Tackling racism as a “wicked” public health problem: Enabling allies in anti-racism praxis

Came, Heather; Griffith, Derek

doi:10.1016/j.socscimed.2017.03.028

Cited by 224Racial and Ethnic Identity ResearchPublic Health Policies and EducationGender, Health, and Social Inequality

Tackling racism as a “wicked” public health problem: Enabling allies in anti-racism praxis

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Came, Heather, Griffith, Derek·2018·Social Science & Medicine

DOI 10.1016/j.socscimed.2017.03.028

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Abstract

Racism is a "wicked" public health problem that fuels systemic health inequities between population groups in New Zealand, the United States and elsewhere. While literature has examined racism and its effects on health, the work describing how to intervene to address racism in public health is less developed. While the notion of raising awareness of racism through socio-political education is not new, given the way racism has morphed into new narratives in health institutional settings, it has become critical to support allies to make informing efforts to address racism as a fundamental cause of health inequities. In this paper, we make the case for anti-racism praxis as a tool to address inequities in public health, and focus on describing an anti-racism praxis framework to inform the training and support of allies. The limited work on anti-racism rarely articulates the unique challenges or needs of allies or targets of racism, but we seek to help fill that gap. Our anti-racism praxis for allies includes five core elements: reflexive relational praxis, structural power analysis, socio-political education, monitoring and evaluation and systems change approaches. We recognize that racism is a modifiable determinant of health and racial inequities can be eliminated with the necessary political will and a planned system change approach. Anti-racism praxis provides the tools to examine the interconnection and interdependence of cultural and institutional factors as a foundation for examining where and how to intervene to address racism.

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For youth-of-color-focused research, structural barriers to resources and funding compound the challenges.
“structural barriers limiting access to resources and funding (111)”
From Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems (2022) · cites this paper as [111]
For youth-of-color-focused research, a shortage of diversity in mental health professions compounds the challenges.
“When the research is focused specifically on youth of color, these challenges are compounded by lack of diversity in the mental health field”
From Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems (2022) · cites this paper as [111]
For youth-of-color-focused research, devaluation of methods suited to minoritized youth compounds the challenges.
“the undervaluing of research approaches relevant to working with minoritized youth”
From Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems (2022) · cites this paper as [111]

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Bhui, K. S., Halvorsrud, K., & Nazroo, J. Y. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2018.148 · Cited by 59 · see citing works
Review: Structural Racism, Children’s Mental Health Service Systems, and Recommendations for Policy and Practice Change
Álvarez, K., Cervantes, P. E., Nelson, K. L., Seag, D. E. M., Horwitz, S. M., & Hoagwood, K. (2021) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2021.12.006 · Cited by 58 · see citing works
The influence of democratic racism in nursing inquiry
Hilario, C. T., Browne, A. J., & McFadden, A. (2017) · Nursing Inquiry · doi:10.1111/nin.12213 · Cited by 53 · see citing works
Adopting an anti-racism public health curriculum competency: the university of Washington experience
Hagopian, A., West, K. M., Ornelas, I. J., Hart, A. N., Hagedorn, J., & Spigner, C. (2018) · Public Health Reports® · doi:10.1177/0033354918774791 · Cited by 52 · see citing works
“Indeed, in recent years, racism has been conceptualized as a quintessential “wicked problem,” with profound intergenerational effects, and tackling it requires systems change theory and structural power analysis.(6) A curriculum competency is a description of an observable knowledge or skill for students to attain.”
The Waitangi Tribunal's WAI 2575 Report: Implications for Decolonizing Health Systems.
