Dougie Zubizarreta

Structural racism—which encompasses discriminatory laws/policies, institutional practices, and social norms—is a driver of racialized health inequities in the U.S. Notably, laws/policies at the federal, state, and local levels perpetuate structural racism across all societal domains and are key structural determinants of racial health equity. Health equity practitioners play a critical role in mitigating the impacts of structural racism-related laws/policies through their legal, policy, and community-based work at state and local health departments, community-based organizations, and health policy organizations. While the broad professional experiences of health equity practitioners have previously been documented, research specifically examining their approaches to addressing structural racism in the context of racial health equity practice is limited. Hence, we conducted a qualitative study interviewing practitioners (n = 21) employed at organizations seeking to advance racial health equity across the U.S.; interviews were conducted between December 2023-February 2024. We applied template-style thematic analysis, identifying practitioners’ four key approaches to addressing structural racism: (1) documenting racialized health inequities; (2) policy monitoring, evaluation, and analysis to understand the impacts of structural racism-related laws/policies; (3) establishing multisectoral collaborations among academic, community, and government partners; and (4) fostering anti-racism within health equity organizations. Health equity practitioners can address structural racism in the context of racial health equity practice by not only documenting its impacts on racialized health inequities but also developing sustainable partnerships among health departments, community-based organizations, and health policy organizations and meaningfully supporting and aligning with the needs, priorities, and community organizing efforts of marginalized racialized communities.

Background: In the USA, HIV remains a pressing public health challenge (~37 400 new diagnoses in 2018) and pronounced racialised inequities persist. In 2018, Black and Latine people represented 43% and 26% of new diagnoses but only 13% and 18% of the population, respectively. Antiracist laws may help mitigate these inequities, yet research investigating specific laws is lacking. This study aimed to examine associations between state minimum wage laws and new HIV diagnosis rates by racialised group and sex/gender. Methods: We linked data on inflation-adjusted state minimum wage and state-level new HIV diagnosis rates among US adults aged 13–59 years. We fit two-way fixed-effects models to examine associations between changes in minimum wage and changes in new HIV diagnosis rates per 100 000 people from 2010 to 2019 by racialised group (Black/Latine/White) and sex/gender (women/men). Additional analyses tested for effect heterogeneity by racialised group and by sex/gender within racialised group. Results: Findings show an inverse association between state minimum wage and new HIV diagnosis rates across all racialised and sex/gender groups, except White women. Among Black adults, a 1 US Dollar ($) increase in state minimum wage was associated with a 5.81 per 100 000 decrease in new HIV diagnosis rate, followed by Latine (2.81/100 000) and White adults (1.50/100 000). The inverse association was larger among Latine (4.73/100 000) and White men (2.88/100 000) than Latine (0.98/100 000) and White women (0.07/100 000), respectively. There was no evidence of effect heterogeneity comparing Black men to Black women. Conclusions: State minimum wage laws may represent a critical policy intervention to address racialised HIV inequities.