Critical Race Praxis Research Articles

Abstract P650: Addressing Cardiovascular Disease Inequities: Qualitative Process Evaluation From a Co-Investigation With Im/Migrants Exploring How to Sustain a Community-Driven, Social Network Intervention Using a Racism-Conscious Approach

Introduction: Health promotion programs focused on cardiovascular disease are underutilized with im/migrants. The one-time referral to group-based interventions model ignores (1) the complex sociocultural influences on behavior change and (2) the socio-historical context of migration, racialization of immigrants and refugees, and the roles these play in differential social integration of refugees. One solution may be to apply community-based participatory research (CBPR) and Public Health Critical Race Praxis (PHCRP) to social network interventions with opinion leaders. Yet, these interventions are challenging to scale. There is a critical need to understand how to scale community-driven social network interventions to effectively address cardiovascular disease inequities resulting from systemic racism experienced by im/migrant populations. Developed using CBPR and informed by PHCRP, this work builds upon Healthy Immigrant Community (HIC), a collaborative effort between Latinx and Somali im/migrant partners and Rochester Healthy Community Partnership. Our aim is to explore opinion leader recruitment, their characteristics, and expectations for HIC scale-up. Qualitative Hypothesis: Learning more about the opinion leaders’ background and experience in the Healthy Immigrant Community social network intervention will prepare us for a future efficacy study. Methods: We conducted a process evaluation by: (1) interviewing community partners who recruited opinion leaders (n=8) and (2) conducting three pre-intervention focus groups with opinion leaders (Latinx n=4; Somali women n=8; Somali men n=8). We used PHCRP to deductively form codes yet allowed for new ideas that arose from the data by inductively generating additional codes. Results: Interview participants described their decision-making process, qualities considered, recruitment strategies, and expectations for an implementation study. Focus group participants discussed their personal motivations for participation, how they hoped the study would help their community, and the barriers to health they experience because of structural determinism (macro-level forces that sustain inequities). Conclusions: This work will enhance our ability to translate HIC to other communities by expanding our knowledge of opinion leader characteristics that are important in a community-driven, social network intervention. Because social network interventions have been demonstrated to cause positive behavior change, further adapting these interventions in a community setting would be expected to provide a more effective approach compared to individually targeted behavior change strategies. Additionally, selecting OLs is neither time nor resource intensive and could enhance organizational strategies for implementing health promotion programming.

A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine.

Prior evaluation at our hospital demonstrated that, compared to White patients, Black and Latinx patients with congestive heart failure (CHF) were less likely to be admitted to the cardiology service rather than the general medicine service (GMS). Patients admitted to GMS (compared to cardiology) had inferior rates of cardiology follow-up and 30-day readmission. To develop and test the feasibility and impacts of using quality improvement (QI) methods, in combination with the Public Health Critical Race Praxis (PHCRP) framework, to engage stakeholders in developing an intervention for ensuring guideline-concordant inpatient CHF care across all patient groups. We compared measures for all patients admitted with CHF to GMS between September 2019 and March 2020 (intervention group) to CHF patients admitted to GMS in the previous year (pre-intervention group) and those admitted to cardiology during the pre-intervention and intervention periods (cardiology group). Our primary measures were 30-day readmissions and 14- and 30-day post-discharge cardiology follow-up. There were 79 patients admitted with CHF to GMS during the intervention period, all of whom received the intervention. There were similar rates of Black and Latinx patients across the three groups. Compared to pre-intervention, intervention patients had a significantly lower 30-day readmission rate (18.9% vs. 24.8%; p=0.024), though the cardiology group also had a decrease in 30-day readmissions from the pre-intervention to intervention period. Compared to pre-intervention, intervention patients had significantly higher 14-day and 30-day post-discharge follow-up visits scheduled with cardiology (36.7% vs. 24.8%, p=0.005; 55.7% vs. 42.3%, p=0.0029), but no improvement in appointment attendance. This study provides a first test of applying the PHCRP framework within a stakeholder-engaged QI initiative for improving CHF care across races and ethnicities. Our study design cannot evaluate causation. However, the improvements in 30-day readmission, as well as in processes of care that may affect it, provide optimism that inclusion of a racism-conscious framework in QI initiatives is feasible and may enhance QI measures.

