Still we rise: research on bias and discrimination will endure

Abstract

This is a commentary on Reisner et al’s Analyzing multiple types of discrimination using implicit and explicit measures, comparing target vs. Dominant groups, in a study of smoking/vaping among community health center members in Boston, Massachusetts (2020–2022). This manuscript is a study of the intersection of multiple forms of discrimination–racism, sexism, heterosexism, cissexism, ageism, and sizeism–and measures of implicit and explicit bias in the context of current smoking and vaping behavior among patients from targeted versus dominant groups at community health centers in Boston, Massachusetts (USA) from 2020 to 2022. The authors used logistic regression to assess smoking and vaping behavior with each type of discrimination, and then extended this analysis employing a meta-regression approach to better understand relationships across all types of discrimination under consideration in their study. Recently, the grant from the US National Institutes of Health, which supported this research was terminated in progress for ideological reasons by the current US administration under President Donald J. Trump for simply focusing on discrimination. While this study was among the first to be terminated by the Trump administration, hundreds of grants from the NIH and other US research funders have been cancelled in the first half of 2025. Reisner et al’s paper is an important piece of research, but it represents the start of a sophisticated inquiry into discrimination and bias, and future work by this team and in this area of research is necessary and sadly, now impossible to do with federal scientific funding. Work on discrimination and bias has always faced obstacles, but the scope and scale of attacks on science in the US require all scientists to push back against this censorship and political interference in the funding and conduct of research.

In 1883, the first Black woman in the United States to become a physician, Rebecca Lee Crumpler, wrote A Book of Medical Discourses [1]. In this two-volume work, Dr. Crumpler explored the health burdens of newly emancipated African Americans, relying on her experiences in working with the Freedmen’s Bureau in Virginia after the Civil War. As journalist Jeneen Interlandi explained in her essay, “Why Doesn’t the United States Have Universal Health Care? The Answer Has Everything to Do With Race”, in the New York Times Magazine’s 1619 Project special issue, Crumpler was writing in the context of a medical system that blamed Black people for their poor health outcomes [2]. Crumpler recognized that these theories of “black extinction” and racial inferiority ignored the social factors that drove sickness and premature death in this population, writing: “They seem to forget that there is a cause for every ailment, and that it may be in their power to remove it.” [3]. Dr. Crumpler was one of the 19th century’s pioneers in understanding what we now call the social determinants of health in our country, situating contemporary research on health disparities and discrimination in a long, yet obscured and often erased, history when it comes to minoritized communities [4, 5, 6].

The new paper by Reisner and colleagues in this journal adds to this deep legacy of inquiry. Current work on discrimination and health has become increasingly sophisticated since the field took up these issues with a more comprehensive, analytic approach in the 1980s and 1990s [7, 8, 9]. This research, utilizing a meta-regression approach, demonstrates complex and nuanced relationships at work in explicit and implicit bias across different types of discrimination and among group membership. It represents the first time we have seen a study of explicit and implicit discrimination across six types of bias—racism, sexism, heterosexism, cissexism, ageism, and sizeism—among targeted and dominant groups, though previous studies have examined these phenomena separately and in part. This work also integrates sociopolitical issues that were of concern to study participants, their sociodemographic characteristics and residential contexts and finally, evaluates the impact of explicit and implicit discrimination across types of bias among targeted and dominant groups on current smoking and vaping behavior. Surprisingly, the researchers here found greater odds (1.18 CI = 1.00-1.39) of smoking/vaping among dominant, but not target group members, when comparing explicit to implicit discrimination measures, perhaps, as the authors suggest, from coping strategies among targeted groups to mitigate the health-harming effects of discrimination.

After reading this paper, I wanted more; more of this work, expanded to other setting beyond Boston, looking at other health outcomes, employing new tools to examine the mechanistic and causal pathways that might be involved. Good research answers questions, but more importantly, generate additional ones and in ordinary times, I would look forward to the next step in this research, the ways in which the investigators will follow up on their insights here in additional work. Yet, these are extraordinary times, and the future of this research is in jeopardy. The grant that supported this study was in the very first set focused on domestic research questions to be terminated by the National Institutes of Health on February 28, 2025, for the reasons stated below:

DEI: Research programs based primarily on artificial and non-scientific categories, including amorphous equity objectives, are antithetical to the scientific inquiry, do nothing to expand our knowledge of living systems, provide low returns on investment, and ultimately do not enhance health, lengthen life, or reduce illness. Worse, so-called diversity, equity, and inclusion (“DEI”) studies are often used to support unlawful discrimination on the basis of race and other protected characteristics, which harms the health of Americans. Therefore, it is the policy of NIH not to prioritize such research programs.

As of early May, hundreds of grants have been terminated by the NIH (and the National Science Foundation), many because of their focus on discrimination of some kind, or simply because of any mention of race, gender or sexuality [10, 11]. There is no scientific rationale for these terminations and while some grants have been reinstated, most have not endangering the future of research on these and other issues (e.g., HIV, vaccines).

It is important to name what is behind these new policies by the Trump Administration, it is a neo-segregationist initiative, across government, and across the very types of bias this paper focused upon, including race, gender and gender identity, sexuality [12, 13]. We already know from previous research that in fact, social determinants of health, including racism, sexism, heterosexism, cissexism, ageism and sizeism are indeed tied to poorer health outcomes, greater sickness and reduced survival, despite what the Trump administration says above. The evidence is in the decades of scientific study of these issues, but more importantly embodied in the millions of people who have suffered the real-world effects of discrimination in this country from the Middle Passage to our contemporary moment.

Close to 150 years ago, Dr. Rebecca Crumpler challenged the segregationist narrative that we see being revived today. The attacks on black and brown people, on the LGBTQ community, on women require that all of us stand up, push back and challenge what is happening in the US. Part of that is pushing ahead with the science, advancing our knowledge of how discrimination works to endanger our health. In this case, Reisner and colleagues’ article also stands as a moment of bearing witness, of re-inscribing what the Trump administration would erase, so that the rest of us can see it, plain as day.

Author contributions

G.G. was the sole author of this commentary.

Funding

No funding of any kind supported this manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval

Not applicable.

Competing interests

The authors declare no competing interests.