Critical Anti-Racist Discourse Analysis Applied to Federally Qualified Health Center Policy

Abstract

Federally 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 anti-racist. This can result in institutional racism shaping and influencing policy. FQHCs motivated to engage racism-conscious policy need anti-racism policy analyses. We applied one such method to an FQHC’s operations manual: Critical, Anti-Racist, and Discourse Analysis (CARDA). Using CARDA, three themes were identified, describing pathways along which institutional racism might be reified: (a) procedures for actions were specified but no specific position was listed as responsible, (b) policies written in passive voice, and (c) absence of explicit delineation of workflow responsibilities. Dismantling institutional racism requires analyzing policies that have potential for unintended effects. Cultivating clear policies and procedures for addressing harm and naming positions responsible for implementation of policy and procedure builds accountability, trust, and relationships between institutions and communities.