Optimizing the Equitable Deployment of Virtual Care for Women: Protocol for a Qualitative Evidence Synthesis Examining Patient and Provider Perspectives Supplemented with Primary Qualitative Data.

Women experience numerous barriers to patient-centered health care (e.g., lack of continuity). Such barriers are amplified for women from marginalized communities. Virtual care may improve equitable access. We are conducting a partner-engaged, qualitative evidence synthesis (QES) of patients' and providers' experiences with virtual health care delivery for women. We use a best-fit framework approach informed by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework and Public Health Critical Race Praxis. We will supplement published literature with qualitative interviews with women from underrepresented communities and their health care providers. We will engage patients and other contributors through multiple participatory methods. Our search identified 5525 articles published from 2010 to 2022. Sixty were eligible, of which 42 focused on women and 24 on provider experiences. Data abstraction and analysis are ongoing. This work offers four key innovations to advance health equity: (1) conceptual foundation rooted in an antiracist action-oriented praxis; (2) worked example of centering QES on marginalized communities; (3) supplementing QES with primary qualitative information with populations historically marginalized in the health care system; and (4) participatory approaches that foster longitudinal partnered engagement. Our approach to exploring virtual health care for women demonstrates an antiracist praxis to inform knowledge generation. In doing so, we aim to generate findings that can guide health care systems in the equitable deployment of comprehensive virtual care for women.

Mitigating the Spread of COVID-19: Differential Perceptions of Midwestern University Students.

Racially minoritized groups have disproportionately borne the impacts of the COVID-19 pandemic in America. We draw on Public Health Critical Race Praxis to investigate racial differences in college students' attitudes about mitigation efforts to limit the spread of COVID-19 and concerns about one's own and others' actions in these efforts. We used survey data from a random sample of Midwestern undergraduates (n = 620) who participated in a fall 2020 COVID-19 study; chi-square tests and logistic regression modeling were employed. Students of color were more likely than white students to report mitigation strategies as not sufficiently restrictive and that communities ought to prioritize limiting the spread of COVID-19. Students of color were also more likely to be concerned that the actions of others were spreading COVID-19. Universities need to continuously ask how their policies and practices acknowledge the broader racial context and seek the perspectives of diverse students.

Impact of structural racism on inclusion and diversity in precision oncology: A scoping and critical review of the literature.

Inclusion and diversity in precision oncology are essential in reducing cancer disparities among racial and ethnic groups. However, present studies have favored the recruitment and participation of Whites, with limited applicability of their results to minority groups. Many reasons for their underrepresentation are downstream manifestations of structural racism. Therefore, this scoping review provides a precise mapping of recruitment and participation barriers for minorities in precision oncology that are associated with structural racism, including a critical appraisal of how disciplinary norms, paradigms, and tools used therein could inadvertently contribute to unforeseen inclusion and diversity challenges. Empirical and theoretical publications from Web of Science and PubMed were searched and analyzed to identify recruitment and participation barriers for minorities in precision oncology. In addition, using the public health critical race praxis (PHCRP) as guiding analytical framework, empirical studies were analyzed to identify unforeseen barriers resulting from simplification processes, assumptions, norms, paradigms, and tools used during the research process. One-hundred thirty-five barriers to recruitment and participation were identified or reported in included publications. They were subsequently categorized as being a manifestation of one of the following forms of racism, namely internalized, interpersonal, institutional, and structural racism. The PCHRP analysis revealed four additional factors to be considered in precision oncology studies in ensuring appropriate representation of their study populations. Future interventions aimed at reducing health disparities should focus predominantly on barriers associated with structural and institutional racism, which should then have ripple effects on other forms of racism. Importantly, the four factors identified through the PHCRP framework could further explain the lower participation rates of minorities in precision oncology and related activities. Therefore, they should be given due consideration by all stakeholders involved in the precision oncology ecosystem, from researchers and healthcare professionals to policy-makers, research ethics committees, and funders.

Adjustment.

