Federally Qualified Health Centers (FQHCs) were created to improve health outcomes in underserved communities, providing holistic care that integrates physical health, mental health, maternal health, dental care, and more. Positioned to address the needs of predominantly Black and Brown communities, these centers aim to reduce disparities by increasing access to essential services. Yet, the policies governing these institutions often reflect and reproduce the systemic inequities they seek to eliminate.
As public health scholars Jennifer Jabson Tree, Judson Laughter, Sandra Wairimu, Khadijah Melvin, and Eboni Winford observe:
âFederally Qualified Health Centers (FQHCs) seek to improve health equity for marginalized and historically disenfranchised communities. However, FQHC policies are not necessarily designed to be explicitly antiracist. This can result in institutional racism shaping and influencing policy.â
In their recent study, published in Health Promotion Practice, the team critically examines the policies underpinning FQHCs using a rigorous, qualitative method called Critical Anti-Racist Discourse Analysis (CARDA). Their findings reveal how vague, passive, and unaccountable policy language can undermine equity and perpetuate harm, even within organizations explicitly committed to health justice.
The authors argue that anti-racist reform must begin by recognizing the structural and linguistic mechanisms through which institutional racism operates. Their research highlights key vulnerabilities in existing policies and demonstrates how actionable anti-racist change can emerge through intentional, critical analysis.
As they write, âpolicy may offer a promising dimension because it guides activities, services, behaviors, and expectations that directly relate to health care outcomes.â
However, unless explicitly designed with anti-racist principles, policies may inadvertently âreifyâ existing inequities.
Through their CARDA analysis, the team identifies three recurring patterns in FQHC policies that allow institutional racism to persist: unclear assignment of responsibilities, the use of passive language, and the absence of explicit workflows to address structural inequities. These findings challenge FQHCs to align their policies with their mission by embedding accountability, transparency, and anti-racist intent into every level of their operations.