‘Different Than a Regular White’

Abstract

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.

Whiteness hurts society: How whiteness shapes mental, physical, and social health outcomes

“…Our paper expands on the whiteness and health framework, and research by others (e.g., Efird, 2021;Efird & Lightfoot, 2020;Ford & Sharif, 2020;Metzl, 2019;Versey et al, 2019), to further investigate the effects of whiteness on health and mental health among White Americans. Specifically, we highlight how the ideologies of whiteness can influence Whites' specific psychosocial responses (see Figure 1), and our unique contribution names how these ideologies can shape Whites' health, while simultaneously adversely affecting the health and function of society at large.…”

“…In particular, how do characteristics, such as religious affiliation, class status, gender identity or expression, place of residence, or political affiliation relate to White identity? While some of these issues have been explored (Efird, 2021; Jardina, 2019; Scott, 2022), scholars still lack knowledge regarding how these potential variations might be associated with White Americans’ specific health outcomes.…”

“…Since that time, many majority‐Republican states have refrained from expanding Medicaid (Hertel‐Fernandez et al., 2016; Shepherd, 2022). Research consistently demonstrates that White Americans associate needs‐based social programs, such as Medicaid, with people of color (Efird, 2021; Gilens, 1996; Snowden & Graaf, 2019) and many White Americans remain avidly opposed to Medicaid expansion (Fiscella, 2016; Grogan & Park, 2017; Jardina, 2019; Metzl, 2019). Fueled by whiteness, hostility toward people of color “encourages Whites to reject policies designed to help the poor and reduce inequality” (Malat et al., 2018, p.151).…”

The importance of family relationships for the health of underserved Appalachians: An application and extension of the biobehavioral family model.

“…These relationships are beneficial and help individuals mitigate economic and geographic barriers, thus promoting health (Ehsan et al, 2019; Grevenstein et al, 2019) and healthcare utilization (Roberson et al, 2020). At the same time, the Appalachian culture is characterized by mistrusting healthcare providers and tends to rely on kinship networks for health advice (Efird, 2022), potentially leading to challenges in improving health. Therefore, given the interpersonal characteristics of this subculture, nonmarital and marital family relationships may both be critical to health outcomes among Appalachians, especially in the context of rurality.…”

Perceived status threat and health among White Americans: A scoping review

“…For example, alignment with racist, anti-communist, and U.S. imperialist orientations underpinned the naming of SARS-CoV-2 and COVID-19 as “the China virus” or “the Chinese flu” ( Daniels et al, 2021 ; Perry et al, 2021 ; Scott, 2022 ). Even in less overtly bigoted expressions, resistance to pandemic-era public health mandates ( Koon et al, 2021 ) has been deeply wrapped up in racial and right-wing ideologies and rhetoric regarding individualism ( Efird, 2021 , Efird & Lightfoot, 2020 , Mendenhall, 2022 , Metzl, 2019a , Metzl, 2019b ). For example, being made aware of racial disparities in COVID-19 outcomes made White Americans less likely to support public health mandates ( Skinner-Dorkenoo et al, 2022 ).…”