The adult spine, aka backbone, is composed of 24 segments. Separately, each segment is incapable of animating our bodies. Communities of color, low-income communities, and other marginalized groups represent the backbone of the health equity research enterprise-it literally cannot exist without our bodies and what they are subjected to in the face of structural inequality. And more often than not, researchers believe they can break our bodies into discrete segments and somehow animate a body of literature capable of healing a whole us. This poem, as counternarrative and enactment of public health critical race praxis principles of "voice" and "disciplinary self-critique", engages the spine as metaphor to name and render visible the epistemic and symbolic violences that prop up public health's body of evidence/knowledge. In doing so, it challenges the field's dominant knowledge production paradigm (e.g. positivist reductionism), and draws attention to the settlercolonial, racial-capitalist, and extractivist logics of racial and health equity discourses dominated by narratives produced by mostly White scholars and "health equity tourists", often using complex statistical techniques to complete secondary quantitative analyses about health in communities they've never stepped a single foot in. Under this paradigm, scores of researchers/practitioners are led to believe that they can somehow come to "know" us via variables and models alone. This poem suggests that-more than anything else-this model of practice is what's most in need of adjustment, and warrants a greater degree of ethical scrutiny than historically/presently afforded. To view the original version of this poem, see the supplemental material section of this article online.

Understanding Black women’s experiences with genetic services for ovarian cancer: A qualitative study (435)

<b>Objectives:</b> Studies have consistently demonstrated that Black women with ovarian cancer are less likely to obtain guideline- recommended genetic testing than other racial/ethnic groups. The current study sought to explore Black women's experience with genetic testing during ovarian cancer care from the perspective of patients, providers, and genetic counselors. <b>Methods:</b> We conducted semi-structured interviews (<i>n</i>=20) with five patients, six physicians, four advanced practice providers, and five genetic counselors. The study was designed using Anderson's Behavioral Model and the Public Health Critical Race Praxis as theoretical frameworks to inform our research design, data collection, and interpretation. Data were recorded, transcribed, and coded, and framework analysis was used to identify themes. <b>Results:</b> All five of the patients in the study completed genetic testing. For the providers, uptake of genetic services varied according to the practice location but ranged from 50-80% for genetic counseling and 40-95% for genetic testing. Most providers in our study felt that rates of genetic counseling and testing were similar for Black women compared to other racial/ethnic groups in their practice, except those providers who cared for Black ovarian cancer patients at safety-net hospitals. Four themes emerged from the data. First, participants felt that all women are too overwhelmed to prioritize genetic testing, but Black women also have daily experiences with racism that adds additional complexity to navigating cancer care. Second, Black women are unable to access genetic testing due to socioeconomic disadvantages related to a long history of structural racism in the U.S. Third, Black women may be unwilling to complete genetic testing due to mistrust of providers and the healthcare system. Finally, Black women are less likely to receive genetic services prior to their ovarian cancer diagnosis due to cultural barriers and provider misconceptions about Black women's hereditary cancer risk. <b>Conclusions:</b> Our findings highlight that Black ovarian cancer patients are less likely to obtain genetic counseling and testing due to experiences with individual and structural racism<i>.</i> To increase uptake of genetic testing, it is critical that providers prioritize communication and patient education that is culturally responsive to the needs of Black women, as well as offer social supports to help Black women navigate their cancer care. Given the prevalence of hereditary cancer syndromes in ovarian cancer patients, as well as the impact that identification of a mutation has on cancer prevention, treatment, and survival, it is critical to ensure that genetic services are provided equitably to all women. Therefore, gynecologic oncology providers need education about the unique barriers Black women face in accessing genetic services so we may increase opportunities to provide guideline-concordant genetic services to Black women.

Integrated Methods for Applying Critical Race Theory to Qualitative COVID-19 Equity Research.

Racism persists, underscoring the need to rapidly document the perspectives and experiences of Black, Indigenous and People of Color (BIPOC) groups as well as marginalized populations (eg, formerly incarcerated people) during pandemics. This methods paper offers a model for using Public Health Critical Race Praxis (PHCRP) and related critical methodologies (ie, feminist and decolonizing methods) to inform the conceptualization, methods, and dissemination of qualitative research undertaken in response to the evolving COVID-19 pandemic. Using purposive snowball sampling, we identified organizations involved with health equity and social justice advocacy among BIPOC and socially marginalized populations. Focus group participants (N=63) included community members, organizers, activists, and health workers. We conducted topic-specific (eg, reproductive justice) and population-specific (eg, Asian and Pacific Islander) focus groups (N=16 focus groups) in rapid succession using Zoom software. A self-reflexive, iterative praxis guided theorization, data collection and analysis. We obtained community input on study design, the semi-structured discussion guide, ethical considerations and dissemination. Applying PHCRP, we assessed our assumptions iteratively. We transcribed each interview verbatim, de-identified the data, then used two distinct qualitative techniques to code and analyze them: thematic analysis to identify unifying concepts that recur across focus groups and narrative analysis to keep each participant's story intact. The praxis facilitated relationship-building with partners and supported the iterative assessment of assumptions. Logistical constraints included difficulty ensuring the confidentiality of virtual discussions. These novel approaches provide an effective model for community-engaged qualitative research during a pandemic.