Came, H. A., O’Sullivan, D., Kidd, J., & McCreanor, T. (2020) · PubMed Central · Cited by 49 · see citing works
Self-citation
“They created a team of almost entirely the people who work and are like them”: A qualitative study of organisational culture and racialised inequalities among healthcare staff
Woodhead, C., Stoll, N., Harwood, H., TIDES Study Team, Alexis, O., & Hatch, S. L. (2021) · Sociology of Health & Illness · doi:10.1111/1467-9566.13414 · Cited by 48 · see citing works
Family theorizing for social justice: A critical praxis
Allen, K. R., & Henderson, A. C. (2022) · Journal of Family Theory & Review · doi:10.1111/jftr.12450 · Cited by 48 · see citing works
Occupational Justice—Colonial Business as Usual? Indigenous Observations From Aotearoa New Zealand: La justice occupationnelle : sous régime colonial comme d’habitude? Observations d’autochtones d'Aotearoa en Nouvelle-Zélande
Emery-Whittington, I. G. (2021) · Canadian Journal of Occupational Therapy · doi:10.1177/00084174211005891 · Cited by 47 · see citing works
How interprofessional collaborative practice can help dismantle systemic racism
Cahn, P. S. (2020) · Journal of Interprofessional Care · doi:10.1080/13561820.2020.1790224 · Cited by 46 · see citing works
“Wherever a group of people has been historically subjugated or marginalized, they suffer negative health consequences (Came & Griffith, 2018).”
Background
Race, Place, And Structural Racism: A Review Of Health And History In Washington, D.C.
King, C. J., Buckley, B. O., Maheshwari, R., & Griffith, D. M. (2022) · Health Affairs · doi:10.1377/hlthaff.2021.01805 · Cited by 43 · see citing works
Self-citation
Making Communities More Visible: Equity‐Centered Data to Achieve Health Equity
Ponce, N., Shimkhada, R., & ADKINS‐JACKSON, P. B. (2023) · Milbank Quarterly · doi:10.1111/1468-0009.12605 · Cited by 40 · see citing works
“4,71,72 73–76”
Incorporating an Equity Agenda into Health Professions Education and Training to Build a More Representative Workforce
Effland, K. J., Hays, K. E., Ortiz, F. M., & Blanco, B. A. (2020) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.13070 · Cited by 39 · see citing works
Defining equity, its determinants, and the foundations of equity science
Plamondon, K., & Shahram, S. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.116940 · Cited by 37 · see citing works
Art, Anti-Racism and Health Equity: “Don’t Ask Me Why, Ask Me How!”
Griffith, D. M., & Semlow, A. R. (2020) · Ethnicity & Disease · doi:10.18865/ed.30.3.373 · Cited by 34 · see citing works
Self-citation
“It was as if I wasn't there” – Experiences of everyday racism in a Swedish medical school
Kristoffersson, E., Rönnqvist, H., Andersson, J., Bengs, C., & Hamberg, K. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.113678 · Cited by 34 · see citing works
“Many agree that key to succeeding in this goal is for bystanders to talk to, support, and become ‘allies ’ to those targeted by discrimination (Came and Griffith, 2018; DiAngelo, 2018).”
Background
Inequities in quality perinatal care in the United States during pregnancy and birth after cesarean
Ibrahim, B. B., Vedam, S., Illuzzi, J. L., Cheyney, M. J., & Kennedy, H. P. (2022) · PLoS ONE · doi:10.1371/journal.pone.0274790 · Cited by 32 · see citing works
“Racism and racial discrimination are linked to poor health [23, 24], and specifically, negative birth outcomes for women of color and their infants [24–27].”
Background
Rassismus und Diskriminierung im Kontext gesundheitlicher Ungleichheit – ein narratives Review
Kajikhina, K., Koschollek, C., Bozorgmehr, K., Sarma, N., & Hövener, C. (2023) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-023-03764-7 · Cited by 32 · see citing works
A tool to assess alignment between knowledge and action for health equity
Plamondon, K. (2020) · BMC Public Health · doi:10.1186/s12889-020-8324-6 · Cited by 32 · see citing works
Addressing Structural Racism Through Constitutional Transformation and Decolonization: Insights for the New Zealand Health Sector
Came, H. A., Baker, M., & McCreanor, T. (2021) · Journal of Bioethical Inquiry · doi:10.1007/s11673-020-10077-w · Cited by 32 · see citing works
Self-citation
Flexible resources and experiences of racism among a multi-ethnic adolescent population in Aotearoa, New Zealand: an intersectional analysis of health and socioeconomic inequities using survey data
Simon‐Kumar, R., Lewycka, S. O., Clark, T. C., Fleming, T. M., & Peiris-John, R. J. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01537-9 · Cited by 32 · see citing works
Uses of theory in racial health disparities research: a scoping review and application of public health critical race praxis
Mannor, K. M., & Malcoe, L. H. (2022) · Annals of Epidemiology · doi:10.1016/j.annepidem.2021.11.007 · Cited by 30 · see citing works
Awakening
Andrasik, M. P., Maunakea, A. K., Oseso, L. N., Rodríguez-Díaz, C. E., Wallace, S. E., Walters, K. L., & Yukawa, M. (2022) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2022.01.009 · Cited by 28 · see citing works
Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities in health services; diversity, equity, and inclusion; and implementation science
Byams, V. R., Baker, J., Bailey, C., Connell, N. T., Creary, M., Curtis, R., Dinno, A., Guelcher, C., Kim, M. H., Kulkarni, R., et al. (2023) · Expert Review of Hematology · doi:10.1080/17474086.2023.2183836 · Cited by 28 · see citing works
“mantling racism and unearned privilege, with institutional, social, attitudinal, and behavioral dimensions [51,54].”
