Evidence and Gap Map
Evidence and Gap Map
Black scholars and civil rights activists have named systemic barriers to health equity for over a century. However, interventions that name racism as a root cause of disparate outcomes are new. The approaches employed by these interventions to address racism are complex and diverse.
Georgia Health Policy Center researchers conducted a systemic scoping review to describe interventions addressing systemic racism implemented in the United States since 1960. These interventions were examined within the and by what social or structural determinant of health they addressed. The goal was to increase understanding of these interventions (e.g., impact, context applied) and where there are gaps in knowledge.
Findings are presented as an evidence and gap map (EGM), which summarizes and describes the characteristics or components of interventions (e.g., location where intervention was implemented, description of sample or population impacted by intervention) and the evidence or lack of evidence relative to target outcomes. This map aligns outcomes around the seven Vital Conditions for Health and Well-Being. The map may help researchers, practitioners, evaluators, public health professionals, community-based practitioners, and funders in designing and implementing interventions seeking to improve health equity.
Click on the arrows in the column or row heads to expand or collapse a row or a column. Hover over the row and column headings and subheadings for descriptions and definitions. Select the Fullscreen view for an expanded view (select escape to exit Fullscreen viewing). Click on a bubble to see all the references included in that square. Once you click on any bubble you can also sort and filter the map by an outcome(s) and/or any of the intervention characteristics.
This EGM includes 91 records (e.g., studies, reports) that describe an intervention designed to address some aspect of how racism impacts health and well-being. Of these, two are qualitative, five are reviews, six are pilot studies, 12 are observational, and 66 are impact evaluations.
Most interventions report operating at the individual level (n = 81). A total of 49 interventions focuses on the interpersonal level, followed by 52 at the community level, 46 at the institutional level, and 46 at the structural level.
Evidence: Most interventions report outcomes that fall within the health domain (n = 81). Of those, 24 interventions focus on chronic disease management (e.g., diabetes, cancer, kidney disease); 19 interventions concentrate on health knowledge/literacy; 18 address child and infant health; 16 focus on mental or behavioral health; and 16 concentrate on tobacco, alcohol, or substance use prevention or treatment.
Gaps: We found little evidence of interventions that focus on the built and natural environments. There are also notable gaps in several other domains, including lifelong learning and public safety. Few, if any, interventions reported politico-legal outcomes as they pertain to policy, law, regulation, guidance, or budgetary decisions.
Extensive literature describe health outcomes that are impacted by racism. Little is understood regarding the interaction between multilevel interventions and the interdependent outcomes that interventions purport to impact. Future should consider examining how interventions operate within and across sectors. It would be incredibly valuable to understand the degree to which interventions include a long-term evaluation to assess and report change over time. This body of research would benefit from understanding how successful interventions integrate a politico-legal component regarding how practices, policy, regulations, and budgetary decisions are created or change in response to an intervention.