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We must do better science: addressing racism to improve health and safety for all people
  1. Christen J Rexing1,
  2. Bernadette C Hohl2,
  3. Renee Johnson3,
  4. Marizen Ramirez4,
  5. Kathleen F Carlson5,6,
  6. Theresa H Cruz7
  1. 1 Department of Urban Public Health & Nutrition, School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA
  2. 2 Department of Biostatistics & Epidemiology, School of Public Health, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
  3. 3 Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4 Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
  5. 5 School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
  6. 6 Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon, USA
  7. 7 Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
  1. Correspondence to Dr Bernadette C Hohl, School of Public Health, Department of Biostatistics & Epidemiology, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA; bernadette.hohl{at}

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The brutal killings of George Floyd, Ahmaud Arbery, Breonna Taylor and others sparked widespread protests for racial and economic justice in the USA and around the globe. A fundamental principle espoused by the Black Lives Matter movement and other groups involved in direct action is that our most enduring social problems are rooted in structural factors and must therefore be addressed with structural solutions. (In this context, ‘structural’ refers to elements of social systems that provide a foundation for how societies operate, such as policies, norms, religion and other belief systems and economies.) This principle is as relevant to injury and violence as it is to other health and social problems; disparities in injury outcomes are closely connected to social inequities.1

At this critical point in history, we are called to confront the influence of structural factors on injury and violence directly. Giles and colleagues2 recently recommended that we incorporate equity as the fourth ‘e’ in injury prevention. Building on their recommendation, we argue that it is critical to highlight structural racism as a determinant of injury and violence. Structural racism is at hand when race and ethnicity serve as the basis for conferral of advantages to White people and disadvantages to Black, Latino/a/x (the authors acknowledge that the acceptability of Latino/a/x varies among groups but use this language in an attempt to be inclusive), Indigenous and other groups.3–5 Structural racism exerts effects through policies and practices of social institutions, such as education, housing or criminal justice systems, and provides a foundation for economic status. Understanding and addressing structural racism is imperative to moving the field forward.

As a fundamental cause of injury and violence, structural racism is remarkably understudied. Consequently, we have limited information with which to identify and address modifiable structural determinants of injury and violence,3 greatly limiting the advances that could be made in prevention. We can and must expand our scientific frameworks and approaches to directly examine how structural racism impacts injury and violence. One needed change is a more thorough and explicit conceptualisation of how race and ethnicity are associated with risk and, subsequently, how the variables measuring these social constructs are used analytically.6 7 A growing body of research points to ways we can make this change. Examples include (1) use of terms, concepts and variables that recognise the social processes that shape risk, for example, by refocusing from race/ethnicity to direct measures of structural racism; (2) richer discussions of the exposures that race/ethnicity categories are meant to measure, instead of treating race as an independent variable in and of itself or as a confounder to be quietly adjusted away and (3) posing scientific questions that explicitly improve knowledge of how structural inequalities give rise to racial, ethnic and other status-based disparities in injury and violence.3 6–8 We must ask ourselves: what about race or ethnicity is of interest—is it experiences with interpersonal racial discrimination; is it structural inequities that drive income, occupation or education? We must then ask ourselves if there are better (more direct and modifiable) measures than race/ethnicity for the constructs we are studying. As in recent examples,9–13 this approach can yield clearer recommendations for structural interventions that transform the social and economic conditions causing the observed inequities in injury and violence risk.14

SAVIR is committed to advancing diversity, equity, inclusion (DEI) and antiracism both within the organisation and in the field of injury and violence prevention. Heeding the scientific data showing that diverse teams conduct better science,15–17 we endeavour to enhance diversity in our membership and in our field more broadly. As a professional organisation representing injury and violence researchers, it is our responsibility to challenge our community of scientists to ensure our research is inclusive and represents the state of the science. We are committed to advancing the study and practice of injury and violence prevention and control by pushing for science that explicitly examines how structural factors shape risk and that yields new insights into structural interventions. This commitment was reflected in the 2020 Annual Meeting theme, Promoting Health Equity Through the Science of Injury and Violence Prevention. For this meeting, we created a Statement on Health Equity, Key Definitions and Guidance for Abstract Submissions to guide meeting presenters on embedding principles of antiracism and health equity into their presentations. We hope this statement will serve as a foundation for further improvements to the procedures and policies that guide the work in our field.

Moving forward, SAVIR is committed to identifying and implementing new DEI strategies and initiatives, across all of its committees, with an explicitly antiracist framework. Additionally, we have founded an interest group charged with spearheading antiracism efforts within the organisation and the field. We are eager to see our members advocate for, and embrace, new methods, new voices and new organisational partnerships in our work and—ultimately—produce better injury and violence prevention science leading to better injury and violence prevention solutions. This work is all of ours to do, and we urge you to join us.



  • Twitter @bchohl

  • Contributors CJR, BCH, RJ, MR, KFC and THC each contributed to conceptualising and drafting and the manuscript. Each approved the final version for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.