J Afr Am St (2015) 19:94–104 DOI 10.1007/s12111-014-9292-7 B R I E F R E P O RT

Expanding the African-American Studies Paradigm to Include Health: a Novel Approach to Promoting Health Equity Alyssa G. Robillard & S. Melinda Spencer & Joseph B. Richardson Jr.

Published online: 11 July 2014 # Springer Science+Business Media New York 2014

Introduction

Of all the forms of inequality, injustice in health [care] is the most shocking and inhumane. Rev. Dr. Martin Luther King, Jr. Dr. King’s declaration in 1966 speaks to the unrealized ideal of equal and appropriate attention to health as a human right and is echoed by the World Health Organization, which describes “the highest attainable standard of health” as a “fundamental right of every human being” (WHO 2012). Proponents of social justice share this view and understand the paradigmatic shift in thought and deed necessary to bring this view to reality (Marmot and Bell 2009; Hofrichter 2003). Inherent in the perspective of holding health as a human right is the notion of the “universal cultural value” of health as an indicator of the well-being of a community and the status of its members (Pinkney 2000, p. 131). When health is robust, communities flourish. When health is compromised, communities are weakened. For marginalized individuals and communities, the notion of health is a ubiquitous yet often suppressed concern, until it becomes too great to ignore. Even then, without appropriate resources and support, it can be difficult to significantly reverse the course of poor health outcomes. A. G. Robillard (*) : S. M. Spencer Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 529, Columbia, SC 29208, USA e-mail: [email protected] J. B. Richardson Jr. Department of African American Studies, University of Maryland, 1137 Taliaferro Hall, College Park, MD 20742, USA

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African Americans bear a greater burden of death and disease compared to Whites. This speaks to the reduced vitality of African-American communities and underscores a history of marginalized citizenship. Further, those with lower socioeconomic statuses (SES) do not fare nearly as well on indices of health as those with higher SES (Banks et al. 2006). The complex mix of race and class has had severe consequences on the health of African Americans, resulting in disparities in health and health care that for many constitute a public health crisis (Satcher Health Leadership Institute, n.d.). Addressing these disparities requires innovative, multipronged approaches. One such approach involves a targeted expansion of the African-American studies paradigm to include health. The purpose of this discussion is to offer justification for expanding the African-American studies paradigm using a public health-oriented approach, specifically grounded in health education and promotion, to examine health disparities as a point of emphasis with a focus on social determinants of health. This discussion also offers practical recommendations for incorporating health in Black studies and presents dual models of inclusion.

African-American Studies Although nomenclature varies, e.g., African-American studies, Africana studies, Black studies, African diaspora studies, etc. (Norment 2001), definitions routinely emphasize the centrality of an African-American perspective. 1 The original intent of AfricanAmerican studies programs was to fill a void in the Academy on aspects of AfricanAmerican culture and the depth and breadth of the African-American experience (Bobo et al. 2004; Mazama 2006). Gordon (1981) defines African-American studies as “an analysis of the factors and conditions which have affected the economic, psychological, legal and moral status of the African in America as well as the African in diaspora” (p. 233). It is, by conception and definition, interdisciplinary in nature considering past, present, and future experiences holistically while stressing both scholarship and practice (Karenga 1988). It follows an intellectual tradition that is corrective (challenging stereotypes and misinformation) and prescriptive (offering recommendations to resolve problems faced by African Americans) in its approach (Marable 2001). African-American studies curricula have traditionally included history and literature, with complementary courses in sociology, political science, psychology, and other social sciences, as well as courses in art, music, and language and/or linguistics (Hines 2001). One area of study that seems to be less visible in the discourse of African-American studies is that of public health. Incorporating public health, and particularly health education and health promotion, is a natural fit because AfricanAmerican studies, as a field, is “concerned with the development of new approaches to the study of the Black experience and with the development of social policies which will impact positively upon the lives of Black people” (Gordon 1981, p. 233). In this way, approaches to eliminate health disparities are predicated on a multidimensional 1 African-American studies and Black studies are used interchangeably in this paper. The author acknowledges the breadth of study afforded to Black studies as it covers the entire African diaspora. This paper focuses on the health experiences of the African diaspora in the USA.

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understanding of the African-American experience, including the many factors affecting African-American health.

