Using theory to connect structural racism to health outcomes

EPID 684
Spatial Epidemiology
University of Michigan School of Public Health

Jon Zelner
[email protected]

Today’s Theme

How can we appropriately measure the impacts of structural racism on spatial health inequality?


  • Methodological considerations in the measurement of structural racism.

  • Brief overview of infectious disease transmission models

  • Hands-on with mechanisms discussed in Acevedo-Garcia paper.

  • Discussion of the cyclical nature of residential segregation and infection.

What does it mean to model infectious disease transmission?

  • Represent change over time in disease outcomes.
  • Explore possible futures if key parameters such as \(R_0\) are changed.
  • \(R_0\) = the average number of new infections generated by a single case in a fully susceptible population.
  • In general, \(R_0 > 1 \to\) outbreak/epidemic.

What goes into a parameter like \(R_0\)?

Figure from Zelner et al. 2022

What might not sit right about this statement?

“Isolation may increase the risk for gonorrhea through its effect on social factors as well. Social norms — which also can be transmitted — have been shown to be associated with sexual risk among adolescents and among Black women. In isolated communities, within group norms for risky sexual behavior might be strengthened.” (1)

How do measures like dissimilarity and isolation reflect transmission risks?

Hands-on with a mechanistic version of this model

Values and biases are baked into the ways we measure…everything.

Suggestions for accurately measuring the nature of and impact of structural racism on health outcomes (From (2))

Doing better work on structural racism requires creativity

We must think beyond our training, statistical tests, and practices that dismiss methodologies that we may be unfamiliar with. There is scholarship being overlooked that proposes new approaches we could explore…, but we cannot move forward with capturing variables like structural racism if we do not explore our creativity. (From Adkins-Jackson 2021)

Next Time

Biello KB, Kershaw T, Nelson R, et al. Racial Residential Segregation and Rates of Gonorrhea in the United States, 2003. American Journal of Public Health [electronic article]. 2012;102(7):1370–1377. ( (Accessed December 15, 2019)
Adkins-Jackson PB, Chantarat T, Bailey ZD, et al. Measuring Structural Racism: A Guide for Epidemiologists and Other Health Researchers. American Journal of Epidemiology [electronic article]. 2021;kwab239. ( (Accessed February 8, 2022)