Background
Re-imagining anti-racism as a core organisational value
Elias, A., Ben, J., & Hiruy, K. (2023) · Australian Journal of Management · doi:10.1177/03128962231151579 · Cited by 26 · see citing works
“For instance, Came and Griffith (2018) discuss system change as an intervention strategy in tackling racism systematically across multiple levels.”
BackgroundInfluential
Methodological tensions for non-Indigenous people in Indigenous research: A critique of critical discourse analysis in the Australian context
McCartan, J., Brimblecombe, J. K., & Adams, K. (2022) · Social Sciences & Humanities Open · doi:10.1016/j.ssaho.2022.100282 · Cited by 25 · see citing works
Creating ‘safe spaces’: A qualitative study to explore enablers and barriers to culturally safe end-of-life care
Gott, M., Wiles, J. L., Mason, K. R., & Moeke‐Maxwell, T. (2022) · Palliative Medicine · doi:10.1177/02692163221138621 · Cited by 25 · see citing works
Transformative Sustainability Education and Empowerment Practice on Indigenous Lands
Williams, L. (2018) · Journal of Transformative Education · doi:10.1177/1541344618789363 · Cited by 25 · see citing works
Why don't health care frontline professionals do more for segregated Roma? Exploring mechanisms supporting unequal care practices
Belák, A., Bobáková, D. F., Gecková, A. M., van Dijk, J. P., & Reijneveld, S. A. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112739 · Cited by 24 · see citing works
The Presence 5 for Racial Justice Framework for anti‐racist communication with Black patients
Brown‐Johnson, C. G., Cox, J., Shankar, M., Baratta, J., Leon, G. D., Garcia, R., Hollis, T., Verano, M., Henderson, K., Upchurch, M., et al. (2022) · Health Services Research · doi:10.1111/1475-6773.14015 · Cited by 23 · see citing works
Anti-racism and Occupational Therapy Education: Beyond Diversity and Inclusion
Sterman, J. J., Njelesani, J. E., & Carr, S. (2022) · Journal of Occupational Therapy Education · doi:10.26681/jote.2022.060103 · Cited by 22 · see citing works
Using psychological science to support social distancing: Tradeoffs between affiliation and disease‐avoidance motivations
Young, S. G., Brown, M., & Sacco, D. F. (2021) · Social and Personality Psychology Compass · doi:10.1111/spc3.12597 · Cited by 22 · see citing works
“…to improve public health outcomes (see Glanz & Bishop, 2010), these have often focused on reducing racial and socioeconomic disparities in health (Came & Griffith, 2018; D. R. Williams, 1997), leveraging social norms to encourage healthy behavior in various domains (e.g., Papies et al., 2008;…”
Background
Riding the merry‐go‐round of racial disparities in ADRD research
Adkins‐Jackson, P. B., Kraal, A. Z., Hill‐Jarrett, T. G., George, K. M., Deters, K., Besser, L. M., Avila‐Rieger, J. F., Turney, I. C., & Manly, J. J. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.13359 · Cited by 20 · see citing works
Applying anti-racist approaches to informatics: a new lens on traditional frames
Platt, J. E., Nong, P., Merid, B., Raj, M., Cope, E. L., Kardia, S. L. R., & Creary, M. (2023) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocad123 · Cited by 19 · see citing works
Blending integrated knowledge translation with global health governance: an approach for advancing action on a wicked problem
Plamondon, K., & Pemberton, J. (2019) · Health Research Policy and Systems · doi:10.1186/s12961-019-0424-3 · Cited by 18 · see citing works
“Unequal and unfair systems of power between and within nation states are widely recognised as driving forces in the creation of structures that disproportionately advantage some lives at the cost of others [8, 14, 37].”
