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

摘要

Racial scholars argue that racism produces rates of morbidity, mortality, and overall well-being that vary depending on socially assigned race. Eliminating racism is therefore central to achieving health equity, but this requires new paradigms that are responsive to structural racism's contemporary influence on health, health inequities, and research. Critical Race Theory is an emerging transdisciplinary, race-equity methodology that originated in legal studies and is grounded in social justice. Critical Race Theory's tools for conducting research and practice are intended to elucidate contemporary racial phenomena, expand the vocabulary with which to discuss complex racial concepts, and challenge racial hierarchies. We introduce Critical Race Theory to the public health community, highlight key Critical Race Theory characteristics (race consciousness, emphases on contemporary societal dynamics and socially marginalized groups, and praxis between research and practice) and describe Critical Race Theory's contribution to a study on racism and HIV testing among African Americans. ALTHOUGH RACE REMAINS salient to public health in a variety of ways, the field's theoretical and methodological conventions inadequately address the complexity with which structural racism influences both health and the production of knowledge about populations, health, and health disparities. Many projects lack clarity about the nature of racial stratification. They conceptualize, measure, and analyze race- and racism-related factors using tools better suited for studying other risk factors. Although structural forces drive inequities, research and interventions disproportionately emphasize individual and interpersonal mechanisms. Additionally, overconfidence in the objectivity of research can blind investigators to the inadvertent influence of a priori assumptions on research. Race as a category denoting skin color was first used to classify human bodies by Francois Bernier, a French physician. 1 The notion of racial groupings was introduced in Carolus Linnaeus's Natural History in 1735 and subsequently advanced by many others. 1 Both Linnaeus's concept of race and the subsequent racial groupings devalued and degraded those classified as non-European. 2 Linnaeus's classification became the foundation on which many countries, including the United States, based their racial policies. Later, racialized policies gained “scientific” affirmation in the work of scholars such as Josiah Nott, whose publications reinforcing White supremacy appeared in 1843 in such respected journals as the American Journal of the Medical Sciences . Prevailing notions about race shaped early scientific research, but because investigators were not critical about their relationships to their racialized social contexts, they were unable to perceive the insidious influence of racism in their work. The contributions of minorities who might have challenged underlying assumptions were largely excluded. Their exclusion buttressed artificially high levels of confidence among researchers about the import and validity of racial findings. Against this backdrop, progressive scholars, many of them racial or ethnic minorities, began to scrutinize knowledge production processes and the implications for minority communities. By the late 20th century, they had begun developing new frameworks such as Critical Race Theory to explicitly account for the influences of racism on both outcomes and research processes. Gilmore defines racism as “the state-sanctioned and/or extralegal production and exploitation of group-differentiated vulnerability to premature death.” 3 (p247) This definition suggests that health for all cannot be achieved if structural racism persists. Eliminating racism, therefore, is part and parcel to achieving the objectives of public health. Table 1 provides definitions of public health and of the Critical Race Theory concepts discussed in this commentary. TABLE 1 Definitions of Public Health and Selected Concepts of Critical Race Theory Concept Definition Public health The art (i.e., practice) and science (i.e., research) of protecting and improving the health of communities Centering in the margins Making the perspectives of socially marginalized groups, rather than those of people belonging to dominant race or culture, the central axis around which discourse on a topic revolves Critical consciousness Digging beneath the surface of information to develop deeper understandings of concepts, relationships, and personal biases Experiential knowledge Ways of knowing that result from critical analysis of one's personal experiences Ordinariness The nature of racism in post–civil rights society: that is, integral and normal rather than aberrational Praxis Iterative process by which the knowledge gained from theory, research, personal experiences, and practice inform one another Primacy Prioritizing the study of racial in