Engaging Public Health Critical Race Praxis in Local Social Determinants of Health Research: The Youth Health Equity and Action Research Training Program in Portland, OR-yHEARTPDX.

The social determinants of health (SDH) have long been considered a core mechanism through which racial health inequities are (re)produced and incubated in the U.S. Moreover, scholars have expressly—and appropriately—named structural racism as a precursor to inequities associated with SDH. However, while research on racial health inequities—SDH-related or otherwise—continues to grow, communities of color remain grossly underrepresented as public health researchers and practitioners. Additionally, although SDH are experienced in a very local sense, much research and practice fails to more deeply and thoroughly engage and center local community knowledges. Thus, much work around SDH and racial health inequities presents, ironically, as structurally racist itself—being done/led mostly by White scholars and in ways that do not “center the margins”. Moreover, in the context of public health practice, youth perspective is seldom centered within local health department (LHD) community SDH assessment efforts. With these challenges in mind, this paper introduces and discusses the development of the youth health equity and action research training (yHEART) program as a model for public health researchers/practitioners to engage public health critical race praxis (PHCRP) to better understand and respond to local SDH in communities of color. Specifically, we highlight the significance of PHCRP principles of “voice” and “social construction of knowledge” in advancing antiracism in research and LHD practice related to local SDH. First, we articulate core conceptual and theoretical groundings that informed the yHEART program’s development and animate its ongoing training and research activities. Second, we outline the program’s core training components and overall process, and provide some brief illustrative examples of work completed during the program’s first iteration—yHEART PDX, Vol.I: Youth Participatory Research on Local Social Determinants of Health. We then close with a discussion that reflects on program strengths, challenges, and implications for SDH and racial health equity research/practice in light of growing calls for an antiracist public health.

Black & Mild: A Tutorial, After the CDC.

The Centers for Disease Control and Prevention (CDC) estimates that smoking causes ~480,000 U.S. deaths annually. Many of these deaths are ultimately coded within "heart disease" and "cancer" deaths-the United States' top two causes of death. These deaths represent aggregations of dozens of distinct International Classification of Diseases 10th Revision (ICD-10) codes. COVID-19 has also killed ~480,000 Americans annually. Yet its codes are much more limited/specific-such that COVID-19 might well be the singular leading cause of death in the United States. And yet here we are: 2+ years of pandemic and the CDC not only acting like it can't do math, but actively clearing paths for continued disease/death. This poem, crafted as counternarrative to the superficially apolitical (re/in)actions of the CDC, enacts the public health critical race praxis principle of "disciplinary self-critique" to suggest that the CDC has indeed aligned itself with neoliberal racial capitalism in an unapologetic endorsement/enactment of necropolitics. It draws from a rich archive of Black music that thematically engages smoking as ritual, resistance, and practice of community, as well as metaphor for/of transcendence and self-love in the face of structural violence and thinly-veiled necropolitical sacrifice at the altar of neoliberal public health-an altar long-built from the blood and bones of the "sick and tired." Or, if you prefer, the lungs and breath of the "mild." In the face of all the resources-financial and regulatory-governmental public health uses to keep us from smoking, vaping, and getting high, apparently, it's the CDC that is high-so high it is no longer able/willing to see the foundations of social justice that anchor our field. To view the original version of this poem, see the supplemental material section of this article online.

Addressing Racism in the Domestic Minor Sex Trafficking of Black Girls: The Role of Public Health Critical Race Praxis.

Addressing Racism in the Domestic Minor Sex Trafficking of Black Girls: The Role of Public Health Critical Race Praxis.

