of MLTSS programs to serve members of color. 33,34 Improving health equity in MLTSS programs requires health and social needs interventions at multiple levels. 34 Central to these efforts is increasing trust in the medical and social services that are responsive to the lived experiences of racial and ethnic minorities.…”

“…33,34 Improving health equity in MLTSS programs requires health and social needs interventions at multiple levels. 34 Central to these efforts is increasing trust in the medical and social services that are responsive to the lived experiences of racial and ethnic minorities. Examples of such strategies include legislation in Baltimore to ensure staff are providing trauma-responsive care, 35 required implicit bias training for health professional license renewal in Michigan, 36 and antiracism training in Greensboro, North Carolina, 37 as well as efforts aimed at dialogue in the truth, racial health and transformation framework that have taken place nationally.…”

Advancing health equity through social care interventions

“…25 Persons identifying as part of the lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual/aromantic/ agender, and more (LGBTQIA+) community, particularly those who identify as transgender, experience stigma-related violence that makes navigating healthcare and community settings more challenging, especially in settings that do not use trauma-informed practices. 26 32 Leveraging insights from previous work, the research team developed a framework to evaluate the extent to which studies advanced racial health equity. 32 The research team also examined the extent to which interventions were socioculturally tailored or adapted to mitigate the impact of racism.…”

“…26 32 Leveraging insights from previous work, the research team developed a framework to evaluate the extent to which studies advanced racial health equity. 32 The research team also examined the extent to which interventions were socioculturally tailored or adapted to mitigate the impact of racism.…”