Guides

Research Methodology

Voices for Healthy Kids is dedicated to exposing and dismantling structural racism—the policies, systems and social norms created and upheld to give white people advantages not offered to American Indians and Alaska Natives, Latinos, Black and African Americans, and Asian and Pacific Islanders. It’s a public health crisis that harms physical and mental health, and widens gaps in access to health care, education, income, housing and other factors vital to well-being.

Policies often create unjust conditions that uphold structural racism. They can also be used to tear it down. This means policies must spell out where implementation will be prioritized—geographically and demographically—to benefit the communities where the need is greatest, and how the policy should be designed to address the communities’ specific contexts, issues and barriers. Without that specificity, policies intended to expand equity can actually have the opposite effect. For example, a policy intended to benefit “all children” fails to recognize that, because of structural racism, some communities have less access to programs or funding created by those policies. Or, a one-size-fits-all policy fails to meet the specific needs of communities where the disparity is greatest. Instead of benefiting from the intended purpose of the policies, children in these communities continue to be left behind, and the disparity gap widens.

Our Racial Equity in Public Policy Message Guide includes tested messages to support conversations among community leaders, advocates, decision-makers to embed racial equity in public policy. The details of our testing methodology are outlined below.  

  • Step 1: Develop messages with advocates

    Advocates across the country, including people of color and those working with and in communities experiencing structural racism, as well as those working in both progressive and conservative areas, helped develop the initial messages. They provided invaluable input about what needs to be said, the conversation it will spark, and the support people need to have these conversations.

    Step 2: Test with decision-makers

    We tested the messages in four interviews and an online survey [1]. The objective was not to soften our messages; rather we wanted to understand how to maintain our conviction while advancing an effective discussion.

    The national survey consisted of 102 decision-makers and influencers with the following demographics:

    Occupation

    Percentage of Respondents

    State and local government staff 

    23%

    State elected officials[2]

    2%

    Policy influencers: community leaders, lobbyists, academics, and association and non-profit executives

    75%

    Political Party

    Percentage of Respondents

    Democrat

    50%

    Republican

    14% 

    Independent

    36%

    Geography

    Percentage of Respondents

    Northeast

    21%

    Midwest

    13%

    West

    19% 

    South

    48%

    Race and Ethnicity

    Percentage of Respondents

    People of color or Indigenous people

    25%

    White

    69%

    Hispanic

    2%

    Unspecified

    7%

    Gender Identity

    Percentage of Respondents

    Male

    61%

    Female

    36%

    Age

    Percentage of Respondents

    24-44

    26%

    45-66

    56%

    65+

    16%

  • Testing showed that our messages make a credible case with decision-makers. How we enter and have the conversation will vary depending on their mindset. There are two subgroups:

    Those who may be more ready for direct conversations about racial equity (66% of respondents). These respondents are mostly progressive, see structural racism as a problem in the U.S. today, and respond well to messages that acknowledge the need to redress unjust practices. (Note that even these champions may not always be comfortable or fluent in these conversations or may not have thought about why or how to target policies. Similarly, you may encounter leaders in racial justice who are not yet aware of how our policies, written strongly, can bolster their work.)

    Those who may be less ready for direct conversations about racial equity (34% of respondents). These respondents lean conservative, do not see structural racism as a problem in the U.S. today, and prefer messages that avoid suggesting causes of inequities or assigning blame. They may be in various stages of readiness when it comes to having these conversations and doing the work.

    Across both groups, a solid majority think people who are white enjoy at least a “fair amount” of benefits not available to people of color. This is a significant opening for our work. But only about half recognize this as structural racism. Others point to other factors, including personal behavior or choices, cultural and family situations, or lack of access to jobs. Most of the decision-makers in the survey prioritize opportunity for people in the community when they make policy. From there, the two subgroups split on their underlying values, as shown below. 

  • Those values—especially the shared value of opportunity—give us a great place to start. To build out the full messages, we tested every message combination to determine the set that most effectively makes the case for targeting policies where the need is greatest, especially in communities experiencing structural racism. 

    Most effective messages for those who may be more ready for direct conversations:

    Testing showed that these three message points are effective with an audience that is “more ready” and values equity. This message combination resonated with 85% of the “more ready” sub-audience in our survey.

    1. Unjust policies that shape physical, economic, cultural and societal environments have resulted in poorer health, lower incomes, higher medical costs and limited opportunities for social, economic and financial advancement. 

    2. New policies cannot undo the damage of structural racism and ongoing discrimination, but they can advance health and prevent future harm.

