Engaging Antiracist And Decolonial Praxis To Advance Equity In Oregon Public Health Surveillance Practices.

Public health surveillance and data systems in the US remain an unnamed facet of structural racism. What gets measured, which data get collected and analyzed, and how and by whom are not matters of happenstance. Rather, surveillance and data systems are productions and reproductions of political priority, epistemic privilege, and racialized state power. This has consequences for how communities of color are represented or misrepresented, viewed, and valued and for what is prioritized and viewed as legitimate cause for action. Surveillance and data systems accordingly must be understood as both an instrument of structural racism and an opportunity to dismantle it. Here, we outline a critique of standard surveillance systems and practice, drawing from the social epidemiology, critical theory, and decolonial theory literatures to illuminate matters of power germane to epistemic and procedural justice in the surveillance of communities of color. We then summarize how community partners, academics, and state health department data scientists collaborated to reimagine survey practices in Oregon, engaging public health critical race praxis and decolonial theory to reorient toward antiracist surveillance systems. We close with a brief discussion of implications for practice and areas for continued consideration and reflection.

Centering Communities of Color in the Modernization of a Public Health Survey System: Lessons from Oregon.

Context: Public health survey systems are tools for informing public health programming and policy at the national, state, and local levels. Among the challenges states face with these kinds of surveys include concerns about the representativeness of communities of color and lack of community engagement in survey design, analysis, and interpretation of results or dissemination, which raises questions about their integrity and relevance. Approach: Using a data equity framework (rooted in antiracism and intersectionality), the purpose of this project was to describe a formative participatory assessment approach to address challenges in Oregon Behavioral Risk Factor Surveillance System (BRFSS) and Student Health Survey (SHS) data system by centering community partnership and leadership in (1) understanding and interpreting data; (2) identifying strengths, gaps, and limitations of data and methodologies; (3) facilitating community-led data collection on community-identified gaps in the data; and (4) developing recommendations. Results: Project team members' concerns, observations, and critiques are organized into six themes. Throughout this engagement process, community partners, including members of the project teams, shared a common concern: that these surveys reproduced the assumptions, norms, and methodologies of the dominant (White, individual centered) scientific approach and, in so doing, created further harm by excluding community knowledges and misrepresenting communities of color. Conclusions: Meaningful community leadership is needed for public health survey systems to provide more actionable pathways toward improving population health outcomes. A data equity approach means centering communities of color throughout survey cycles, which can strengthen the scientific integrity and relevance of these data to inform community health efforts.

PRESENCE//Gifted: On Poetry, Antiracism, and Epistemic Violence in Health Promotion.

Through poetry, I offer a critical reflection on the racialized contexts, consequences, and (mis)representations of overlapping pandemics-COVID-19 and structural racism-crafted as counternarrative to public health's and medicine's ahistorical, apolitical, and racist proclivities in times of crises (e.g., plague, 1918 flu, HIV/AIDS, addiction, racialized police violence). I weave public health and medical concepts together with Black music, poetry, scholarship, and history to (re)frame/analyze interconnections between COVID-19 and structural racism-centering love, resistance, and solidarity to counter Black erasure within the public health knowledge canon. I contextualize the poem/use of poetry as praxis in public health antiracism discourse through a brief essay, drawing from critical, critical race, and Black feminist theory to position poetry as a space of health equity testimony, and a mode of antiracist praxis to reclaim/center the margin as site of knowing and resistance. Specifically, I discuss testimonial quieting, testimonial smothering, and testimonial incompetence as critical concepts for health promotion scholars, practitioners, and students to engage as germane to interrogating our present knowledge production norms in regards to epistemic violence and its implications for prospects of antiracist public health futures. In doing so, I suggest that poetry can play a critical role in challenging, opening up, and reimagining discourse of antiracism for advancing health equity knowledge and action.

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.

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.

PARTICULATES//Tulips: (Or, Estimating Respiratory Effects of Ambient Air Pollution and COVID-19 Using a Policing-Climate Adjusted Hazard Function).

Through poetry, I offer a creative, critical analysis of the intersections of COVID-19, structural racism, and racialized police violence-situating present COVID-19 discourse within a broader historical arc of respiratory distress within communities of color, all while centering Earth Day and climate change as both metaphor and corollary. In doing so, I enact poetry as praxis, reflecting critically on the racialized contexts and consequences of overlapping threats to our health, while simultaneously crafting counternarrative to public health's ahistoric, apolitical, and racist proclivities in times of public health crises.