Social Determinants of Health and Health Disparities

The most difficult social problem in the matter of Negro health is the peculiar attitude of the nation toward the well-being of the race. W.E.B. DuBois Healthy People 2020 describes health disparities as differences in health outcomes that are closely tied to social, economic, and/or environmental disadvantage historically linked to discrimination or exclusion (USDHHS 2011). African Americans experience earlier deaths, decreased quality of life, loss of economic opportunities, and higher health care costs when compared with Whites (CDC 2014). Differential access to health care, education, housing, and employment are just a few of the structural factors that contribute to health disparities among African Americans. Although efforts to address health disparities have begun and stand as a prominent goal for the next decade, data indicate that great disparities in the USA, particularly for African Americans, remain. Closing the Black-White mortality gap could eliminate over 80,000 excess deaths per year among African Americans (Satcher et al. 2005), but it will require an intensive focus on improving the social determinants of health. Taking a social determinants perspective on health requires that researchers work to better understand the conditions in which people are born, live, and age that affect their health, functioning, and quality of life (USDHHS 2012). These conditions are the most important determinants of one’s health status (Commission on Social Determinants of Health 2008); they not only determine access to health services but also influence the lifestyle choices people are able to make (Satcher 2010). Dahlgren and Whitehead (1991) explained that health is influenced by multiple layers which include one’s biological constitution (e.g., age, sex, genetics), individual lifestyle factors, social and community networks, living and working conditions (e.g., education, housing, work environment, and health care services), and general socioeconomic, cultural, and environmental conditions. Examining health in this way helps us to recognize the broader factors that contribute to health disparities across the life span for elevated quality of life. Inequalities along any of these levels have real and serious consequences that manifest across a range of health outcomes. To effectively address racial disparities in health, it is necessary to understand the underlying factors which affect the racial patterns of disease and death (Williams et al. 2010). Considering health outcomes from a social determinants perspective provides insight into how inequalities develop and are sustained. It also gives us direction in examining possible points of intervention to alleviate health inequities. This is a task that should be a priority for policy makers in every sector (Marmot 2005). It will require interdisciplinary approaches that incorporate novel ways of thinking about and responding to health concerns affecting African Americans.

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Expanding the Paradigm

Without health and long life all else fails. Booker T. Washington African-American studies involve an in-depth examination of the multidimensional aspects of the African-American experience, both past and present (Karenga 1982). As such, health—or more accurately, compromised health—is an important facet of the African-American experience. The health of a people marks their ability to prosper, and the field of African-American studies has its foundation in the promotion of equality. It is appropriate, then, that public health be given targeted consideration as an important aspect of African-American studies. As a system, public health works by identifying problems and using collective action to protect, promote, and improve health (Turnock 2009). As an area of study in public health, health education and health promotion supports the mission of public health by fostering collective and intentional actions to support health for individuals and communities. Both African-American studies and public health are inherently committed to inquiry and practice as a central aspect of their approach. Marable (2001) points out the connection between theory and “practical action” necessary for African-American studies, to avoid a disconnect between scholars in the field and the community. As in African-American studies, the community is central to every aspect of study, research, and practice in health education/promotion. Green and Kreuter (1991) describe community as “the center of gravity” for health promotion. Each area of study utilizes and is invested in a collective approach to solving problems. Another commonality between African-American studies and health education/promotion is that both are transformative in nature (Marable 2001); they seek to educate and change the larger society. Introducing health into African-American studies follows the tradition of intellectual inquiry into social problems that impact African Americans and explores them within the historical and cultural context that has traditionally been denied, ignored, and/or deprecated (Adams 2001; Henderson 2001). Airhihenbuwa (1995) emphasizes the fundamental role of culture in public health and health promotion by calling attention to the “importance of history, politics and education in shaping the landscape of cultural production (p. xii).” There have been many efforts to acknowledge the role of cultural competency and proficiency in responding to health disparities (O’Brien 2009); however, the degree to which these efforts truly acknowledge history, politics, education, etc., is unclear. Fostering “critical consciousness”—an approach that places public health practice in a social, cultural, and historical context—may be a better approach to health equity (Kumagai and Lypson 2009). Practitioners who acknowledge the role of critical consciousness understand that having knowledge of community assets can lead to effective health interventions. For example, institutions such as the Black church, educational institutions, and the family have significant cultural relevance for African Americans (Hecht et al. 2003). Working with these institutions and understanding the centrality of collectivism in community building (Airhihenbuwa 1995; Daniel and Smitherman 1995) can be an effective way to address health disparities.

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Critical Race Theory has also been adapted for use in public health research, scholarship, and practice (Ford and Airhihenbuwa 2010). As applied to public health, Critical Race Theory offers a new paradigm to examine racial health disparities and encourages solutions designed to address social determinants of health, e.g., housing, education, employment, and discrimination. Ford and Airhihenbuwa (2010) articulate the application of Critical Race Theory and its implications for policy and practice in achieving health equity. Trained health professionals with a keen cultural sense of the African-American experience, as well as an ability to think critically about race, racism, and power in health disparities, will be better equipped to plan, implement, and evaluate the needs of diverse communities to promote positive health outcomes.

