Race, Power and Privilege in Health Policy: Developing a Critical Race Policy Analysis Framework

Background and Purpose: Social determinants of health, or the conditions in which people are born, live, work, play, and age, are maintained through policies and institutions which systematically work to put certain social groups at an economic and social disadvantage. This system of maintaining or furthering social disadvantage for certain social/racial groups is of great concern because these conditions play a fundamental role in disparities of health. Recently, the American Journal of Public Health (2019) states that past and current health disparities research tends to focus on single or individual level factors. The National Institutes of Health has called for research to utilize macro approaches to address health disparities to understand structural drivers. Focusing on these upstream social determinants of health such as policy and governance which work to shape the pathways that lead to health disparities needs to be better understood.

This paper helps to fill this gap by developing a critical race policy analysis framework to analyze local, state, and national policies to increase racial equity in health outcomes. My research explains how social and economic policies work to set up systems of oppression to limit resources and restrict social mobility for communities of color leading to health disparities.

Methods: Content analysis is a qualitative systematic research method for analyzing textual information in a standardized way that allows evaluators to make inferences about that information.³⁰ This method is used to “determine the presence of certain words, concepts, themes, phrases, ideas, characters, or sentences within texts or sets of texts and to quantify this presence in an objective manner”. A critical race policy analysis framework lists the questions an analyst would post in systematically analyzing policy. The questions establish a critical racial lens through which to examine any policy topic regardless of whether it specially references race or not.  

Data: Twenty key readings from the critical racy theory literature were analyzed though a content analysis methodology to systematically pull out key concepts of CRT and develop an analytic framework through which to engage policy. Included in this text are key writings written by scholars and authors of critical race theory such as Derrick Bell Jr, Kimberly Crenshaw, Richard Delgado, Mari Matsuda, Dorothy Roberts, Gary Peller, and Neil Gotanda just to name a few.

Findings: The analysis led to the development of a critical race policy analysis framework. The framework consists of 35 questions divided into several categories: values, goals, permanence of racism, color neutrality, interest convergence, challenging dominant ideology, intersectionality, revisionist history, counter storytelling, and commitment to social justice.

Conclusion and Implications: The literature and practice in health care indicates a growing need for new paradigms of analysis that are responsive to structural racism and its influence on health disparities. A critical race policy analysis framework helps analysts design inclusive health policies and dismantle the relationship between power and privilege and the implicit patterns and habits that make dominant groups stay in power, in other words dismantling white supremacy in health policy.