Toward a fourth generation of disparities research to achieve health equity.
Annual Review of Public Health, 32: 399-416
Achieving health equity, driven by the elimination of health disparities, is a goal of Healthy People 2020. In recent decades, the improvement in health status has been remarkable for the U.S. population as a whole. However, racial and ethnic minority populations continue to lag behind whites with a quality of life diminished by illness from preventable chronic diseases and a life span cut short by premature death. We examine a conceptual framework of three generations of health disparities research to understand (a) data trends, (b) factors driving disparities, and (c) solutions for closing the gap.Wepropose a new, fourth generation of research grounded in public health critical race praxis, utilizing comprehensive interventions to address race, racism, and structural inequalities and advancing evaluation methods to foster our ability to eliminate disparities. This new generation demands that we address the researcher's own biases as part of the research process.
Chandra L. Ford, PhD, and Collins O. Airhihenbuwa, PhD
Critical Race Theory, Race Equity, and PublicHealth: Toward Antiracism Praxis
Am J Public Health. 2010;100: S30–S35. doi:10.2105/AJPH. 2009.171058
Racial scholars argue that racism produces rates of morbidity, mortality, and overall well-being that vary depending on socially assigned race. Eliminating racism is therefore central to achieving health equity, but this requires new paradigms that are responsive to structural racism’s contemporary influence on health, health inequities, and research. Critical Race Theory is an emerging transdisciplinary, race-equity methodology that originated in legal studies and is grounded insocialjustice. CriticalRace Theory’s tools for conducting research and practice are intended to elucidate contemporary racial phenomena, expand the vocabulary with which to discuss complex racial concepts, and challenge racial hierarchies. We introduceCritical Race Theory to the public health community, highlight key Critical Race Theory characteristics (race consciousness, emphases on contemporary societal dynamics and socially marginalized groups, and praxis between research and practice) and describe Critical Race Theory’s contributionto a studyonracism and HIV testing among African Americans.
Chandra L. Forda, Collins O. Airhihenbuwa
The public health critical race methodology: Praxis for antiracism research
Social Science & Medicine 71 (2010) 1390e1398
The number of studies targeting racial health inequities and the capabilities for measuring racism effectshave grown substantially in recent years. Still, the need remains for a public health framework that moves beyond merely documenting disparities toward eliminating them. Critical Race Theory (CRT) has been the dominant inﬂuence on racial scholarship since the 1980s; however, its jurisprudential origins have, until now, limited its application to public health research. To improve the ease and ﬁdelity with which health equity research applies CRT, this paper introduces the Public Health Critical Race praxis (PHCR). PHCR aids the study of contemporary racial phenomena, illuminates disciplinary conventions that may inadvertently reinforce social hierarchies and offers tools for racial equity approaches to knowledge production.
Nancy Krieger, PhD
Does Racism Harm Health? Did Child Abuse Exist Before 1962? On Explicit Questions, Critical Science, and Current Controversies:
An Ecosocial Perspective
American Journal of Public Health | February 2003, Vol 93, No. 2
Research on racism as a harmful determinant of population health is in its infancy. Explicitly naming a long-standing problem long recognized by those affected, this work has the potential to galvanize inquiry and action, much as the 1962 publication of the Kempe et al. scientific article on the “battered child syndrome” dramatically increased attention to—and prompted new research on— the myriad consequences of child abuse, a known yet neglected social phenomenon. To further work on connections between racism and health, the author addresses 3 interrelated issues: (1) links between racism, biology, and health; (2) methodological controversies over how to study the impact of racism on health; and (3) debates over whether racism or class underlies racial/ethnic disparities in health.
Lisa Bowleg, PhD
The Problem With the Phrase Women and Minorities: Intersectionality— an Important Theoretical Framework for Public Health
Am J Public Health. 2012;102:1267–1273. doi:10. 2105/AJPH.2012.300750
Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, ocioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism). Public health’s commitment to social justicemakes it a natural fit with intersectionality’s focus on multiple historically oppressed populations. Yet despite a plethora of research focused on these populations, public health studies that reflect intersectionality in their theoretical frameworks, designs, analyses, or interpretations are rare. Accordingly, I describe the history and central tenets of intersectionality, address some theoretical and methodological challenges, and highlight the benefits of intersectionality for public health theory, research, and policy.
Collins O. Airhihenbuwa, PhD, MPH, Chandra L. Ford, PhD, and Juliet I. Iwelunmor, PhD
Why Culture Matters in Health Interventions: Lessons From HIV/AIDS Stigma and NCDs
Theories about health behavior are commonly used in public health and often frame problems as ascribed or related to individuals’ actions or inaction. This framing suggests that poor health occurs because individuals are unable or unwilling to heed preventive messages or recommended treatment actions. The recent United Nations call for strategies to reduce the global disease burden of noncommunicable diseases like diabetes requires a reassessment of individual-based approaches to behavior change. We argue that public health and health behavior intervention should focus more on culture than behavior to achieve meaningful and sustainable change resulting in positive health outcomes. To change negative health behaviors, one must first identify and promote positive health behaviors within the cultural logic of its contexts. To illustrate these points, we discuss stigma associated with obesity and human immunodeficiency virus and acquired immune deficiency syndrome. We conclude that focusing on positive behaviors and sustaining cultural and personal transformations requires a culturally grounded approach to public health interventions, such as that provided by the PEN-3 model.
Juliet Iwelunmor, Valerie Newsome, & Collins O. Airhihenbuwa
Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions
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