Table 3 Example excerpts with broad and granular labels

Dismissal

Dismisses racism as a mechanism; does not name racism

In a time when all physicians of goodwill are working to eliminate the racial discrimination that remains in American medicine, it is most disheartening to read Dr. Therman E. Evans’s call for prescription of racial quotas on all “advisory panels, review committees and policy boards” (N Engl J Med 295:1013, 1976). That the men and women who serve on such boards and committees should be selected for their service on merit, and without regard to criteria like race, creed or color, should not need to be stated. [20]

Person-level

Attributes race-related difference in health to interpersonal (aberrant) factors

Higher levels of implicit bias among clinicians have been directly linked with biased treatment recommendations in the care of black patients, although the pattern is not uniform. [21]

Societal

Describes structural (embedded into society) factors; does not name racism

Our results provide key evidence that the plurality of HIV-related disparities in US black MSM relative to other MSM are disparities in HIV clinical care access and use, structural issues (e.g., low income, unemployment, incarceration, low education), and sex partner characteristics, rather than disparities in sexual and substance-use risk behaviours. Low income, unemployment, incarceration, and low education are not only interrelated, but also all are independently associated with HIV infection … Possible intervention strategies for black MSM overall, HIV-positive black MSM, and young black MSM to address these and other disparities are outlined in the appendix. [22]

Actionable

Describes racism as structural (embedded into society); recommends action

Although there is much to do, we recommend that health care systems engage, at the very least, in five practices to dismantle structural racism and improve the health and well-being of the black community and the country. [23]