When Does Political Empowerment Mitigate Racial Disparities in Infant Mortality? A Simulation Study
1
Institute for Global Health, University College London, London, United Kingdom
2
Faculty of Political Science, University of Florida, Gainesville, United States
3
School of Nutrition, Federal University of Bahia, Salvador, Brazil
4
Department of Health and Mental Hygiene, Government of New York, New York, United States
5
Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2757
ABSTRACT
BACKGROUND:
Structural racism shapes health inequalities through macro processes involving political power, spatial determinants, and resource allocation. Traditional epidemiological studies capture downstream impacts, but are limited in their ability to model how racial politics and health systems interact at scale. Yet sustained reductions in health inequality require systems-level change. We used system dynamics modelling to simulate the impacts of political empowerment of minoritised populations on health inequalities in the UK and Brazil.
METHODS:
As part of the Lancet Commission on Racism and Child Health, we collaborated with 26 multidisciplinary experts and four international youth advisory boards to develop a model for key dynamics linking racism and child health using a causal loop diagram. We translated this into stock-and-flow models for the UK and Brazil using empirical literature and country-specific data, which captured demographic change, health system capacity, and political decision-making over resource allocation. We simulated scenarios varying the extent to which minoritised populations could ensure that their health needs were prioritised in health system funding decisions.
RESULTS:
In the UK model, where policy levers primarily target access barriers to a shared health system (e.g. language or cultural barriers), greater influence for ethnic minorities yielded clear reductions in infant mortality disparities at negligible cost to the majority. In the Brazil model, where racial groups are unevenly distributed across geographic regions and policy levers operate through geographically targeted health system funding, greater influence of minoritised groups reduced mortality disparities between regions, but left racial disparities at the national level intact.
CONCLUSIONS:
Our findings suggest that political empowerment of minoritised groups may not have uniform effects on inequalities in infant mortality, but depends on the policy mechanism through which benefits are distributed. Modelling complex systems dynamics provides a powerful framework for surfacing often counter-intuitive distributional consequences that are difficult to predict a priori.
Structural racism shapes health inequalities through macro processes involving political power, spatial determinants, and resource allocation. Traditional epidemiological studies capture downstream impacts, but are limited in their ability to model how racial politics and health systems interact at scale. Yet sustained reductions in health inequality require systems-level change. We used system dynamics modelling to simulate the impacts of political empowerment of minoritised populations on health inequalities in the UK and Brazil.
METHODS:
As part of the Lancet Commission on Racism and Child Health, we collaborated with 26 multidisciplinary experts and four international youth advisory boards to develop a model for key dynamics linking racism and child health using a causal loop diagram. We translated this into stock-and-flow models for the UK and Brazil using empirical literature and country-specific data, which captured demographic change, health system capacity, and political decision-making over resource allocation. We simulated scenarios varying the extent to which minoritised populations could ensure that their health needs were prioritised in health system funding decisions.
RESULTS:
In the UK model, where policy levers primarily target access barriers to a shared health system (e.g. language or cultural barriers), greater influence for ethnic minorities yielded clear reductions in infant mortality disparities at negligible cost to the majority. In the Brazil model, where racial groups are unevenly distributed across geographic regions and policy levers operate through geographically targeted health system funding, greater influence of minoritised groups reduced mortality disparities between regions, but left racial disparities at the national level intact.
CONCLUSIONS:
Our findings suggest that political empowerment of minoritised groups may not have uniform effects on inequalities in infant mortality, but depends on the policy mechanism through which benefits are distributed. Modelling complex systems dynamics provides a powerful framework for surfacing often counter-intuitive distributional consequences that are difficult to predict a priori.
| eISSN: | 2654-1459 |
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