Centering the relationship between structural racism and individual bias.

Cesario misrepresents or ignores data on real-world racist and sexist patterns and processes in an attempt to discredit the assumptions of implicit bias experimentation. His position stands in stark contradiction to substantive research across the social sciences recognizing the widespread, systematic, and structuring processes of racism and sexism. We argue for centering the relationship between structural racism and individual bias.

Rationing, racism and justice: advancing the debate around 'colourblind' COVID-19 ventilator allocation.

Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities-who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey's Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on 'objective medical knowledge'. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance.

Sequential organ failure assessment, ventilator rationing and evolving triage guidance: new evidence underlines the need to recognise and revise, unjust allocation frameworks.

We respond to recent comments on our proposal to improve justice in ventilator triage, in which we used as an example New Jersey's (NJ) publicly available and legally binding Directive Number 2020-03. We agree with Bernard Lo and Doug White that equity implications of triage frameworks should be continually reassessed, which is why we offered six concrete options for improvement, and called for monitoring the consequences of adopted triage models. We disagree with their assessment that we mis-characterised their Model Guidance, as included in the NJ Directive, in ways that undermine our conclusions. They suggest we erroneously described their model as a two-criterion allocation framework; that recognising other operant criterion reveals it 'likely mitigate[s] rather than exacerbate[s] racial disparities during triage', and allege that concerns about inequitable outcomes are 'without evidence'. We highlight two major studies robustly demonstrating why concerns about disparate outcomes are justified. We also show that White and Lo seek to retrospectively-and counterfactually-correct the version of the Model Guideline included in the NJ Directive. However, as our facsimile reproductions show, neither the alleged four-criteria form, nor other key changes, such as dropping the Sequential Organ Failure Assessment score, are found in the Directive. These points matter because (1) our conclusions hence stand, (2) because the public version of the Model Guidance had not been updated to reduce the risk of inequitable outcomes until June 2021 and (3) NJ's Directive still does not reflect these revisions, and, hence, represents a less equitable version, as acknowledged by its authors. We comment on broader policy implications and call for ways of ensuring accurate, transparent and timely updates for users of high-stakes guidelines.

The racial geography of child welfare: toward a new research paradigm.

This article examines the community-level impact of concentrated child welfare agency involvement in African American neighborhoods. Based on interviews of 25 African American women in a Chicago neighborhood, the study found that residents were aware of intense agency involvement in their neighborhood and identified profound effects on social relationships including interference with parental authority, damage to children's ability to form social relationships, and distrust among neighbors. The study also discovered a tension between respondents' identification of adverse consequences of concentrated state supervision for family and community relationships and neighborhood reliance on agency involvement for needed financial support. The author discusses the implications of these findings for a new research paradigm aimed at understanding the community-level effects of racial disproportionality.

Is race-based medicine good for us?: African American approaches to race, biomedicine, and equality.

This article presents a preliminary framework for exploring the intersection of science and racial politics in the public debate about race-based pharmaceuticals, especially among African Americans. It examines the influence of three political approaches to race consciousness on evaluations of racial medicine and offers an alternative critique.

Legal constraints on the use of race in biomedical research: toward a social justice framework.

This article addresses three questions concerning the legal regulation of the use of race as a category in biomedical research: how does the law currently encourage the use of race in biomedical research?; how might the existing legal framework constrain its use?; and what should be the law's approach to race-based biomedical research? It proposes a social justice approach that aims to promote racial equality by discouraging the use of "race" as a biological category while encouraging its use as a socio-political category to understand and investigate ways to eliminate disparities in health status, access to health care, and medical treatment.

The persistence of white privilege and institutional racism in US Policy

In this analysis report, racial minorities are cast as "problems to be solved" instead of victims of an unjust system. Yet, as 19th century, an African American freedom fighter put it nearly a century ago, "There is no Negro problem, the problem is whether the American people have loyalty, honor, patriotism enough, to live up to their own constitution." White privilege is more than a set of attitudes or individual opinions. It is an overarching, comprehensive framework of policies, practices, institutions and cultural norms that undergird every aspect of US society. Too often, discussion of racial discrimination focuses solely on the effects on those who are oppressed as if there are no oppressors or beneficiaries.