Dr. Williams Responds to APHA's Recommendations on Racial and ethnic data: Forcing race is not ethical or scientific

May 12, 2025

By Christopher Williams, PhD
Principal Investigator, Critical Race Framework Study

The American Public Health Association (APHA) repeatedly acknowledges structural determinants as major drivers of racial and ethnic disparities in its October 2024 policy statement, The Case for Improved Racial and Ethnic Public Health Data Collection Practices to Reduce Racial Disparities in Health.[1] Yet, its attempt at reform only worsens the anachronism and misappropriation of race in modern science. The field of public health should privilege scientific principles, as discussed extensively in the Critical Race Framework Study, over ideological preference for race while prioritizing action to anticipate and affect the poor performance of the public health economy.

Even if refined, the continental or supra-construct of race is not appropriate because humans do not inherently belong to and cannot be grouped into racial groups that hold scientific meaning. To allege otherwise is to uphold scientific racism. There is no genetic, cultural, historical, ideological, political, religious, linguistic, convergent, or divergent justification for racial grouping. No, descendants of US enslaved and Jim Crow families are not part of a global "Black race" that includes anyone from African countries or that Nigerians and Ethiopians belong to a "Black" monolith. They should not be studied as such. No, US-based ethnic groups should not be grouped based on crude phenotypic characteristics with any global population of varying sociocultural backgrounds to form a "White race." Perhaps, a fatal blow to APHA's recommendations on refining race is the variable temporospatial performance of macro and micro public health economies. Even if science were to arrive at reliable and valid population descriptors, public health economies vary too wildly. For example, an African American (ADOS) born in DC in the 1960s would have stark life outcomes than an African American (ADOS) born in Central Virginia in the same period, as would with an African American (ADOS) born in DC in 1999, given the severe underperformance of DC's public health economy until the beginning of the 21st century.  A recent study highlights such differences, "All-Cause Mortality and Life Expectancy by Birth Cohort Across US States". [2] It should be noted that the Critical Race Framework regards African Americans (ADOS) as a US-based ethnic group that warrants sustained study and who deserves reparations. However, this example shows that racial refinement is not necessarily uniformly deterministic in terms of public health outcomes.

This critique of racial categorization is secondary to the urgent need to reform public health training, research, and practice "to achieve health equity and advance social justice for all," as APHA states as its goal. [1] For all its discussion about structural racism, neighborhood determinants vary considerably not only across states but within cities. As conceptualized in Public Health Liberation theory, the nature of the public health economy is highly context-dependent. [3] The intersection and interplay of social, political, economic, educational, legal, and regulatory determinants of health should be the basis for a new transdiscipline à la the public health economy.

APHA does not address that previously published research is highly attenuated because of overreliance on racial analysis and insufficient examination of threats to study quality. The National Academies of Sciences, Engineering, and Medicine had a similar oversight in their report in 2024, Rethinking Race and Ethnicity in Biomedical Research. [4] Racialization carries enormous risks to public health research quality. The Critical Race Framework Study aligned its critique of race closely with scientific reasoning in the development of a critical appraisal tool in four inviolable areas: reliability, validity, internal validity, and external validity.

APHA's statement was situated within structural racism, which appears to marginalize the health needs of non-minority (racialized "White American") populations for which structural racism does not typically apply. Structural inequity and depravity are major determinants of health that warrant public health commitment and intervention.  Seeking to further equity while sidelining 60% of the US population is an untenable position. The field has become too fixated on racializing public health research. For example, vaccine hesitancy is common across populations regardless of race and ethnicity. It just may be less noticeable for racialized White populations with high vaccine hesitancy because of data choices that average White respondents. In fact, socioeconomic measures, such as educational attainment, income, and occupation, are often associated with vaccine hesitancy. [5] 

The Critical Race Framework study extensively discussed potential errors in public health research. When researchers applied the critical appraisal tool, they found that 20 highly cited health disparities overwhelmingly had low quality of discussion. Instead of clearing this stain on science, the APHA perpetuates a harmful and abused practice in research. APHA needed to unequivocally state that there are no global races. It did not. APHA needed to better convey an understanding of the influence of macro and micro public health economies and applied scientific reasoning in public health research. APHA cannot realize its stated goal to achieve health equity as long as the myth of global races and racial subgroups persist.