    3. When people make decisions about their health—or the health of their children—we should be sure that policies do not limit their options and opportunities. We need to recognize and address the ways in which policies impact communities differently, especially those most affected by structural racism.  

    Most effective messages for those who may be less ready for direct conversations:

    Similarly, testing showed that these three message points are effective with people who are “less” ready and who prioritize personal liberty and stewardship of public funds. This message combination resonated with 97% of your audience of the “less ready” sub-audience in our survey.

    1. When people make decisions about their health—or the health of their children—we should be sure that policies do not limit their options and opportunities. We need to recognize and address the ways in which policies impact communities differently.

    2. We will know that we have achieved health and racial equity when race can no longer be used to predict health, well-being and longevity.

    3. Unjust policies that shape physical, economic, cultural and societal environments have resulted in poorer health, lower incomes, higher medical costs and limited opportunities for social, economic and financial advancement.

    Most effective proof points across the board: 

    We also tested a variety of proof points to use with the messages that help illustrate the impact of structural racism. The majority of respondents across the entire survey rated the following points most effective at making the case for targeting policies to communities experiencing structural racism.

    • The COVID-19 pandemic showed that disparities in health, economic and social conditions put people of color at much higher risk of illness and death than white people. [3]

    • Even among working people earning low wages, people of color are at a greater disadvantage.[4] Even at high-income levels, people of color have worse health outcomes than white people at the same income level. [5]

    • A study by the financial company Citigroup[6] estimates that systemic racism faced by Black people over the last 20 years has cost the U.S. economy $16 trillion, including gaps in wages, access to housing and higher education, and investment in Black-owned businesses. 

    • Historically, policies have placed people of color at significant disadvantage by denying education, mortgages, loans, and health benefits provided to white people. [7]

  • We took these testing insights back to the advocates who helped shape the initial messages. With their guidance, we created two message pathways to productive conversations—one for decision-makers who may be more ready for direct conversations about racial equity, and one for those who may be less ready. We recognize that no one will fall neatly into one set of messages, and the conversation will evolve over time. We know that some advocates will want to be even more direct in their conversations, and we wholeheartedly support that. Our hope is that these messages help normalize the conversation about racial equity, lead to concrete changes in policy language, and expand over time as our nation works to eliminate structural racism. 

Download the message guide

This guide includes tested messages for advocates to use with decision-makers to secure racial equity language in public policy. We suggest you start here.

The left-hand navigation menu will take you to additional online resources to support your work.

Citations:

  • [0] Survey conducted in October 2020 by Metropolitan Group and Prime Group. Participants were recruited through Leadership Connect, a comprehensive, national database of policy leaders and influencers. We randomly selected a sample of people in the database and emailed invitations to participate, then screened potential respondents to confirm their policy experience before they were offered the survey. Percentages may not add up to 100 percent in every case because some people left answers blank. This audience is generally representative of policy leaders and influencers nationwide. The n=102 sample size provides a reliable read on the overall audience and their messages preferences, but analysis of subgroups should be considered directional due to the smaller sample sizes.
  • [1] The survey was conducted during the COVID-19 pandemic, so many lawmakers were not available to participate.
  • [2] Samantha Artiga, Bradley Corallo, and Olivia Pham, “Racial Disparities in COVID-19: Key Findings from Available Data and Analysis,” Issue brief, KFF (August 2020), http://www.kff.org/report-section/racial-disparities-in-covid-19-key-findings-from-available-data-and-analysis-issue-brief/.
  • [3] Office of Disease Prevention and Health Promotion, “Healthy People 2020, Self Determinants of Health, Poverty,” http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/poverty.
  • [4] Kanetha B. Wilson, Roland J. Thorpe, Jr, and Thomas A. LaVeist, “Dollar for Dollar: Racial and Ethnic Inequalities in Health and Health-Related Outcomes Among Persons with very High Income,” Science Direct, Preventive Medicine 96 (March 2017): 149-153, https://www.sciencedirect.com/science/article/abs/pii/S0091743516302444?via%3Dihub
  • [5] “Closing the Racial Inequality Gaps: The Economic cost of Black Inequality in the U.S.,” Citi Global Perspectives & Solutions Report (September 2020), https://www.citivelocity.com/citigps/closing-the-racial-inequality-gaps/
  • [6] Keith Churchwell et al., “Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory from the American Heart Association,” Circulation 142, no.24 (November 2020), http://www.ahajournals.org/doi/10.1161/CIR.0000000000000936.

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