Recommendations for Curriculum and Training We submit that education on health enhances the African-American studies curriculum (Harris-Olayinka 2000) and opportunities exist where topics related to health and health disparities can be easily introduced. These courses can broaden the knowledge of the African-American health experience for both students of African-American studies programs and students from other areas of study (e.g., biology, communications, sociology, etc.). We describe five important ways through which education and training for students can occur: (1) course content, (2) independent/directed study, (3) research and teaching assistantships, (4) internships and community partnerships, and (5) unitsponsored seminars and conferences. Course Content Interesting and innovative courses are a fundamental way to introduce students to health-related courses focusing on African Americans. A foundational course that introduces students to “Health Issues in the African-American Community” can serve as a springboard for more specialized topical seminar courses, such as “HIV/AIDS and African Americans.” Courses that allow students to explore social and behavioral theories of public health, with bridges to local community-based organizations serving African Americans, can provide hands-on learning of public health practice. Creativity in course development can also lead to interesting courses, e.g., “African Americans in Science” and “Racialized Medicine and Public Health” or “Race, Genetics and Biomarkers.” Courses can also incorporate humanities-oriented work for creative examples of the intersections of race/ethnicity, self-identity, and health outcomes, such as that illustrated in Toni Morrison’s The Bluest Eye. Independent/Directed Study Directed study provides an opportunity for students to work one-on-one with professors to gain in-depth knowledge on a given topic, such as “African-American women’s health” or “juvenile justice and African-American youth.” Directed study can be especially beneficial for students who have an expressed interest in health-related fields of study but are limited in what courses are available to explore these issues in greater depth. This is an excellent mentoring opportunity for students and can be intellectually

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stimulating and professionally beneficial to professors as well. The results of directed study experiences can include tangible scholarly products, including publications and conference presentations. Research and Teaching Assistantships Research assistantships provide students with the chance to gain research experience, either for pay or course credit. For graduate and undergraduate students, this is an excellent opportunity for students to learn and practice hands-on community-based research. Teaching assistantships can increase knowledge and skills related to curriculum development and implementation. Working closely with the faculty mentor, students can review teaching strategies and develop their own teaching philosophy. For advanced undergraduates, both of these experiences can foster an interest in graduate studies to better understand health-related issues in the African-American community and potentially explore career options in academia. Internships, Service Learning, and Community Partnerships Establishing community partnerships is critical for African-American studies, as well as health education and promotion. Not only are these partnerships useful for community partners and faculty but they can also lead to internship opportunities for students. In this way, service learning opportunities can be built into the curriculum and support civic engagement, scholarly practice, and activism for students. Additionally, community partnerships can be helpful for university administrators to better understand the viability and necessity of African-American studies. Unit-Sponsored Seminars and Conferences Topical conferences can be a useful way to introduce issues of African-American health disparities to students and faculty audiences alike. As Hines (2001) suggests, presenters can share their expertise and receive feedback on their work. The interdisciplinary and transdisciplinary natures of health-related work in African-American studies make it quite suitable for seminars/conferences in partnership with other units, e.g., public health, nursing, and social work. Conferences can and should include community partners to encourage community residents to see universities as more accessible (Hines 2001).

Models for Incorporating Health into African-American Studies Incorporating health into African-American studies is not without challenges. Strong support from university leaders and equally strong departmental leadership are key, as is the need for a shared departmental mission. An internal understanding and appreciation by African-American studies faculty for public health as an addition to the paradigm are also important. In some cases, with interdisciplinary work, miscommunication can occur because humanities and social sciences sometimes speak “different languages.” Patience along with strategies to bridge understanding is necessary. It is

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also critical for public health faculty working in African-American studies to maintain links with public health for continued productivity, to stay current in the field, and to avoid professional isolation. As a first step, however, it is useful to consider models of inclusion that support teaching, research, and service across different scholarly fields. Two models are presented: (1) an interdisciplinary (or multidisciplinary) model and (2) a transdisciplinary model. Interdisciplinarity refers to work that critically draws upon two or more disciplines, leading to an integration of disciplinary discoveries (Newell and Green 1982). This approach is necessary to give students an “encompassing knowledge” of the AfricanAmerican experience. To do this, African-American studies must be interdisciplinary (Henderson 2001). As Fig. 1 illustrates, many areas of study can inform the AfricanAmerican experience, especially when they acknowledge both history and culture. This model incorporates health education and promotion to be inclusive of health issues that affect African Americans. This approach may be especially useful for curriculum building. Transdisciplinarity is heavily invested in the assumption that all knowledge is united, thus making divisions in knowledge pointless (Newell and Green 1982). The transdisciplinary framework encourages the practical application of knowledge that incorporates multiple areas of study. In this model, health issues are brought to bear as they are linked to disciplines in African-American studies. Although it usually privileges one discipline over the other(s), transdisciplinarity can be a useful approach to research and teaching related to the African-American experience. The model in Fig. 2 illustrates the many areas of study and how these areas overlap to address important questions. As an example, research that examines the impact of racism might employ measures and methodology from psychology and use literature to examine the potential consequences, using A Raisin in the Sun by Lorraine Hansberry as an example of how Health Issues in the African American Community

