Whether the current focus on racism as a public health crisis will be a temporary uptick or a sustained push depends largely on the people now enrolled in public health graduate schools across the country. They are the next generation of scientists and practitioners who will do much of the heavy lifting required to disassemble the systems and structures that have supported racism for centuries. If talking to a few such Rollins students is any indication, they are up for the challenge.
“I want to study and promote positive, health-protective factors for Black people living in Black communities.” —Izraelle McKinnon
Izraelle McKinnon 16MPH came to Rollins determined to study racism and its contribution to health disparities. Growing up, she thought it was normal to have so much disease in her family—grandparents, parents, aunts, and uncles with hypertension, diabetes, and heart disease. Not until she began learning about health disparities in college did she link the poor health of her family members to experiences of racism and the low-resource Black neighborhood they lived in.
McKinnon is focusing her dissertation in the Department of Epidemiology on social capital as possible protection against the health effects of racism, specifically heart disease in younger women 30 to 45 years old. Black women of this age have a higher prevalence of heart disease not only than white women but also than Black and white men of the same age. McKinnon is evaluating factors that might protect against early cardiovascular disease among young Black women. “When we talk about Black neighborhoods, we tend to focus on material deprivation or social disorder, but there is a flip side,” she says. “Research in many other minority communities—your Chinatowns and Little Mexicos—tends to focus on the potential for positive health outcomes related to living in close-knit neighborhoods, where people help each other out, share resources, and support each other.”
Bringing in the perspective of protective characteristics in Black neighborhoods, instead of focusing exclusively on detrimental factors, is necessary not only to inform prevention interventions, but to reexamine the narrative of Black health in Black neighborhoods.
McKinnon is looking at what factors in a community contribute to its social cohesion, and if they, in turn, are protective against heart disease. Is having a place of worship important for health? What about having a YMCA or another space where people can gather socially? Are community network resources like home and business ownership important for health?
“We will be isolating these social capital effects from other things that could be affecting outcomes, so we’ll be controlling for things like education, employment status, and household income, as well as cardiovascular disease risk factors such as obesity, physical activity, and diabetes,” she says. “We want to see if there is something about social capital above and beyond the other things that we know affect cardiovascular disease that is important for health in majority Black communities.
“If we can show how high social capital and high social cohesion translates into better health outcomes, that could help justify investing in those things within the community,” she continues. “Basically, I want to study and promote positive, health-protective factors for Black people living in Black communities.”
After she earns a PhD in December, McKinnon plans to continue her research. “Working with and studying under people like Tené Lewis and Michael Kramer paved the way for research like mine,” she says. “They have helped upcoming scholars like me by shining light on the importance of this line of study.”
“Before I even knew the phrase ‘social determinants of health,’ I saw them in action.”—Lasha Clarke
Lasha Clarke 16MPH grew up in a predominantly Black and low-income neighborhood in Brooklyn, but she attended school in an affluent, predominantly white neighborhood on the Upper East Side. “The world where I spent my day was completely different than the world I went home to,” she says. “Before I even knew the phrase ‘social determinants of health,’ I saw them in action.”
After college, Clarke volunteered as a doula for Black and Latinx women in her community, and once again was struck by how different her clients’ pregnancy and birth experiences were from those of women of other race/ethnicities.
Clarke came to Rollins to earn an MPH in global epidemiology in the hopes of better understanding the causes and solutions for the disparities she had been seeing her whole life. While working with Dr. Carol Hogue, Jules and Uldeen Terry Chair in Maternal and Child Health emeritus, she was finally able to put a name to her particular interest—gendered racism.
Under Hogue, Clarke studied the vastly disproportionate rates of adverse birth outcomes, such as preterm birth and low birthweight, among Black women. There has been a growing consensus in the literature that stress, particularly racial stress, may be the culprit. “Studies have shown that even when you control for education, income level, and employment, the disparity between Black and white women still exists,” says Clarke.
For her dissertation in the Department of Epidemiology, Clarke is moving beyond looking at racism in general as a stressor for pregnant women, focusing instead on the health impact of both gender and race. She is finding that gendered racial stress is a distinct measure of stress. “It is time to move beyond looking at racism writ large as a public health issue and get into more solutions.” she says.
Specifically, Clarke is investigating how gendered racism contributes to spontaneous preterm birth. As a proxy for the level of stress internalized by a pregnant woman, she is measuring levels of C-reactive protein (CRP) in the blood, which is a well-known marker of systemic inflammation. She is, in fact, finding an association between gendered racial stress and CRP levels. “You start to suspect inflammation when CRP passes 3.0mg/L,” says Clarke. “In women who report experiencing gendered racism, we are finding levels greater than 8.0 mg/L.”
