By Keon L. Gilbert and Jerrell DeCaille
The health justice movement helps to marry social justice models with equity frameworks.
This critical partnership advances health equity through community-based approaches to health care and social services, collaborations that minimize duplicative services, and the creation of sustainable relationships to advocate for systemic change.
Critical Race(ing) towards Health Equity
Our scholarship is guided by our understanding of health justice as a movement that centers community-engaged research, evaluation, and practice. We are currently engaged in collaborative research opportunities to explore the determinants of the negative trends in Black men’s health that are shaped by social policies. Some of this work focuses on Black men’s health behaviors and their access to and use of health care and social services that help them to prevent or manage chronic diseases. Other aspects of this work focus on the high risk of Black males being killed by police and the illness spillovers that result in communities.
We introduce Public Health Critical Race Theory (PHCRT) to guide the overall frame of our work, which focuses on how to improve the health and well-being of Black men.
First, PHCRT calls into question extant research that creates inopportunity and renders communities invisible. For our work, this may involve analyzing how research describes the criminalization of Black males across the life course, justifies over-policing of Black communities, reinforces stereotypes that Black communities are dangerous and crime-ridden, and supports policies that further disinvest in these communities.
Second, PHCRT provides researchers with a lens to consider how a public health challenge inequitably limits health-promoting opportunities. Criminalizing Black males limits healthy racial and gender identity formations and poses a threat and risk to healthy lifestyles for black males.
Third, PHCRT requires those who engage in research to promote equitable outcomes that include social, structural, and ecological determinants of health. These goals are aligned with the main tenets of a health justice movement. PHCRT is one model that structures our approach to health equity research, which aims to facilitate access and use of health care services for Black men and to prevent policing in health care settings.
Community Engagement to Achieve Health Equity
Community engagement is central to improving life expectancy and reducing chronic disease prevalence for Black men.
In our research, we use several methods to explore how the intersections of race, class, gender, place, and culture shape social relationships within various structures and contexts — such as barbershops, schools, neighborhoods, and churches. We have traditionally relied on these contexts for public health interventions, which remain important, but are limited without a clear community-engaged approach.
A Continuum of Partnership Approaches
Community-oriented research projects exist within a continuum. “Community-placed” research, which occurs in settings like churches, barbershops, schools, or youth-serving organizations, often minimally engages communities and relies on these settings and partners to help with the recruitment and retention of participants.
On the other end of the continuum are “community-based” interventions, which fully engage communities, for example, incorporating culture, language, and representatives from those communities to develop, implement, evaluate, and disseminate findings from the work.
The closer our work focuses and integrates principles of community-based research, the more equitable and inclusive community-engaged processes become. Ultimately, this right-sizes power imbalances, and structures communities as the drivers of these partnerships.
Pushing research past description and identifying causal factors requires digging more deeply into community-engaged models that achieve social justice and health equity. The challenge is for scholars to understand that community-based interventions should be the goal, but reaching that goal may begin with variations of working alongside community partners to identify community issues that matter to them, engaging these partners to sort through solutions, and selecting the best strategies to address public health challenges using models that include health justice, equity, and anti-racist principles.
Transformative public health work that includes a health justice framing creates structures to think about capacity building and advocacy opportunities to affect family, community, and local change. This in turn may affect health outcomes and access to health care and social services, which improves population health outcomes, and narrows disparities caused by systemic and structural racism.
Concepts, models, and methods to achieve health justice, racial and health equity, and an anti-racist public health call for a focus on systemic change.
Issues of segregation, poverty, quality education, and chronic unemployment uniquely affect communities of color and have shortened the life expectancy of Black males. These structural issues pose a set of intersecting risks and reflect systemic injustices that can only be changed with meaningful and committed partnerships, collaborations, and community engagement that seek to achieve equity and systemic reform by undoing racism embedded within these structures.
Placing community first and allowing them to drive solutions-based strategies is imperative to the health justice movement.
Keon L. Gilbert, DrPH is an Associate Professor of Behavioral Science and Health Education at the College for Public Health and Social Justice at Saint Louis University. He is also Co-Founder of the Institute for Healing Justice and Equity, and a David M. Rubenstein Fellow at the Brookings Institution.
Jerrell DeCaille, MPH is a doctoral student in Public Health Studies at the College for Public Health and Social Justice at Saint Louis University.