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Tackling racism as a “wicked” public health problem: Enabling allies in anti-racism praxis
Open accessAbstract
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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“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).”
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“…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.,…”
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“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
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“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…”
BackgroundMethodAnti‐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
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
“Health promoters in all spheres must develop a deep race consciousness that acknowledges the centrality of race and racism in everyday life (9, 19).”
Background2.2 Equity, Power, and Transformative Research Coproduction
Plamondon, K., Ndumbe-Eyoh, S., & Shahram, S. (2022) · doi:10.1002/9781119757269.ch3 · Cited by 11
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
“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].”
BackgroundBoland, 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
“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).”
BackgroundGriesemer, 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 11
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
“…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).”
Cave, L., Shepherd, C., Cooper, M. N., & Zubrick, S. R. (2019) · SSM - Population Health · doi:10.1016/j.ssmph.2019.100492 · Cited by 10
Belák, A., van Dijk, J. P., & Reijneveld, S. A. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.117322 · Cited by 10
Cruz, F. A., & Jegede, O. O. (2024) · Current Psychiatry Reports · doi:10.1007/s11920-024-01556-7 · Cited by 12
“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].”
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
“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].”
BackgroundAllen, 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
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
“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).”
MethodEthnic (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
Self-citationGonzales, 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 10
“…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).”
BackgroundCarrijo, 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
“Confronting racism is a health-promoting action: a necessary and urgent public health policy [3,4].”
BackgroundOmar, S., Williams, C. C., Bugg, L. B., & Colantonio, A. (2024) · Disability and Rehabilitation · doi:10.1080/09638288.2024.2361803 · Cited by 9
“…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].”
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
Daniel, B.-J. M. (2020) · Child & Youth Services · doi:10.1080/0145935x.2020.1840348 · Cited by 11
Fleming, E. B., Frantsve‐Hawley, J., & Minter‐Jordan, M. (2022) · The AMA Journal of Ethic · doi:10.1001/amajethics.2022.48 · Cited by 8
French, M., Keegan, T., & Preston, N. J. (2022) · Palliative Medicine · doi:10.1177/02692163221133977 · Cited by 8
Metadata
- Authors
- Came, H., & Griffith, D.
- Affiliations
- Auckland University of Technology (NZ)
- Vanderbilt University (US)
- Corresponding author
- Came, Heather
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 199
- Pages
- 181-188
- ISSN
- 0277-9536 (ISSN-L)
- 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
- FWCI
- 32.23
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- 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 › Medicine › Public Health, Environmental and Occupational Health › 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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