Poetry as Praxis + "Illumination": Toward an Epistemically Just Health Promotion for Resistance, Healing, and (Re)Imagination.

Health promotion is facing a most challenging future in the intersections of structural racism, COVID-19 (coronavirus disease 2019), racialized police violence, and climate change. Now is a critical moment to ask how health promotion might become more responsive to and representative of people's daily realities. Also how it can become a more inclusive partner in, and collaborative conduit of, knowledge-one capable of both informing intellects and transforming hearts. It needs to feel the pulse of the "fierce urgency of now," and perhaps nothing can reveal this pulse more than the creative power of art-especially poetry. Drawing from critical and Black feminist theory, I use commentary in prose to conceptualize and call for an epistemically just health promotion guided by poetry as praxis-not just as method. I posit that, as praxis rooted in lived realities, poetry becomes experiential excavation and illumination; a practice of community, communion, and solidarity; a site and source of healing; and a space to create new narratives of health to forge new paths toward its promotion. I accordingly suggest a need to view and value poetry as a critical scholarship format to advance health promotion knowledge, discourse, and action toward a more humanized pursuit-and narrative-of health equity.

LATENT//Missing: On Missing Values, Narrative Power, and Data Politics in Discourse of COVID-19.

April is National Minority Health Month in the United States. The first week of April is National Public Health Week. This year, both occasions passed as the COVID-19 pandemic unfolded and, in the process, rendered remarkably clear the magnitude of the United States' collective shortcomings in advancing population health equity-particularly as related to dominant narratives of health and data politics. Drawing from critical theory, I use essay to contextualize present COVID-19 discourse and poetry to situate this discourse within a broader historical arc of the United States' racist, classist, and homophobic proclivities in times of public health crises. I use the combination of essay/poem as creative praxis to analyze and reflect on our present moment in relation to public health pasts and to raise questions about public health research, education, and data futures-offering a critical commentary on the intersections of infectious diseases, structural inequality (e.g., racism), data politics, and public health violence.

Intergenerational photovoice perspectives of place and health in public housing: Participatory coding, theming, and mapping in/of the "structure struggle".

This paper details an intergenerational photovoice project exploring spatial and perceptual differences of "place" and health among adult and youth public housing residents in a small urban rustbelt city in the Midwestern United States. It specifically highlights the value of fully participatory photovoice processes-participatory narrative-coding and digital web-based photo-mapping-in furthering conceptual and analytical understanding of "place" and health. Results indicate the critical import of accounting for non-residential locations (i.e. activity spaces), and the significance of engaging the generationally- and spatially-specific social and physical landscapes of residents' lived "place" to improve health opportunities within place-based strategies involving public housing.

Towards a People's Social Epidemiology: Envisioning a More Inclusive and Equitable Future for Social Epi Research and Practice in the 21st Century.

Social epidemiology has made critical contributions to understanding population health. However, translation of social epidemiology science into action remains a challenge, raising concerns about the impacts of the field beyond academia. With so much focus on issues related to social position, discrimination, racism, power, and privilege, there has been surprisingly little deliberation about the extent and value of social inclusion and equity within the field itself. Indeed, the challenge of translation/action might be more readily met through re-envisioning the role of the people within the research/practice enterprise-reimagining what "social" could, or even should, mean for the future of the field. A potential path forward rests at the nexus of social epidemiology, community-based participatory research (CBPR), and information and communication technology (ICT). Here, we draw from social epidemiology, CBPR, and ICT literatures to introduce A People's Social Epi-a multi-tiered framework for guiding social epidemiology in becoming more inclusive, equitable, and actionable for 21st century practice. In presenting this framework, we suggest the value of taking participatory, collaborative approaches anchored in CBPR and ICT principles and technological affordances-especially within the context of place-based and environmental research. We believe that such approaches present opportunities to create a social epidemiology that is of, with, and by the people-not simply about them. In this spirit, we suggest 10 ICT tools to "socialize" social epidemiology and outline 10 ways to move towards A People's Social Epi in practice.

The body language of place: A new method for mapping intergenerational "geographies of embodiment" in place-health research.

