Taking the Measure of Health Inequities

Written By: Robyn Fieser

There are two things Ester Villalonga Olives, PhD, MSc, never expected would happen when she came to the United States from Menorca, Spain, 11 years ago as a fellow at the Harvard T.H. Chan School of Public Health at Harvard University.

One was to stay longer than a year.

The other was to receive a prestigious grant from the National Institutes of Health (NIH).

It was the cultural richness and diversity of this country, which, she says, is both fascinating and challenging, that captivated her attention, leading her to settle here and focus her research on the social determinants of health.

Now, with a $3 million NIH grant, Villalonga Olives, associate professor in the Department of Practice, Sciences, and Health Outcomes Research at the University of Maryland School of Pharmacy, is developing an innovative measurement tool that will help researchers better understand the social and structural factors that contribute to health inequities for Black and Hispanic people.

“Our proposed measure reflects the complex interplay of cultural, social, and environmental factors across levels — from individual to societal — that impact people’s lives and assert racist policies and beliefs,” she says.

Villalonga Olives’ Structural Racism Measure builds on current tools to better capture social disadvantage by taking what she calls an “intersectional” approach that includes data from many sources and sectors.

For example, Villalonga Olives plans to add important economic indicators to existing measures of discrimination from sectors such as housing, education, and employment to her model. The wealth gap, she explains, is directly related to structural racism and impacts people’s health.

“We saw this during the pandemic,” she says. “I looked at the economic practices of people struggling to keep their businesses open and found that the federal government’s loan program was going to mostly White owners.”

Perhaps the most transformational aspect of the Structural Racism Measure is that it will be expanded to Hispanics, a population Villalonga Olives believes has been left behind for too long in studies looking at race and its relationship to health inequities.

“Many of the measures that already exist were not developed for and tested with Hispanics,” she says.

Leading a diverse and multidisciplinary team of social epidemiologists, behavioral scientists, and psychometricians from Yale, Duke, Johns Hopkins, and other universities, Villalonga Olives will compile a series of indicators from existing indexes that assess discrimination at multiple levels across key sectors. The team will then work with an expert panel of researchers and community participants, including community business owners, to ensure the measures are culturally relevant for both Blacks and Hispanics and in both English and Spanish.

“We need to make sure that what we are asking is meaningful to both groups. It is about diversity, and it is about considering the voices of different people,” says Villalonga Olives.

Being able to work on a project she believes will have major impact alongside a diverse team of people she likes and admires is the “sweet spot” of her career, says Villalonga Olives, who came to the School of Pharmacy in May 2017.

She became interested in the immigrant experience when she immigrated to the United States and has since then become an advocate in the Hispanic community. She recently traveled to El Salvador to experience firsthand the hardships pushing so many people to leave Central America and settle in the Baltimore/ Washington area.

“Sometimes I just feel like I have to intervene,” she says.

By creating a tool that is free of bias and works for Black and Hispanic people, Villalonga Olives hopes her study will open new horizons for decision makers, clinical practitioners, and researchers to reduce racial health inequities.

“We cannot change things if we can’t measure them well.”

This article originally appeared in the Spring 2024 issue of Capsule Magazine.