The Role of Implementation Science in Dismantling Structural Racism: Expanding Strategies and Recognizing Power as a Central Determinant
摘要
Implementation science (IS) was developed to more rapidly apply evidence-based practices that improve population health. Its focus on multi-level contexts underscores the recognition that achieving population health requires cultivating environments that promote health for all, positioning health equity as a central priority within IS. However, structural racism remains a significant barrier to realizing both health equity and population health. This commentary responds to the call from IS leaders Shelton, Adsul and Oh to apply IS methods toward dismantling structural racism by drawing on foundational work, including the Public Health Critical Race Praxis, as a lens to explore strategies to achieve this objective. Central to this discussion is the recognition of power imbalances between decision-makers in the outer levels of context (e.g. policy-makers) relative to those in the inner levels (e.g. clinicians and patients). This imbalance emphasizes the need to focus efforts to dismantle structural racism at political and policy levels—where decisions that have the broadest impact are made. Concrete examples from implementation research offer use cases of the suggested strategies presented, demonstrating how these approaches can effectively address structural racism and in doing so advance health equity and population health.