Background
Linking critical consciousness and health: The utility of the critical reflection about social determinants of health scale (CR_SDH)
Windsor, L., Jemal, A., Goffnett, J., Smith, D., & Sarol, J. (2022) · SSM: Population Health · doi:10.1016/j.ssmph.2022.101034 · Cited by 16 · see citing works
“Research shows that SDH explain a wide variety of health outcomes as well as health inequities (Came & Griffith, 2018).”
Background
Beyond stress and coping: the relevance of critical theoretical perspectives to conceptualising racial discrimination in health research
Varcoe, C., Browne, A. J., & Garneau, A. B. (2019) · Health Sociology Review · doi:10.1080/14461242.2019.1642124 · Cited by 17 · see citing works
“…in health sciences to the impact of racism at structural and systemic levels – and for policies and strategies to mitigate the negative effects on health and healthcare delivery (Bailey et al., 2017; Came & Griffith, 2018; Paradies, 2016; Wyatt, Laderman, Botwinick, Mate, & Whittington, 2016).”
Background
Psychiatric nursing care experiences of immigrant patients: A Focused ethnographic study
Kallakorpi, S., Haatainen, K. M., & Kankkunen, P. (2018) · International Journal of Mental Health Nursing · doi:10.1111/inm.12500 · Cited by 18 · see citing works
Cultural Competence in the Field of Child Maltreatment
Fontes, L. A. (2021) · Springer eBooks · doi:10.1007/978-3-319-89999-2_16 · Cited by 17 · see citing works
A critical analysis of te Tiriti o Waitangi application in primary health organisations in Aotearoa New Zealand: Findings from a nationwide survey
Kidd, J., Came, H. A., Doole, C., & Rae, N. (2021) · Health & Social Care in the Community · doi:10.1111/hsc.13417 · Cited by 17 · see citing works
Self-citation
Combating Racism Through Research, Training, Practice, and Public Health Policies
Hall, J. E., & Boulware, L. E. (2023) · Preventing Chronic Disease · doi:10.5888/pcd20.230167 · Cited by 17 · see citing works
Whiteness hurts society: How whiteness shapes mental, physical, and social health outcomes
Efird, C. R., Wilkins, C. L., & Versey, H. S. (2024) · Journal of Social Issues · doi:10.1111/josi.12598 · Cited by 17 · see citing works
Antiracist Praxis in Public Health: A Call for Ethical Reflections
Fletcher, F. E., Jiang, W., & Best, A. (2021) · The Hastings center report · doi:10.1002/hast.1240 · Cited by 15 · see citing works
How Social Welfare and Health Professionals Understand “Race,” Racism, and Whiteness: A Social Justice Approach to Grounded Theory
Vanidestine, T., & Aparicio, E. M. (2019) · Social Work in Public Health · doi:10.1080/19371918.2019.1616645 · Cited by 17 · see citing works
“Furthermore, we must highlight racism and whiteness (white supremacy) as ethical issues (Johnstone & Kanitsaki, 2009), which include a specifically anti-racism praxis with the health-care system (Came & Griffith, 2018; Ford & Airhihenbuwa, 2010).”
Background
Mitigating structural racism to reduce inequities in sepsis outcomes: a mixed methods, longitudinal intervention study
Linnander, E. L., Ayedun, A. A., Boatright, D. B., Ackerman-Barger, K. W., Morgenthaler, T. I., Ray, N., Roy, B., Simpson, S. Q., & Curry, L. A. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08331-5 · Cited by 15 · see citing works
“subsequent workshops, members will report on their progress, with the goal of solving implementation challenges and further developing their individual and group capacity for adaptive leadership [25, 26].”