African American History

African American Women Writers of the Harlem Renaissance Psychological Stress in African Americans

African American Art

African American Children and Families

Pre-colonial Africa

African American Polical st Leadership in the 21 Islam in America

Fig. 1 Example of multidisciplinary African American studies course offerings

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Fig. 2 Examples of transdisciplinary teaching and research in African-American studies

empowerment can increase self-esteem and improve mental health in AfricanAmerican men. Each area can, through a transdisciplinary approach, inform the process of exploring and responding to mental health needs among African Americans.

Building on Social Justice and Innovation to Achieve Health Equity

We need a new way of thinking, one where, as public health professionals, we lead by taking an interdisciplinary approach and collaborating across a wide range of disciplines, developing our own workforce to effectively address social determinants of health, and insisting health and non-health policies incorporate a social determinants approach. Dr. David Satcher

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The barrage of “post racial” rhetoric following the election of Barack Obama as the first African-American President of the USA belies the current state of affairs for African Americans. In spite of many social, economic, and political advances, disparities remain in the areas of income, education, and health. Disproportionate rates of poverty, unemployment, poor housing, inadequate schooling, and health care are indicative of the continued need for efforts that seek equity. African-American studies and public health share the goal of equity—a goal built on social justice. Social justice is the foundation of public health (Turnock 2009). Not only does social justice require that all individuals and populations be valued as equal, it ensures conditions that support optimal health, particularly for those who have experienced historical and contemporary injustices (Jones et al. 2009). Awareness of the social factors that contribute to health disparities is necessary to give them appropriate redress. Achieving health equity requires a broad approach that can only be enhanced by a more in-depth cultural understanding and appreciation for the ways race, racism, and power contribute to health disparities. Challenging or expanding the traditional assumptions about what African-American studies should look like allows us to examine health and health disparities as part of the African-American experience. Further, it can be beneficial in broadening cultural knowledge to improve approaches to achieve health equity. Many public health professionals lack cultural competence and/or a comprehensive knowledge of the African-American experience. This competence and/or knowledge is, in most cases, unrelated to race (Henderson 2001). A more in-depth knowledge of the African-American experience can result in much more culturally competent approaches that ultimately result in decreases and elimination of health disparities. African-American studies are uniquely positioned to provide a solid cultural framework for the study of African-American health. In a talk on “The Future of Public Health,” Dr. Roberta Ness (January 19, 2011) discussed the need to address disparities and better understand the social determinants of health using novel approaches to overcome public health problems. She suggested innovation—“applying a creative process toward an improved product”—as a tool to respond to public health problems. One approach was to recognize and find alternatives to our normal paradigms of thinking. Expanding the traditional curriculum to include the study of public health as part of the African-American experience represents one such strategy, and many African-American studies departments have already begun this process, with some effectively incorporating it into their curriculum as well as their faculty research. Incorporating health into African-American studies allows us to consider aspects of the historical and cultural African-American experiences that will help in understanding and promoting healthy behavior. Having a keen sense of the African-American experience can make one more well-rounded as a practitioner and better able to engage with the community. As Dr. Satcher (2010) suggests, new ways of thinking that include interdisciplinary and collaborative approaches to address social determinants of health are warranted. These innovations can result in public health professionals who have an intimate understanding of the populations they serve and can successfully bridge the disciplines of African-American studies and public health in the interest of health equity.

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Acknowledgments The lead author would like to acknowledge Drs. Ayanna Thompson and Lisa Aubrey for their insistence that this perspective be shared, as well as Dr. Jill E. Rowe-Adjibogoun, a colleague of public health in African-American studies, who graciously offered support through intellectual exchanges and editing. Thanks are also extended to the Future of Minority Studies Program for help in conceptualizing the bridging of humanities and social science. Lastly, thanks are extended to Dr. Arna Bontemps, Faculty Head of African & African American Studies, Arizona State University, and Dr. Leanor Boulin Johnson for their enthusiasm of this project.

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