Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis

“…forms of privilege and oppression that are unequally experienced across intersecting social categories (Bowleg, 2012), such as gender (Calzo, Katz-Wise, Charlton, Gordon, & Krieger, 2018), ethnicity (Holmes, 2011), race (Ford & Airhihenbuwa, 2010), and economic class (Coburn, 2004; Navarro, 2009).”

“According to the “Critical Race Theory” (28), race is not just a personal characteristic, but a socially constructed concept.”

“Race and ethnicity have been found to be the fundamental cause of health inequities [29-31].”

“31 This study explores the relationship between life course exposure to structural socioeconomic racism and structural socioeconomic resilience with cognitive change over time in a national sample of older adults racialized as Black (age ‡ 51).”

“Using Critical Race Theory was helpful for the research team to ensure participants’ voices were expressed without oppression and fragmentation (Ford & Airhihenbuwa, 2010).”

“These suggestions echo others calling for the movement away from individual and interpersonal mechanisms and toward structural understandings of health that can advance health equity (Bauer, 2014; Ford & Airhihenbuwa, 2010; Krieger, 2011; Petteway, 2020).”

“Public Health Critical Race Praxis (PHCRP) applies CRT to health equity research and addresses universal shortcomings in public health, some of which appear in the book, such as the need for a shared language to generate new knowledge surrounding complex problems across disciplines [5, 6].”

“Such comparisons between races lead us to answer questions such as, “How does Black race influence cancer screening?” [53,77], rather than racial equity-focused questions, such as, “How do the racialized experiences of African Americans influence cancer screening?” [53,77].”

“van Ryn and colleagues describe how health care providers or insurers may justify limiting the treatment they recommend for Black patients relative to White patients based upon the stereotype that Blacks are not sufficiently motivated or capable of taking care of their health.(28) These decisions produce health dispar…”

“Levels of discrimination vary depending on socially assigned characteristics of race or ethnicity (Ford and Airhihenbuwa 2010).”

“Several conceptual models have been developed by researchers to frame key aspects of health disparities, stress and health, and/or the interaction of race/racism and health [9,31,33,34].”

“…critical race theory (CRT) and community ‐ based participatory research (CBPR) principles, rooted in social justice pursuits and critical analysis of systems contributing to structural rac-ism and health inequities (Ford & Airhihenbuwa, 2010; Iglesias ‐ Ríos et al., 2022; Wallerstein et al., 2017).”

“…and children with asthma and the community partners that support them are required for the iterative process of hypothesis testing and evaluating data in the context of personal experiences needed to identify meaningful metrics of success and solutions to disparities in childhood asthma (48, 49).”

“This scoping review is informed by the central tenets of Critical Race Theory (CRT), which acknowledge race as social construct rather than a biological factor and that racism is intentionally and systemically imbedded across sectors such as health care [16, 17].”

“When applying the intersectional lens, it is necessary to consider individuals ’ identities through various dimensions, encompassing race, ethnicity, gender, socioeconomic status, geographic location, immigrant status, medical issues, and language pro fi ciency (Ford & Airhihenbuwa, 2010).”

“Although the stratification of populations by race facilitated the initial identification of health disparities, this context is more closely linked to the social determinants of health rather than biological determinants [63].”

“This delay in meaningful acknowledgment of the impact of systemic racism occurs despite health disparities described in the Institutes of Medicine’s “Unequal Treatment” in 2003 [8], and similar articulations by public health and social science scholars who have been championing this work for decades [9,10,11].”

“In other words, poetry can facilitate what is referred to in critical race theory as “centering the margins” (Ford & Airhihenbuwa, 2010a), and from a public health critical race praxis perspective (Ford & Airhihenbuwa, 2010b), thereby honor their “voice”—offering new avenues toward a “disciplinary…”

“…implementation requires a critical pedagogy that embodies the praxis necessary to address health equity in public health interventions (Ford & Airhihenbuwa, 2010; Freire, 1Johns Hopkins University, Baltimore, MD, USA Corresponding Author: R. Tyler Derreth, SOURCE, the Service-Learning…”

“We would instead suggest a race consciousness framework (Ford and Airhihenbuwa 2010) based in Critical Race Theory (CRT), wherein we always acknowledge and interrogate the racialized social context of our research participants.”

“For the second keynote, 83% of respondents reported motivation or inspiration with a median score of 5 (1), 93% found the content to be important and relevant with a median score of 5 (1), and 61% felt they learned new information with a median score of 4 (1) (Table 3).”

“Scholars have also noted the incongruity between racial and ethnic communities and the logic of RCTs, in which the scientific method is privileged over relevance to target populations (Ford & Airhihenbuwa, 2010; Rencher & Wolf, 2013).”

“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).”

“According to the praxis, health equity research needs to be grounded in the lived experiences of the marginalized and should be community-engaged and iterative (Ford & Airhihenbuwa, 2010a, 2010b).”

“Critical Race Theory draws attention to the ways in which racism permeates society through institutional systems, thereby perpetuating the oppression of marginalized people of color (Ford & Airhihenbuwa, 2010).”

“…echoes the call from critical race theorists, social science, and public health scholars that meaningful interventions must address the racialized social structures that perpetuate racism, and not simply make gestures toward equity (Bonilla Silva, 1997; Cross, 2018; Ford & Airhihenbuwa, 2010).”

“measures that were examined by cross-sectional design included infant health outcomes [26, 29, 30, 50], chronic conditions [27, 47, 48, 53], access and quality of healthcare [49, 52], quality of life [30, 47, 48], communicable diseases [22, 32], and mental health [28, 31].”