BackgroundMethod
Examining the transformative potential of emotion in education: A new measure of nursing and midwifery students' emotional learning in first peoples' cultural safety
Mills, K., Creedy, D. K., Sunderland, N., & Allen, J. (2021) · Nurse Education Today · doi:10.1016/j.nedt.2021.104854 · Cited by 16 · see citing works
Systemic Racism and the Family Medical Leave Act (FMLA): Using Critical Race Theory to Build Equitable Family Leave Policies
Vohra-Gupta, S., Kim, Y., & Cubbin, C. (2020) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-020-00911-7 · Cited by 15 · see citing works
Applying hybrid effectiveness-implementation studies in equity-centered policy implementation science
Asada, Y., Kroll‐Desrosiers, A., Chriqui, J. F., Curran, G. M., Emmons, K. M., Haire-Joshu, D. L., & Brownson, R. C. (2023) · Frontiers in Health Services · doi:10.3389/frhs.2023.1220629 · Cited by 18 · see citing works
“Finally, and importantly, we highlight the equity dimension: “evidence” generation has historically been the privilege of white, Western, male researchers, with the intentional exclusion of historically disadvantaged groups, including women and people of color (27, 28).”
Background
Pandemic Racism: Lessons on the Nature, Structures, and Trajectories of Racism During COVID-19
Elias, A., & Ben, J. (2023) · Journal of Bioethical Inquiry · doi:10.1007/s11673-023-10312-0 · Cited by 15 · see citing works
A pūrākau analysis of institutional barriers facing Māori occupational therapy students
Davis, G., & Came, H. A. (2022) · Australian Occupational Therapy Journal · doi:10.1111/1440-1630.12800 · Cited by 15 · see citing works
Self-citation
Racial and Ethnic Disparities in Laryngeal Cancer Care
Cox, S. R., & Daniel, C. (2021) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-021-01018-3 · Cited by 14 · see citing works
Moving forward: Recommendations to overcome existing structural racism
Brathwaite, S. A., West‐Livingston, L. N., Williams, D., Blakely, C. B., Rice, J. R., & Alabi, O. (2021) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2021.03.053 · Cited by 14 · see citing works
Developing an antiracist lens: using photography to facilitate public health critical race praxis in a foundational MPH course
Lightfoot, A. F., Efird, C. R., & Redding, E. M. (2021) · Pedagogy in Health Promotion · doi:10.1177/23733799211045712 · Cited by 14 · see citing works
“Within public health, CRT scholars seek to illuminate the ordinariness of racism within American life and the ways in which all forms of racism perpetuate health disparities and inequities (Came & Griffith, 2018; Ford & Airhihenbuwa, 2010).”
Background
Evaluating the impact of ‘Ask the Specialist Plus’: a training program for improving cultural safety and communication in hospital-based healthcare
Kerrigan, V., McGrath, S. Y., Doig, C., Herdman, R. M., Daly, S., Puruntatameri, P., Lee, B., Hefler, M., & Ralph, A. P. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-10565-4 · Cited by 13 · see citing works
“Issues regarding culturally unsafe care and poor communication are also experienced by minority populations and Indigenous peoples globally who are profiled by health systems built on White and/ or dominant culture norms [19, 67–70].”
Background
The Role of Anti-Racist Community-Partnered Praxis in Implementing Restorative Circles Within Marginalized Communities in Southern California During the COVID-19 Pandemic
Adkins‐Jackson, P. B., Vázquez, E., Henry-Ala, F. K., Ison, J. M., Cheney, A. M., Akingbulu, J., Starks, C., Slay, L., Dorsey, A., Marmolejo, C., et al. (2022) · Health Promotion Practice · doi:10.1177/15248399221132581 · Cited by 13 · see citing works
“A structural power analysis is a process where the pathways through which racism operates are identified and opportunities for anti-racist intervention are targeted (Came & Griffith, 2018).”
BackgroundMethodInfluential
Māori and Tauiwi nurses’ perspectives of anti-racism praxis: findings from a qualitative pilot study
Kidd, J., Came, H. A., Herbert, S. E., & McCreanor, T. (2020) · AlterNative An International Journal of Indigenous Peoples · doi:10.1177/1177180120974673 · Cited by 13 · see citing works
Self-citation
Wicked Problems in Pharmacy Education
Smith, K. J. (2021) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe8491 · Cited by 13 · see citing works
What Are We Fighting For? Lay Theories About the Goals and Motivations of Anti-Racism Activism
Pham, M. D., Chaney, K. E., & Ramírez‐Esparza, N. (2023) · Race and Social Problems · doi:10.1007/s12552-023-09393-8 · Cited by 12 · see citing works
“…goals did not entail empowering oppressed communities, such as by amplifying their voices and celebrating their joy in daily lives (Bon-nett, 2000; Came & Griffith, 2018; Griffith et al., 2007), and addressing broader axes of power and oppression that intersect with racism (Crenshaw, 1989; e.g.,…”
A systematic review of systems leadership in education: taking a social justice lens
Glowach, T. (2025) · International Journal of Leadership in Education · doi:10.1080/13603124.2025.2481060 · Cited by 12 · see citing works
HIV Prevention Among Cisgender Men Who have Sex with Transgender Women
Poteat, T., Cooney, E. E., Malik, M., Restar, A., Dangerfield, D. T., & White, J. J. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03194-z · Cited by 13 · see citing works
“Reckoning with systemic racism in public health and medical institutions is key to reducing these barriers [51].”
