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 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 health care 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 antiracism 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 health care models. There is 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.

Keywords: CKD; health disparities; racial and ethnic disparities; racism.

Figure 1.

Conceptual framework for root causes of kidney health disparities. Structural racism contributes to longstanding and stark inequities in health and health care for people with kidney disease including the upstream structural determinants—including inequitable health and health care policies that create and perpetuate health disparities; the midstream social determinants such as housing conditions, neighborhood environment, food insecurity, and access to equitable high-quality health care that shape health; and the downstream effects these social determinants have on the lives of individuals at risk of and living with kidney disease.