After she earns a PhD in the spring, Clarke plans to continue her research into reproductive health disparities. “I want to focus on maternal health equity with a community approach,” she says. “I would like to bring members of the community into the studies as collaborators to not only describe what is happening, but to develop solutions together that are culturally rooted and culturally relevant.”
“We’ve done enough measuring and assessing. We really need to move toward eliminating these disparities and their disproportionate risks and impacts. Everyone deserves the right to live in a community where they can play outside and breathe fresh air.”—Dana Williamson
Dr. Dana Williamson 03MPH 20G focused her dissertation in the Department of Behavioral, Social, and Health Education Sciences on building community capacity as a way to counteract environmental injustices. The subject is close to her heart, having grown up in in Detroit, a city burdened by excessive pollution and near Flint, Michigan.
Williamson evaluated capacity-building efforts of both traditional public health interventions used to address environmental inequities, gleaned from a systematic review that spanned 30-years worth of work, and of interventions through the EPA’s Environmental Justice Academy, a leadership development program for community activists.
In the systematic review, Williamson found a preponderance of “helicopter science.” Researchers went into a community, extracted needed data for their studies, and left without engaging meaningfully with the community or leaving behind a structure for making policy or systems for environmental change. “Granted, the articles that fit my criteria for review were fairly limited, but in most of them the researchers came in with their own agenda,” says Williamson, who is currently an ASPPH Environmental Health Fellow with the EPA Office of Science Advisor, Policy, and Engagement.
By contrast, the interventions by EJ Academy fellows started with finding out what the community wanted. In one example, Williamson cites an intervention in a town in which a busy road with high truck traffic passed directly in front of a local school. The children, many of whom had asthma, were exposed to high levels of exhaust. The intervention—putting a stop sign in front of the school—resulted in the rerouting of much of the tractor trailer and 18-wheeler traffic.
“By truly working with the community, EJ Academy fellows were able to push forward in making some actual community changes,” says Williamson. “Compare that to the more typical academic research approach of coming in and measuring air quality as it relates to asthma. We’ve done enough of measuring and assessing. We really need to move toward eliminating these disparities and their disproportionate risks and impacts. Everyone deserves the right to live in a community where they can play outside and breathe fresh air.”
“Asking how you fix racism is such a vast, broad question that it’s hard to pinpoint something tangible. But this project got students to focus on one specific aspect of racism and then come up with things they could actually do to address it.”— Saundra Latimer
Saundra Latimer, a first-year MPH student in the behavioral, social, and health education sciences department, worked with Dr. Briana Woods-Jaeger on her study of Black youth’s exposure to violence in Kansas City. Latimer coordinated a photovoice project with area teens.
The students were instructed to go out and take photos that symbolized some aspect of racism to them. One of the photos was selected at each session, and Latimer helped the teens drill down into what was being represented in the photo, how it related to their lives, and what would they like to do about it.
One photo, for example, focused on a young woman’s dreadlocks. During the discussion that followed, one teen recounted the violation she felt when a woman she didn’t know touched her hair in a restaurant. Others shared stories of people they knew who felt they had to change their hair style and even the way they talked at work in order to be seen as more professional. Several students were frustrated that people outside the Black community did not understand that dreadlocks are a way to keep hair healthy and prevent damage. “In the end, they felt that if people just understood Black culture, they might be more respectful of it,” says Latimer. “So they proposed using TikTok, podcasts, YouTube, and the like to try to educate people.”
A photo of a Civil War statue led to a discussion about the dearth of African American history taught in schools, and a focus on oppression rather than achievements when it is taught. The students want to advocate for a curriculum change to incorporate more positive Black history.
A photo of vinyl records by Black recording artists brought up feelings of Black culture being appropriated by whites and of a need to pass on Black traditions, family stories, and memories to the next generation. In response, some of the students have started making videos while interviewing family members, collecting family photos, and devising other ways to hold on to memories and traditions.
“Asking how you fix racism is such a vast, broad question that it’s hard to pinpoint something tangible,” says Latimer. “But this project got students to focus on one specific aspect of racism and then come up with things they could actually do to address it. I think it was a very empowering way to deal with it. People, even young people, can make a difference.”
Mural messages | Atlanta has a thriving street art scene, with many works portraying aspects of racism and racial justice. Pictured in this article are murals by Joe Camoosa (1), and SofaHood (2). For more about Atlanta's street murals, visit streetartmap.org.
Story by Martha McKenzie
Designed by Linda Dobson
Photography by Kay Hinton