Editor's Desk: Taking action to address structural racism at Health Services Research

One of HSR's ambitions, articulated last year, is to address structural racism at the journal. ¹ Our motivating concern is that there may be parts of the health services research community to which HSR is not equitable and accessible.

To explore and address this, the editorial team, including the Editor in Chief, Senior Associate Editors, and Senior Managing Editor, along with the Editorial Board, spent the year defining our goals and identifying action items. Those goals and action items, along with the process undertaken to arrive at them, are fully described in a report available online. ² Below, we summarize efforts and plans more fully articulated in the report.

1. PROCESS

Preliminary goals (final versions of which are below) were developed by this editorial's authors in the first half of 2021 and presented to the Editorial Board in June. In late August, they were reviewed by HSR Editorial Board members and Senior Associate Editors at a Working Group Meeting. The Working Group Meeting also included breakout sessions to identify action items to meet the goals. Upon circulating our draft report that captured the meeting's content, we received additional feedback by email.

Incorporating feedback received through this process, below we list our final goals and describe action items in process or to be pursued this calendar year. Please consult the final report for details. ²

2. GOALS AND GUIDING PRINCIPLES

HSR's three goals to enhance inclusiveness and access broadly, and to address structural racism, are as follows:

1. For HSR to be equitable and accessible to the entire health services research community – from editorial positions to reviewer roles to publication in our journal.

2. In reviewing and publishing manuscripts, for HSR to be consistent, fair, and objective in how it handles “race” and “ethnicity” however they arise (e.g., as control variables, a main focus, etc.).

3. For HSR to be intentionally and transparently receptive to scholarship on structural racism as an underlying driver of inequities.

To achieve these goals, the Working Group suggested a few guiding principles that will inform how we move forward in addressing them. For example, one recommendation was to identify what is different about HSR in this space. Following this suggestion, to maximize our impact, we will pursue actions that build on HSR's strengths so that they lead to meaningful change. Second, another recommendation was to focus our efforts, not spread them too thinly. This is wise, as spreading effort over too many fronts is unlikely to yield the results we need on any.

Finally, we were advised to stay true to our mission to publish rigorously conducted scholarship, both quantitative and qualitative, as well as work that illuminates the theoretical underpinnings of issues in our field. Here, we must acknowledge that what is considered “rigorous” varies across subdisciplines within health services research. HSR has historically published studies with different types of methods, varying by subdiscipline and question addressed. This is one of the reasons a diverse editorial team is essential, to reflect the diversity in the field.

3. SHORT‐TERM ACTION ITEMS

We are already pursuing, or will be pursuing this year, a number of recommendations suggested by the Working Group. These are described below.

3.1. Diversify and Educate Editors

Beginning in January 2021, HSR began a conscious and ongoing effort to diversify its Editorial Board and Senior Associate Editor team. Diversity is multidimensional, including race and ethnicity, gender, sexual orientation/gender identity, ability/disability, socioeconomic status, and other lived experiences with social marginalization, as well as age/career stage, geography, institutional affiliation, discipline of study, and other factors. HSR will strive to broaden diversity in a way that takes these dimensions into consideration.

As the editorial team is diversified, we will also be raising the skills of current editors to attend to how structural racism issues arise (or should arise if they do not) in the manuscripts we receive. To do so, we will continue the process already underway in holding facilitated discussions and making external resources available at editorial staff meetings about structural racism issues.

3.2. Increase Author/Reviewer Expectations

In revised author instructions, ³ we have clarified HSR's expectations for how of race and ethnicity are included in research methods, findings, and discussion. In particular, the instructions refer authors to detailed, external resources for appropriate guidance. ⁴ , ⁵ We will also amend our reviewer invitation email to point to these resources and to this editorial, stating that it is our expectation that authors follow this guidance and editors, with the help of reviewers, enforce it.

3.3. Call Attention to Structural Racism and Racial Equity

In several new and ongoing ways, HSR will call attention to the role of structural racism as a driver of racial health inequities. First, as we have in the past, we will continue to group articles thematically in each issue. As the journal publishes articles on structural racism and health equity, it will designate them as such.

Second, we are planning several sponsored, special issues on health equity to be published in 2022 and 2023 that specifically invite articles on structural racism. The intention of one of them is to invite junior scholars from structurally disadvantaged populations and provide mentorship through the authorship process for those who need it. These are part of an ongoing commitment of HSR to dedicate special issues to exploring racism and health equity that includes the 2019 Robert Wood Johnson Foundation‐sponsored special issue on the experience of discrimination in America. ⁶

Finally, early this year we will post on our website an open call (not tied to any organizational sponsorship) that invites manuscripts that empirically document relationships between racism and the financing, organization, delivery, and outcomes of health services. This call, as well as the special issues mentioned above, will be receptive to work that identifies the relationship between racism and health inequities, as well as scholarship about data and methods for addressing the study of racism and about theoretical/conceptual guidance and terminology.

4. LOOKING AHEAD

The report includes additional action items that will take beyond 2022 to bring to fruition. ² A particularly important one is collecting demographic data on editors, authors, and reviewers. The data will provide baseline information and ultimately will support longitudinal analysis of diversity and representation of the editorial team, along with analyses of who is invited for commentaries, who gets reviewed by whom, and whose papers are accepted or rejected. We are enthusiastic about this recommendation, but obtaining the infrastructure and resources to implement it will be a multi‐year process.

For transparency, as we turn our attention to this and other action items, in future years we will describe our plans in editorials like this. We will also document progress we have made on actions taken. As we move forward, we will look for opportunities to partner with AcademyHealth. HSR is already in discussions with AcademyHealth to find overlap between their efforts (described in a commentary in this issue ⁷ ) in this area and ours.

In late winter 2022, we will reconvene the Working Group to discuss progress to date and implementation plans for specific action items to be addressed in 2022. Annually thereafter, we will report progress at the Editorial Board meeting in June and, separately for a deeper discussion, reconvene the Working Group.

Finally, we welcome the broadest possible input into our goals and plans. Your opinion matters to us and we hope you will share it by emailing hsr@aha.org.