Integrating institutional and individual self‐reflexivity practices into clinical pharmacy practice: A critical review of race in a widely utilized medical guideline

AbstractIn this clinical pharmacy forum, an argument is presented that clinical pharmacists and their respective institutions must be self‐reflexive about race, racism, and implicit bias in treating patients. Drawing on the Public Health Critical Race praxis and self‐reflexivity practices, this forum provides a critical review of a widely utilized medical guideline and tool, the American College of Cardiology (ACC) and American Heart Association (AHA) Clinical Practice Guideline on the Primary Prevention of Cardiovascular Disease and its respective Arteriosclerotic Cardiovascular Disease Risk Estimator, as an example of how self‐reflexive practices on race, racism, and implicit bias can be accomplished. This critical review offers clinical pharmacists entry points of considerations and actions that can more robustly aid themselves and their institutions to enact racial justice policies and practices in medical contexts.

Bang on the System: People’s Praxis and Pedagogy as Humanizing Violence

Bang on the System pairs critical race theory (CRT) with the litany of radical democratic analysis guiding the social practices of various revolutionary movements, proposing a new pedagogical framework that deploys a mutually informed critical race praxis as the basis to engage historically dispossessed youth in their own learning. This lens is utilized to examine an interpretive case study from a corpus of existing qualitative data collected through teacher action inquiries in one of California’s most underserved schools and targeted communities. Specifically, the authors analyze the role of a People’s praxis as an effective pedagogy to mediate student resistance.

Black Women's Lived Experiences of Abortion.

In this study, we aim to understand abortion in the context of structural racism and reproductive injustice. We designed this study using Reproductive Justice and Public Health Critical Race Praxis frameworks. We conducted in-depth semi-structured interviews with self-identified Black women over the age of 18 who have had an abortion. The primary identified theme is that "choice" around abortion is a privilege that is not always available to Black women. Participants discussed domains of experience around abortion. The domains were (1) community experience and intergenerational wisdom, (2) personal experience and beliefs, (3) the process of accessing abortion, and (4) reflecting on abortion experience and recovery. Understanding the ways in which reproductive injustices and structural racism constrict choices is critical to providing abortion care. Abortion care should seek to honor the experiences of Black women, trust in the expertise that Black women have in our own bodies, and work to provide Reproductive-Justice-informed care.

Ways Forward in Preventing Severe Maternal Morbidity and Maternal Health Inequities: Conceptual Frameworks, Definitions, and Data, from a Population Health Perspective.

Ways Forward in Preventing Severe Maternal Morbidity and Maternal Health Inequities: Conceptual Frameworks, Definitions, and Data, from a Population Health Perspective.

Associations between perceived racial discrimination, racial residential segregation, and cancer screening adherence among low-income African Americans: a multilevel, cross-sectional analysis

ABSTRACT Objectives African Americans suffer disproportionately from cancer compared to their White counterparts. Racism may be an important determinant, but the literature on its association with cancer screening is limited. We examine associations between racism and cancer screening among a sample of African Americans. Design Guided by the Public Health Critical Race Praxis and the Behavioral Model of Health Services Use, we conducted a multilevel, cross-sectional study using cancer risk assessment data collected from 405 callers to the 2-1-1 Texas helpline. We merged these data with contextual data from the U.S. Census Bureau. We assessed perceived racial discrimination using the Experiences of Discrimination Scale and racial residential segregation using the Location Quotient for Racial Residential Segregation. We used multilevel regression models to test hypothesized associations between each indicator of racism and four cancer screening adherence outcomes (Pap test, mammography, colorectal cancer screening [CRCS], and any cancer screening). Results Participants were 18–83 years old (mean = 45 years). Most (81%) were non-adherent to at least one recommended screening. Approximately 42% reported experiencing discrimination and 73% lived in a segregated neighborhood. Discrimination was non-significantly related to lower odds of mammography (aOR = 0.68; 95%CI: 0.38-1.22), CRCS (aOR = 0.79; 95%CI: 0.41-1.52), and any cancer screening adherence (aOR = 0.88; 95%CI: 0.59-1.32). Segregation was related to greater odds of mammography (non-significant; aOR = 1.43; 95%CI: 0.76-2.68) and CRCS (significant; aOR = 2.80; 95%CI: 1.21-6.46) but not associated with any cancer screening. Neither indicator of racism was associated with Pap test screening adherence. Conclusions Racism has a nuanced association with cancer screening among low-income, medically underserved African Americans. Specifically, discrimination appears to be associated with lower odds of screening, while segregation may be associated with higher odds of screening in certain situations. Future research is needed to better explicate relations between indicators of racism and cancer screening among African Americans.

