Racism Counterfactuals in Health Research

There has been an increase in both research and funding aimed at exploring the connections between racism and racial health inequities. Despite these efforts, some quantitative analyses fall short when they rely heavily on counterfactual thinking (e.g., asking "what if" questions) on race and racism. Such methods are based on a theorization of race and racism that inadequately captures the White privilege inherent in the system of racism. Therefore, counterfactual thinking and methods can potentially perpetuate harmful interpretations of data. To address these shortcomings, we advocate for the use of methods that can account for White privilege including race-specific comparative analyses or intra-racial analyses. Unlike traditional counterfactual-based approaches, these types of analyses can provide a comprehensive view of how racism influences health outcomes, recognizing the varying impacts on individuals within structurally disadvantaged groups as opposed to those experienced by White individuals. Furthermore, by focusing on the specific needs of those most affected by health inequities, race-specific and intra-racial analyses adhere to principles of health equity ensuring a more accurate and effective anti-racist approach to understanding and addressing racial health inequities.