Background
The muddle of institutional racism in mental health
Younis, T. (2021) · Sociology of Health & Illness · doi:10.1111/1467-9566.13286 · Cited by 12 · see citing works
“Given these structural inequalities, scholars increasingly underline how anti- racist praxis in mental health must consider macro- level policies (Came & Griffith, 2018; Nazroo et al., 2020).”
Background
[Un]Forgetting History: Preparing Public Health Professionals to Address Structural Racism
Rosario, C., Al Amin, S., & Parker, C. (2022) · Journal of Public Health Management and Practice · doi:10.1097/phh.0000000000001432 · Cited by 12 · see citing works
“Our decision to use the Harvard Case Teaching Method process to ground our course followed recommendations from Who Will Keep the Public Healthy to use a case-based approach(17) and because anti-racism praxis necessitates relationship building and being actively reflexive.(21) The Harvard Case Teaching Method, designe…”
BackgroundMethod
Anti‐oppressive pedagogy in medical education: A qualitative study of trainees and faculty
Punchhi, G., Shum, K., & Sukhera, J. I. (2022) · Medical Education · doi:10.1111/medu.15016 · Cited by 11 · see citing works
What would it take for health promotion to take structural racism seriously?
Ndumbe-Eyoh, S. (2020) · Global Health Promotion · doi:10.1177/1757975920972259 · Cited by 11 · see citing works
“Health promoters in all spheres must develop a deep race consciousness that acknowledges the centrality of race and racism in everyday life (9, 19).”
Background
2.2 Equity, Power, and Transformative Research Coproduction
Plamondon, K., Ndumbe-Eyoh, S., & Shahram, S. (2022) · doi:10.1002/9781119757269.ch3 · Cited by 11 · see citing works
Ear and hearing care programs for First Nations children: a scoping review
Nash, K., Macniven, R., Clague, L., Coates, H. L. C., Fitzpatrick, M., Gunasekera, H., Gwynne, K. G., Halvorsen, L., Harkus, S., Holt, L., et al. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09338-2 · Cited by 11 · see citing works
“These impacts are further compounded by the lack of accessible ear and hearing care services available to First Nations children [48], in part due to systemic and structural racism embedded in healthcare in many of these countries [49].”
Background
Crisis-Resilient and Antiracist Approaches to Community-Based Participatory Research During COVID-19 and Beyond
Boland, S. E., Ivanich, J., Wesner, C. A., Tuitt, N. R., Zacher, T., Asdigian, N. L., & Whitesell, N. R. (2021) · Health Education & Behavior · doi:10.1177/10901981211054791 · Cited by 10 · see citing works
“Complementary to CBPR is the body of literature surrounding antiracism praxis, a relational and reflexive process of confronting, undoing, and eradicating racism in systems, structures, and policies (Came & Griffith, 2018).”
Background
Mechanisms to enhance racial equity in health care: Developing a model to facilitate translation of the ACCURE intervention
Griesemer, I., Birken, S. A., Rini, C. K., Maman, S., John, R., Thatcher, K., Dixon, C., Yongue, C. M., Baker, S., Bosire, C. N., et al. (2022) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2022.100204 · Cited by 10 · see citing works
Perceived status threat and health among White Americans: A scoping review
Efird, C. R., Bennett, F., Metzl, J. M., & Siddiqi, A. (2022) · SSM - Population Health · doi:10.1016/j.ssmph.2022.101326 · Cited by 10 · see citing works
“…despite some growth in the non-White population and decline in the White population, empirical evidence is clear that non-White groups are not catching up to White Americans in wealth, employment, or health (Darity et al., 2018; Williams et al., 2019; Came & Griffith, 2018; Bailey et al., 2017).”