Research on place and health has grown rapidly in recent years, including examining the physiological embodiment of place-based exposures. While this research continues to improve understanding of why place matters, there is particular need for work capable of revealing: 1) which places matter, i.e. spatially-specific notions of "place"); 2) how these places matter-processes and mechanisms of the physiological embodiment of place; and 3) potential intergenerational and life stage differences in place-embodiment experiences/perceptions. The research presented here seeks to make contributions in each of these areas through developing the "geographies of embodiment" concept. Drawing from a multi-method intergenerational community-based participatory research project examining place and health, the research presented here specifically highlights X-Ray Mapping as a new methodology to elucidate subjective notions of place-embodiment within place-health research. Participants were recruited as parent-child dyads and trained in four participatory research methods, including X-Ray Mapping. Participants used X-Ray Mapping and a multimedia-enabled web-based mapping platform to map their "geographies of embodiment". X-Ray Mapping results revealed that 49% of youth place-embodiment locations were spatially outside of their residential census tract-with 75% of positive place-embodiment locations outside, and 66% of negative place-embodiment locations inside. Overall, 67% of youth and adult positive place-embodiment locations were outside of their residential census tract. Through mapping "geographies of embodiment" via participatory methods like X-Ray Mapping, we can gain greater insight into what is embodied (i.e. specific experiences/exposures), and where (i.e. spatially-specific). These gains could improve development of quantitative place-health metrics and enhance efforts to uncover/intervene on the "pathways of embodiment"-specifically, those elements of local social, political, economic, and environmental contexts that constitute expressions of social inequality.

Understanding Embodiment in Place-Health Research: Approaches, Limitations, and Opportunities.

Research on how place affects health continues to grow. Within the place-health research field, there is increasing focus on how place becomes embodied-i.e., how place-based social and environmental experiences and exposures "get under our skin" to affect physiological functioning and health. While much has been learned, currently favored place-embodiment research approaches present limitations that inhibit continued gains in understanding. This article presents a brief summary of place-health literature related to place-embodiment, highlighting common approaches. Core limitations are then discussed with an eye towards improving research going forward, highlighting mixed-method, spatially dynamic, and participatory intergenerational approaches as promising considerations.

Toward an Intergenerational Model for Tobacco-Focused CBPR: Integrating Youth Perspectives via Photovoice.

The growing prominence of community-based participatory research (CBPR) presents as an opportunity to improve tobacco-related intervention efforts. CBPR collaborations for tobacco/health, however, typically engage only adults, thus affording only a partial understanding of community context as related to tobacco. This is problematic given evidence around age of tobacco use initiation and the influence of local tobacco environments on youth. The CEASE and Resist youth photovoice project was developed as part of the Communities Engaged and Advocating for a Smoke-free Environment (CEASE) CBPR collaboration in Southwest Baltimore. With the broader CEASE initiative focused on adult smoking cessation, CEASE and Resist had three aims: (1) elucidate how youth from a high-tobacco-burden community perceive/interact with their local tobacco environment, (2) train youth as active change agents for tobacco-related community health, and (3) improve intergenerational understandings of tobacco use/impacts within the community. Fourteen youth were recruited from three schools and trained in participatory research and photography ethics/guiding principles. Youth met at regular intervals to discuss and narrate their photos. This article provides an overview of what their work revealed/achieved and discusses how including participatory youth research within traditionally adult-focused work can facilitate intergenerational CBPR for sustainable local action on tobacco and community health.

What about your friends? Exploring asthma-related peer interactions.

PURPOSE: School-based asthma interventions have been shown to be effective, but many may not be sensitive to the influence of peer interactions in shaping asthma-related emotional experiences. This exploratory study describes associations between peer interactions and asthma-related emotional experiences, asthma control, and outcomes among elementary-aged children with asthma. METHODS: Data come from the baseline assessment of a randomized trial evaluating the effect of a school-based asthma intervention. Univariate and multivariate statistics were completed to examine associations between peer interactions and asthma-related variables of interest. RESULTS: Eight hundred and thirty-five caregiver and child interviews were used in the analysis. Both males and females were enrolled in this study, 31% had not well controlled or poorly controlled asthma and 44% reported taking asthma medications. Overall, 26% of children talked to friends about asthma. Females were significantly more likely to talk to friends about asthma (p < .05) and more likely to report that they were worried, concerned, or troubled about asthma (p < .01). Significant differences in emotional quality of life between males and females were also found. Children who reported talking to friends about asthma were more likely to report teasing about asthma (OR = 2.47; 95% CI 1.57, 3.89) and to report that friends help with their asthma (OR = 1.79; 95% CI 1.07, 3.01). CONCLUSIONS: School-based asthma interventions should be sensitive to emotional-related outcomes associated with asthma and the influence of asthma-related peer interactions. Providing children with communication strategies for disclosure of asthma status to peers that result in more supportive interactions may be needed.