Racism is a critical determinant of health that affects outcomes; shapes practice, policy, research, and interventions; and disproportionately burdens nondominant racial populations. The racial justice challenges of today, combined with persistent health inequities exacerbated by the COVID-19 pandemic, have intensified the need for racial equity–minded public health professionals. Because training programs play a key role in developing professionals, they must center teaching about racism and promoting antiracism within their curricula. The critical race theory–grounded strategy Public Health Critical Race Praxis (PHCRP) provides a useful framework, calling for examination of how racism operates within individuals and the systems, such as public health, in which they work. Foundational public health courses provide a vital opportunity to launch such an examination and lay the groundwork for antiracism praxis. This article offers a curricular model that integrates PCHRP with a creative approach to facilitate exploration of racial identity among public health students. Students in our course use photography and written reflections to create dual portraits, one depicting how they see themselves and the other imagining how they might be seen by others in our racialized society. Our pedagogical process prompts critical self-reflection about racial identity, a crucial foundation for addressing the health consequences of structural racism. Spurred by creative inquiry, students of all racial and ethnic backgrounds tell us that our course boosts their racial consciousness, enhances their understanding and ability to engage diverse communities, equips them to see and name racism in the public health context, and galvanizes them to work toward dismantling it.
Qualitative research can clarify how the racialized social system of Whiteness influences White Americans’ health beliefs in ways that are not easily captured through survey data. This secondary analysis draws upon oral history interviews (n=24) conducted in 2019 with Whites in a rural region of Appalachian western North Carolina. Interviewees discussed personal life history, community culture, health beliefs, and experiences with healthcare systems and services. Thematic analysis conveyed two distinct orientations toward health and healthcare: (1) bootstraps perspective, and (2) structural perspective. Whiteness did not uniformly shape interviewees’ perceptions of health and healthcare, rather, individual experiences throughout their life course and the racialized social system contributed to these Appalachian residents’ assessments of who is responsible for health and healthcare. Dissatisfaction with the Affordable Care Act was salient among interviewees whose life stories reflected meritocratic ideals, regardless of education level, age, or gender identity. They apprised strong work ethic as a core community value, assuming that personal contributions to the social system match the rewards that one receives in return for individual effort. Conversely, interviewees who were primarily socialized outside of rural Appalachia acknowledged some macro-level social determinants of health and expressed support for universal healthcare models. Findings suggest that there is not one uniform type of “rural White” within this region of Appalachia. Interventions designed to increase support for health equity promoting policies and programs should consider how regional and place-based factors shape White Americans’ sense of identity and subsequent health beliefs, attitudes, and voting behaviors. In this Appalachian region, some White residents’ general mistrust of outsiders indicates that efforts to garner more political will for health-promoting social programs should be presented by local, trusted residents who exhibit a structural perspective of health and healthcare.
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