Racial discrimination and the health and wellbeing of Aboriginal and Torres Strait Islander children: Does the timing of first exposure matter?
Cave, L., Shepherd, C., Cooper, M. N., & Zubrick, S. R. (2019) · SSM - Population Health · doi:10.1016/j.ssmph.2019.100492 · Cited by 10 · see citing works
Social mechanisms behind the poor health of marginalized Roma: Novel insights and implications from four ethnographic studies in Slovakia
Belák, A., van Dijk, J. P., & Reijneveld, S. A. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.117322 · Cited by 10 · see citing works
Addressing Racial and Ethnic Inequities in Opioid Overdose Mortality: Strategies for Equitable Interventions and Structural Change
Cruz, F. A., & Jegede, O. O. (2024) · Current Psychiatry Reports · doi:10.1007/s11920-024-01556-7 · Cited by 12 · see citing works
“Came and Griffith (2018) outlined five core components of an anti-racism praxis: reflexive relational praxis, structural power analysis, socio-political education, monitoring and evaluation and systems change approaches [55].”
Exploring differences in perceptions of child feeding practices between parents and health care professionals: a qualitative study
Rohit, A., Kirkham, R., McCarthy, L., Puruntatameri, V., Maple-Brown, L. J., & Brimblecombe, J. K. (2021) · BMC Public Health · doi:10.1186/s12889-021-11493-2 · Cited by 10 · see citing works
“Anti-racist frameworks are emerging for organizations to support their employees to use selfreflection and confront white supremacy, and to put in place system-wide anti-racist change [68, 69].”
Background
Leading Change at Berkeley Public Health: Building the Anti-racist Community for Justice and Social Transformative Change
Allen, A. M., Abram, C., Pothamsetty, N., Jacobo, A., Lewis, L., Maddali, S. R., Azurin, M., Chow, E. C., Sholinbeck, M., Rincón, A., et al. (2023) · Preventing Chronic Disease · doi:10.5888/pcd20.220370 · Cited by 9 · see citing works
Trauma-Informed Acute Care of Patients With Violence-Related Injury
Hawkins, B., Coupet, E., Saint-Hilaire, S. A., & Dodington, J. M. (2021) · Journal of Interpersonal Violence · doi:10.1177/08862605211041375 · Cited by 9 · see citing works
“Education using antiracism and structural competency frameworks could help providers understand and have language regarding underlying reasons patients may distrust the medical team (Came & Griffith, 2018; Metzl & Hansen, 2014).”
Method
Ethnic (pay) disparities in public sector leadership in Aotearoa New Zealand
Came, H. A., Badu, E., Ioane, J., Manson, L., & McCreanor, T. (2020) · International Journal of Critical Indigenous Studies · doi:10.5204/ijcis.v13i1.1331 · Cited by 9 · see citing works
Self-citation
Perceived Discrimination, Retention, and Diabetes Risk Among American Indians and Alaska Natives in a Diabetes Lifestyle Intervention
Gonzales, K. L., Jiang, L., Garcia-Alexander, G., Jacob, M. M., Chang, J. J., Williams, D. R., Bullock, A. K., & Manson, S. M. (2021) · Journal of Aging and Health · doi:10.1177/08982643211013188 · Cited by 9 · see citing works
“…that some participants perceived discrimination as part of their participation in the SDPI-DP, where they may have encountered condescension, paternalism, and/or judgmental attitudes from certain SDPI-DP staff (Buchanan, 2008; Came & Griffith, 2017; Jacob et al., 2020; Rahill et al., 2018).”
Background
Teaching of the Black Population’s Health: Anti-Racist Lenses for a Paradigm Shift to Address Racial Inequities
Carrijo, A. P. B., de Moura, A. L. D. B., Oliveira, A. C. P. E., Rodrigues, L. V., Oliveira, J. D. M., de Castro, T. F., Torres, O. M., Poças, K. C., & Deusdará, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192416784 · Cited by 9 · see citing works
“Confronting racism is a health-promoting action: a necessary and urgent public health policy [3,4].”