“To make such shifts, we need to practice reflexivity personally and professionally (70, 71).”

“Importantly, to achieve progress in behavioral medicine practice for weight control is to center Black adults in the work [89, 90].”

“The critical race theory helped question how race subtly influences institutions’ functioning and how the invisible barriers in place need to be addressed to affect change (Ford & Airhihenbuwa, 2010).”

“19,20 Through a process of embodiment, 21,22 these historical and present-day experiences shape biology.”

“17 In addition, minority stress theory highlights barriers, discrimination, and disparities experienced by people who identify as gender and sexual minorities.”

“It uses allegory as an antiracism educational tool (Ford and Airhihenbuwa 2010).”

“Instead, we conceptualize these categories as “markers” used to identify individuals at risk for exposure to racism, homophobia, and biphobia which are created, maintained, and reproduced by social structures (Ford & Airhihenbuwa, 2011; Poteat, 2021; Zuberi & Bonilla-Silva, 2008).”

“Public Health CRT was specifically developed to address SDOH (Ford and Airhihenbuwa, 2010a,b) and emphasises action-oriented health research with marginalised groups.”

“In questioning how participants represented their identities, we were concerned about undermining the different ways in which categories may be invoked to note variation in experiences (i.e. voicing; Ford and Airhihenbuwa, 2010).”

“Critical race theory is grounded in four pillars including race consciousness, contemporary orientation, centering in the margins rather than the mainstream, and theory-informed actions, also known as praxis [27].”

“Nonetheless, participants may have felt vulnerable, unsafe, or shame among other emotions and been reluctant to disclose experiencing racism and discrimination (27).”

“Scholars have argued that in the post-civil rights era, there is an “ordinariness” of racism present in society in which structural inequities are present but there is not a dominant narrative to link these inequities to racism [32].”

“, clinical licensure, education systems, and Medicaid regulations) apply equally across populations (Ford and Airhihenbuwa 2010).”

“Critical race theory and social geography scholarship both suggest that people’s experience of, access to, and meanings of neighborhoods and neighborhood characteristics are racialized (Cooper, Arriola, Haardörfer, & McBride, 2016; Ford & Airhihenbuwa, 2010; Sewell, Massey, & Denton, 2010).”

“Consistent with public health critical race praxis guidelines [34, 35], the study interviewers were residents of the communities from which participants were recruited.”

“These findings are consistent with approaches such as the anti-racist stance [42] and projects grounded in Critical Race Theory [43] that call for direct examination of the multi-level barriers to health related to racial/ethnic minority status.”

“To cultivate this behavior, we recommend the widespread integration of foundational principles from Public Health Critical Race Praxis into our public health training (Ford & Airhihenbuwa, 2010).”

“Drawing on the ‘cen-tring the margins’ framework in critical race theory (Ford and Airhihenbuwa, 2010), Fan et al. (2023a) explicitly conceptualised transport systems as socially constructed entities manifesting societal structures and cultural ideologies, shaped predominantly by and…”

“Components of a pedagogical but useful model include identifying and measuring racism in research and analyses, addressing racialized power dynamics that preclude centering the margins, and acknowledging the social construction of knowledge [54].”

“85,86 Researchers should avoid assertions blame patients (e.g., patient mistrust) for identified disparities, instead returning to conceptual frameworks to further map racism to causal pathways.”

“Theoretically, the framework includes many perspectives, such as Critical Race Theory (CRT) (Ford & Airhihenbuwa, 2010; Howard-Hamilton, 2003) which is concerned with the ways that racism is inherent within societal structures and practices; Critical Feminist Theory (CFT) (Howard-Hamilton, 2003) which identi fi es how…”

“The community-driven research framework builds on the interactive and contextual model of community–university collaboration for research and action, 16 the public health critical race framework, 17 situated learning theory, 18 and our experience as community-engaged researchers and practitioners.”

“Racism shapes the provision of services in psychology, social work, education, and public health (Ford and Airhihenbuwa, 2010; Jee-Lyn García and Sharif, 2015; American Public Health Association, 2020; Zhang et al., 2020; Olivares, 2022).”

“This is especially true considering this paper uses CRT, which calls for one to understand how contemporary mechanisms of racism have historical anchors (Ford & Airhihenbuwa, 2010).”

“Consequently, a critical race conscious lens would be useful in pursuing institutional solutions for socioeconomic and health equity [40, 55].”

“28,29 CRT is designed to explicitly name the centrality of racism, illuminate contemporary racial phenomena, expand the discourse about complex racial concepts, and challenge racialized hierarchies.”

“By grounding themselves in the experiences and perspectives of their social identity, these “outsiders within” integrate critical analysis of their lived experience into their respective discipline [12].”

“False racial hierarchies that have been reinforced throughout our history have given way to the continued oppression of people from historically marginalized communities [11].”

“A sequential traversal through the four focus areas of PHCRP, mapped onto the different DJ principles, is provided in the first two columns of Table 1.(19) The third column demonstrates the joint use of these approaches to the case”

“The four focus areas of PHCRP— contemporary racial relations, knowledge production, conceptualization and measurement, and action—include 10 principles researchers can follow to move beyond “documenting disparities” to challenging the roots of health inequity (Ford & Airhihenbuwa, 2010b).”

“A key principle of the Public Health Critical Race Praxis, an antiracism framework grounded in critical race theory, is to center the voices of marginalized populations in addressing racial health inequities [17, 18].”

“Resources and people lost to colonialism and slavery, power and autonomy lost to debtors, unfair trade policies and laws, social and educational services eroded by structural adjustment programmes – all have trickled down through generations of history and to the people and communities who now occupy marginalized iden…”