A path towards measuring and responding to racism in public health in British Columbia

Racism is widely recognized as a determinant of health, yet it is rarely measured in population health data. Efforts to eradicate racism are limited when public health systems fail to document its presence, even though Indigenous, Black, and racialized people experience its harmful effects daily. Efforts to understand racism have primarily focused on experiences of harm, often leaving unexamined the structures that produce and sustain those inequities, including Whiteness. This dissertation examines how racism can be measured, while advancing approaches to make visible the structural conditions that uphold racial inequities, with a focus on British Columbia (BC), Canada. First, a Knowledge Summit with Indigenous, Black, and racialized Knowledge Keepers and subject matter experts explored what is required to measure racism in ways that are safe and grounded in community knowledge. Participants affirmed that what gets measured matters, and that measuring racism must be grounded in community-led governance, rooted in the teachings and worldviews of Indigenous, Black, and racialized peoples, and directly tied to accountability, action, and system transformation. Second, a scoping review identified and analyzed racism measurement tools. While multiple validated tools exist, most focus on interpersonal experiences and lack the conceptual fit or feasibility required for population health use. Third, a pilot study examined how people working in public health respond to an Unlearning Whiteness Questionnaire, looking at the instrument’s functionality, limitations, and future applications. Findings showed that while such tools can prompt reflection and surface tensions, the instrument was limited by conceptual misalignment, design constraints, and challenges related to interpretation and social desirability. The findings demonstrate that measuring racism as a determinant of health is both necessary and possible. Public health systems must develop a racism measurement tool, integrate racism and Whiteness into measurement efforts, and establish accountability mechanisms that turn findings into action. Measurement alone will not dismantle racism. Data must be accompanied by institutional commitment and a willingness to confront the structures of privilege and power that sustain racism and White supremacy. Ultimately, we will know these approaches to measuring racism are being done properly when Indigenous, Black, and racialized people say they are.