Structural Surveillance as a Health Determinant: Mandated Reporting, Medical Practices, and Black Familial Health

In the United States, Black families continue to experience great disparities in both the medical and child welfare systems. Utilizing mandated reporting as a tool, physicians are a primary driver of the racial disparities in the child welfare system. Despite extensive research on racial bias in the child welfare system and health inequities impacting the Black community, prior studies have not examined associations between mandated reporting by physicians and medical adherence by Black parents. Utilizing Structural and Benevolent Harm Theory (BH) and Social Determinants of Health (SDOH) frameworks, this study explores how Black parents understand and experience mandated reporting policies in pediatric settings and how their experiences affect health care utilization practices for families. Thirty-one (n = 31) Black parents participated in semi-structured virtual interviews detailing their knowledge of mandated reporting, their experiences, and the impact of mandated reporting on their family medical decisions. Through thematic analysis, three themes emerged: (1) shared knowledge of racial profiling in medicine, (2) medical decision-making impacted by fears, and (3) racialized physician bias. Findings illustrate that physician interactions associated with mandated reporting affect the medical decision-making of Black parents. This study illuminates an under-researched intersection between child welfare policy, medical practices associated with mandated reporting, and Black healthcare disparities, emphasizing the urgent need for structural and practice-level changes.