Racism in public health authorities-A scoping review and situational analysis

Racism is a structural determinant of health. While racism in health care services is increasingly well-researched, public health services and public health authorities (PHA) have been neglected as institutional contexts. Yet, PHA play an essential role in protecting and promoting population health at a local and national level. To help fill this research gap, we mapped the academic discourse on racism in PHA with a narrative scoping review. We searched in PubMed, Embase, PsycINFO and CINAHL as well as the reference lists of retrieved publications. We included literature assessing racism in interactions between all stakeholders involved or in the actions (not) taken by PHA, while we excluded literature exclusively focusing on health care facilities. We applied situational analysis (SA) for interpreting the scientific discourse on racism in PHA. Our search yielded 55 publications that include survey and intervention studies as well as opinion pieces. Most of the literature focuses on the US, Australia and New Zealand/Aotearoa. The Tuskegee experiment has been discussed extensively acknowledging the political and historical elements of the racist, inhumane practices and policies in PHA. More recent literature explores anti-racism approaches and how they can facilitate access for racialized, socially multiply stigmatized groups (e.g., screening uptake in racialized queer people). SA also suggests racialized groups may be implicated or silenced groups in racism research surrounding PHA. We show that the literature on racism in PHA is limited, mostly processing historical policies. Studies on how racism affects equitable access to PHA and the associated health inequities are lacking. Positive examples highlight the importance of a) building the services in PHA on anti-racism and equity-driven principles and b) integrating and amplifying the voices of racialized community. Public health research on racism needs to extend the scope from health care services to the under researched public health services and authorities.