Definitions and Themes of “Racial Health Equity”: A Systematic Review

Article type
Authors
Terhune E1, Dagne M1, Piper C2, Pizarro A3, Barsoum M1, Rizvi A4, Francis D5, Viswanathan M6, Sathe N6, Welch V7, Duque T8, Riddle D9, Turner II R10, Baker T11, Heyn P1
1Center for Optimal Aging, Marymount University, Arlington, VA, USA
2Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
3Clinical Research Center, Fundación Valle del Lili, Cali, Columbia
4School of Psychology, University of Ottawa, Ottawa, ON, Canada
5School of Health and Human Performance, Georgia College and State University, Milledgeville, GA, USA
6RTI International, RTI-UNC US Cochrane Affiliate, Durham, NC, USA
7Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
8Cochrane, Central Executive Team, London, UK
9Center for Translational Research, Texas Christian University, Fort Worth, TX, USA
10Department of Clinical Research and Leadership, George Washington University, Washington, DC, USA
11Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
Abstract
"Background: The use of the term ""racial health equity"" has significantly risen in academic literature since 2020, although a unifying definition is lacking. There is a need for a clear definition of racial health equity to prevent misunderstandings, promote a shared language across fields, and lead to the establishment of metrics that could affect resource allocation. Thus, we conducted a review of current understandings of the term.
Objectives: This study aimed to systematically review how ""racial health equity"" and related concepts are defined within theoretical and conceptual academic articles.
Methods: We included English-language articles, imposing no date restrictions, to evaluate the definitions of racial health equity and its related terms, including “racial health inequity,” and “racial health disparities.” A thematic analysis was conducted on all included definitions using the 2006 Braun and Clark framework. Patient and healthcare interest holders were involved in the initial design of this project as well as its parent project, “Centering racial health equity in systematic reviews” (Robert Wood Johnson Foundation #79982).
Results: From 1,816 articles retrieved, 16 contained pertinent definitions, with a notable increase in publications from 2020 to 2023. The analysis revealed varied themes in these definitions, particularly racism, healthcare quality, discrimination, and social determinants of health. Other themes included social hierarchy, justice, unmet social needs, and historical events. Nine included articles acknowledged race as a social construct. The foundational literature to support the included definitions varied, with only the 2003 report ""Unequal Treatment"" being cited across multiple definitions.
Conclusions: Our findings highlight a loose consensus on key themes such as racism, healthcare quality, and social determinants of health, although no word-for-word definitions were shared across sources. To advance equity efforts, this study underscores the necessity for ongoing dialogue to refine the understanding of racial health equity. We advocate for establishing a unified and actionable definition to guide health fields toward a common goal.
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