Background
Mapping the institutionalization of racism in the research about race and traumatic brain injury rehabilitation: implications for Black populations
Omar, S., Williams, C. C., Bugg, L. B., & Colantonio, A. (2024) · Disability and Rehabilitation · doi:10.1080/09638288.2024.2361803 · Cited by 8 · see citing works
“…need for anti-racist considerations has also been highlighted in the field of medicine [140,141], including medical education curriculum [142,143] and other areas such as mental health [144,145], the development of anti-racist healthcare algorithms [146], public health [147], and social work [148].”
A guaranteed income intervention to improve the health and financial well-being of low-income black emerging adults: study protocol for the Black Economic Equity Movement randomized controlled crossover trial
Lippman, S. A., Libby, M. K., Nakphong, M. K., Arons, A., Balanoff, M., Mocello, A. R., Arnold, E. A., Shade, S. B., Qurashi, F., Downing, A., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1271194 · Cited by 8 · see citing works
Embedding Anti-Oppression and Anti-Racism Perspectives in the Field of Child and Youth Care: A Case for Rearticulating Relational Care
Daniel, B.-J. M. (2020) · Child & Youth Services · doi:10.1080/0145935x.2020.1840348 · Cited by 8 · see citing works
Health Equity Needs Teeth
Fleming, E. B., Frantsve‐Hawley, J., & Minter‐Jordan, M. (2022) · The AMA Journal of Ethic · doi:10.1001/amajethics.2022.48 · Cited by 8 · see citing works
Facilitating equitable access to hospice care in socially deprived areas: A mixed methods multiple case study
French, M., Keegan, T., & Preston, N. J. (2022) · Palliative Medicine · doi:10.1177/02692163221133977 · Cited by 8 · see citing works

The Future of Public Health Must be Radical: Incorporating Racial Capitalism
Flores, Y. A., & Greenwood, H. M. (2023) · Health Education & Behavior · doi:10.1177/10901981231166572 · Cited by 11 · see citing works
Working Toward Health Equity Requires Antiracist Teaching
Peoples, W. A., Fleming, P. J., & Creary, M. (2023) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2022.10.023 · Cited by 13 · see citing works
Racism and racial health inequity: four theories for public health
Parker, C. M., Agbebiyi, A., Fuller, A., Gupta-Wright, M., Husbands, S., Licorish, J., Marcano, S., Pinkerton, L., Bowers, A. P., & Parker, M. C. G. (2026) · Journal of Public Health · doi:10.1093/pubmed/fdag005
Re-imagining anti-racism in the health sector in Aotearoa New Zealand
Came, H. A., Kidd, J., McCreanor, T., Baker, M., & Rodgers, B. C. (2020) · European Journal of Public Health · doi:10.1093/eurpub/ckaa165.861 · Cited by 2 · see citing works
Self-citation
PUBLIC HEALTH CRITICAL RACE PRAXIS: AN INTRODUCTION, AN INTERVENTION, AND THREE POINTS FOR CONSIDERATION
Ford, C. L. (2016) · eScholarship (California Digital Library) · Cited by 27 · see citing works

Authors: Came, H., & Griffith, D.
Affiliations: Auckland University of Technology (NZ)
Vanderbilt University (US)
Corresponding author: Came, Heather
ORCID: Came, Heather
Griffith, Derek
Venue: Social Science & Medicine
Publisher: Elsevier BV
Published: 2018-02
Volume: 199
Pages: 181-188
ISSN: 0277-9536 (ISSN-L)
DOI: 10.1016/j.socscimed.2017.03.028
OpenAlex: W2595397208
Cited by: 224
References: 77
Citations by year: 2026: 31 · 2025: 18 · 2024: 26 · 2023: 26 · 2022: 42 · 2021: 35 · 2020: 20 · 2019: 15 · 2018: 9 · 2017: 2
FWCI: 32.23
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Social Science & Medicine (publishedVersion)
PubMed (publishedVersion)
Tuwhera (Auckland University of Technology) (submittedVersion)
RePEc: Research Papers in Economics (submittedVersion)
Topics: Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
Keywords: racism, wicked problems, health disparities, systemic racism, allies, monitoring and evaluation, systemic change, racial inequity, public health interventions, New Zealand, United States
MeSH terms: Cooperative Behavior, Humans, New Zealand, Public Health, United States, Racial Groups, Health Status Disparities, Racism

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Tackling racism as a “wicked” public health problem: Enabling allies in anti-racism praxis

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