Beyond Virtue-Signaling: Advancing Equity Through Design Justice and Public Health Critical Race Praxis.

As public health mourns the inequitable loss of lives to coronavirus disease 2019 (COVID-19) and confronts other major social crises, practitioners must explicitly address systems of oppression in their everyday praxis. We describe how the principles of public health critical race praxis (PHCRP) and design justice (DJ) can advance equity in public health. We begin with an overview of PHCRP and DJ, and develop an integrated approach to facilitate community-led change. We apply this approach to the example of COVID-19 vaccine distribution and conclude with a call to action, arguing for PHCRP and DJ to become integral part of public health practice.

Fostering Pre-Service Teachers’ Antiracist Expectations through Online Education: Implications for Teacher Education in the Context of Global Pandemics

The increase in online education programs, accompanied by the current COVID-10 pandemic, has led universities to reconsider alternative ways to prepare teachers for social justice. One under-researched area in this conversation is the need for teacher candidates to examine their racialized expectations that often negate students of color in TK-12 classrooms. This self-study describes one faculty member’s digital critical race praxis (DigitalCrit praxis) as a mediator of her expectations to prepare pre-service teachers for social justice. Research findings have implications for critical multicultural education, digitally based instruction, and teacher preparation.

Racial biases in healthcare: Examining the contributions of Point of Care tools and unintended practitioner bias to patient treatment and diagnosis.

Sophisticated algorithms are used daily to search through hundreds of medical journals in order to package updated medical insights into commercial databases. Healthcare practitioners can access these searchable databases-called Point of Care (PoC) tools-as downloadable apps on their smartphones or tablets to comprehensively and efficiently inform patient diagnosis and treatment. Because racist biases are unintentionally incorporated into the search reports that the companies generate and that practitioners regularly access, the aim of this article is to examine how healthcare practitioners' "pre-existing" racial stereotypes interact with pithy conclusions about race and ethnicity in PoC tools. I use qualitative research methods (content analysis, discourse analysis, open-ended semi-structured interviews, and role play) to frame the analysis within the Public Health Critical Race Praxis (PHCRP). This approach facilitates an understanding of how biological racism-the use of scientific evidence to support inherent differences between races-that is embedded in PoC algorithms informs a practitioner's assessment of a patient, and converges with persistent racial bias in medical training, medical research and healthcare. I contextualize the study with one semi-structured interview with an Editor of a leading PoC tool, MedScope (pseudonomized), and 10 semi-structured interviews with healthcare practitioners in S.E. Ontario, Canada. The article concludes that PoC tools and practitioners' personal biases contribute to racial prejudices in healthcare provision. This warrants further research on racial bias in medical literature and curriculum design in medical school.

Developing an Antiracist Lens: Using Photography to Facilitate Public Health Critical Race Praxis in a Foundational MPH Course

Racism is a critical determinant of health that affects outcomes; shapes practice, policy, research, and interventions; and disproportionately burdens nondominant racial populations. The racial justice challenges of today, combined with persistent health inequities exacerbated by the COVID-19 pandemic, have intensified the need for racial equity–minded public health professionals. Because training programs play a key role in developing professionals, they must center teaching about racism and promoting antiracism within their curricula. The critical race theory–grounded strategy Public Health Critical Race Praxis (PHCRP) provides a useful framework, calling for examination of how racism operates within individuals and the systems, such as public health, in which they work. Foundational public health courses provide a vital opportunity to launch such an examination and lay the groundwork for antiracism praxis. This article offers a curricular model that integrates PCHRP with a creative approach to facilitate exploration of racial identity among public health students. Students in our course use photography and written reflections to create dual portraits, one depicting how they see themselves and the other imagining how they might be seen by others in our racialized society. Our pedagogical process prompts critical self-reflection about racial identity, a crucial foundation for addressing the health consequences of structural racism. Spurred by creative inquiry, students of all racial and ethnic backgrounds tell us that our course boosts their racial consciousness, enhances their understanding and ability to engage diverse communities, equips them to see and name racism in the public health context, and galvanizes them to work toward dismantling it.