Missing Mayberry: How whiteness shapes perceptions of health among white Americans in a rural Southern community

Efird, Caroline R.; Lightfoot, Alexandra F.

doi:10.1016/j.socscimed.2020.112967

Cited by 15 publications

(16 citation statements)

References 27 publications

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“…Similar to Jonathan M. Metzl's (2019) findings in Dying of Whiteness: How Racial Resentment is Killing America's Heartland, I posit that pervasive bootstraps ideology could further negatively affect the health of millions of uninsured Whites who reside in Appalachia (Appalachian Regional Commission 2012), as deaths of despair and perceived social status threat worsen White mortality rates (Siddiqi et al, 2019). These interviews and previous research indicate that the association of former President Barack Obama with the ACA precludes many Whites -especially White Republicans-from supporting it (Efird and Lightfoot, 2020;Metzl 2019;Tesler 2012). Because of this, any local efforts to promote Medicaid expansion in NC should be reframed in ways that de-emphasize the term "Medicaid."…”

Section: Discussionmentioning

confidence: 94%

“…In this manuscript, I will illuminate how Whiteness historically and presently shapes beliefs about health and healthcare programs for Whites in a rural, economically distressed region of the Appalachian Mountains in western North Carolina. Building on my prior research which denotes how Whiteness shapes perceptions of health in a rural community in the American South (Efird and Lightfoot, 2020), I posit that there may be regional, cultural differences in the ways that rural Whites describe health and healthcare. Variations in White American identity and ethnicity exist (Hughey 2010;Kaufmann 2019;McDermott and Samson, 2005;Omi and Winant, 1994), and regional diversity in Whites' affinity for their racial identity is difficult to parse out in nationally representative survey data which do not account for the length of time that Whites have lived in a specific region or area (Jardina 2019).…”

Section: Whiteness In Rural Appalachiamentioning

confidence: 99%

“…Thus, an era of "Laissez-faire racism" (Bobo et al, 1997) bolsters many Whites' denial and blindness to the ways that racism has infiltrated structures and systems throughout history and at present (Bobo 2017a(Bobo , 2017b. Regard for individual effort is deeply rooted in what many Whites equate with being American (Efird and Lightfoot, 2020;Geronimus and Thompson, 2004;Jardina 2019), and individual rights, personal responsibility, and opportunity compose their dominant narrative of what constitutes American values (Geronimus and Thompson, 2004;Kwate and Meyer, 2010). Yet, holding fast to meritocratic ideology is not equally health promoting for all people who have been racialized as White (Geronimus et al, 2015;Malat et al, 2018;Metzl 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Typically blind to the social and economic privileges related to their racial and ethnic identity, White non-Hispanic Americans (hereafter “White”) frequently consider their elevated social status as being a product of their own individual effort and merit, rather than considering how the racialized social system is simultaneously (and systematically) disadvantaging racially and ethnically marginalized groups (Bobo 2017b; Bonilla-Silva 2018; Watson 2013). Additionally, avoidance of direct racial language perpetuates Whites’ propensity to ignore how the racist social system provides them with advantages and privileges not afforded to racial and ethnic groups who have been minoritized (Bobo 2011; Bonilla-Silva 2018; Efird and Lightfoot, 2020; Manning et al, 2015; Lensmire 2017).…”

Section: Introductionmentioning

confidence: 99%

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‘Different Than a Regular White’

Efird

2021

Du Bois Rev.

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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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Section: Discussionmentioning

confidence: 94%

Section: Whiteness In Rural Appalachiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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‘Different Than a Regular White’

Efird

2021

Du Bois Rev.

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“…Because the larger research study aimed to capture patient and provider experiences of health and health care, seven interviewees were practicing or retired healthcare providers (including nurses, physicians, a midwife, and a clinical social worker). Previous health-related qualitative studies in rural communities 11 , 15 – 17 have shown that a sample size of 14 is sufficient to reach theoretical saturation within the data. 11 , 18 All interviewees self-identified as white and non-Hispanic and ranged in age from 29 to 90 years.…”

Section: Methodsmentioning

confidence: 96%

Loss of Obstetric Services in Rural Appalachia

Efird¹,

Dry²,

Seidman³

2021

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Background As rural hospitals across the United States increasingly downsize or close, the availability of inpatient obstetric services continues to decline in rural areas. In rural Appalachia, the termination of obstetric services threatens to exacerbate the existing risk of adverse birth outcomes for women and infants, yet less is known about how the cessation of these services affects the broader community. Purpose The purpose of this paper is to explain how the loss of local obstetric services affects perceptions of healthcare among multi-generational residents of a remote, rural Appalachian community in western North Carolina. Methods An interdisciplinary team of researchers conducted a thematic analysis of health-related oral history interviews (n=14) that were collected from local residents of a rural, western North Carolina community during the summer of 2019. Results The closure of a local hospital’s labor and delivery department fostered (1) frustration with the decline in hospital services, (2) perceived increases in barriers to accessing healthcare, and (3) increased medical mistrust. Implications Findings suggest that the loss of obstetric services in this rural Appalachian community could have broad, negative health implications for all residents, regardless of their age, sex, or ability to bear children. Community-specific strategies are needed to foster trust in the remaining healthcare providers and to increase access to care for local residents. Results serve as formative research to support the development of interventions and policies that effectively respond to all community members’ needs and concerns following the loss of obstetric services in remote Appalachian communities.

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