Mentoring to Dismantle Structural Racism

In 2023, I remarked to a colleague,

I thought I had achieved something. I decided to ignore advice from senior White colleagues who tried to discourage me from applying for what would be the first NIMH [National Institute of Mental Health] Career Development Award given to a person of color. The advice was that the award was ‘not for me,’ but I knew they were advising me in that fashion because I was Black, a woman, and a psychologist (physicians were preferred candidates).

As an assistant professor, I wanted to be trained as a sex researcher and therapist to examine the generational effects of slavery on the mental and sexual health of the descendants of slaves, and to address sexual trauma in the therapy and in behavioral interventions. I spent the next four years writing K and R01 applications nine times. When I finally received fundable scores for both, I was told by a well-meaning colleague that they would never be funded if I did not include a White control group. White women legitimized the study of Black sexuality in slavery and freedom, even though they did not have the same lived experiences.

I decided to spend the next 50 years of my life trying to avoid meaningless comparisons. I joined equally determined colleagues to better inform the science about health inequities and barriers that limit public health for underserved people. We have provided information about the context of health inequities and mentored those who will continue this work (Gail E. Wyatt, oral personal communication, February 2023).

Our early career scholars (many of whom authored articles in this special issue of AJPH) shared experiences of a similar nature occurring within the past five years. For example, being asked by grant and article reviewers to include White samples for comparison purposes and being told that race-related research should not be done because it would eventually be irrelevant.

INTRODUCTION

There is something terribly wrong when the gold standard for acceptable public health, behaviors, and policies in a democratic country is based on principles of White supremacy, including the notion in research that White populations’ behaviors and experiences are the norm to which all other groups are compared. Although much important work has spoken to the importance of decolonizing research and foregrounding intersectionality in the process, we agree with Bowleg that “intersectionality praxis” (i.e., practical application of intersectionality) is urgently needed.¹

Furthermore, the practical application itself—the doing of the work—necessitates greater emphasis on study designs and methods that account for, and may ultimately intervene in, structural inequities. Because these approaches, such as community-based participatory research and qualitative research, are not as highly valued in the research canon (including funding, publications) as experimental designs that are not “real world,”² it can be challenging for early stage investigators, particularly investigators of color, to carve successful career paths based on what will likely be seen as less rigorous or less scientific studies.

These critical research issues have guided the long-standing mentoring program that produced this special issue: the University of California, Los Angeles HIV/AIDS, Substance Abuse, and Trauma Training Program,³ which is funded by the National Institute on Drug Abuse. The articles in this special issue (mainly authored by scholars in this program), “HIV, Substance Use, and Trauma: Mentoring to Dismantle Structural Racism,” highlight innovative and impactful work aimed at advancing solutions that address how structural racism and intersectional stigma and discrimination contribute to inequities in HIV, substance use, and trauma prevention and treatment.

In this editorial, we share our perspectives on issues at the heart of conducting research—and mentoring others to conduct research—with underserved populations, including the importance of (1) studying within-group differences and patterns (rather than fostering potentially erroneous and harmful across-group differences), (2) interrogating the bidirectional relationship between the production (and consumption) of research and academic career development, and (3) embracing cultural humility as a fundamental research stance. We conclude by proposing implications for the future of social and behavioral research and mentoring in and through that space to contribute to the dismantling of structural racism.

STUDYING DIFFERENCES

In the complex landscape of racist politics across the globe today, it has become critical to take a more nuanced approach to understanding and studying differences. Historically, investigating within-group differences was not considered good science—it was not “rigorous.” Two decades ago, Hughes et al. noted:

Many social science researchers use simple demographic markers or proxy variables, such as race or nationality … to define a non-mainstream cultural group, with little attention to group boundaries or to wide within-group variation.^4(p689)

We have observed, and our scholars have observed, that this is still a problem today (with notable exceptions⁵). Public health research has convincingly demonstrated that failure to recognize within-group heterogeneity has the potential to misguide public health policy and practice and to contribute to interventions that are not sustained. We encourage our scholars to interrogate the groupings themselves, paying much closer attention to details such as country of origin, colorism, and immigration status.^6,7

We also support our scholars (most of whom are people of color [See Guest Editors’ Note on Terminology, available as a supplement to the online version of this article at http://www.ajph.org]) in pursuing study designs and methods that prioritize meaningful engagement with communities and participation in research, such as community-based participatory research, photovoice, and citizen science–led research, consistent with Bowleg’s proposed “critical health equity research” methodology⁸ and Krieger’s call for methods that address the “lived realities of discrimination as an exploitative and oppressive societal phenomenon operating at multiple levels and involving myriad pathways across both the life course and historical generations.”^9(p936)

THE PRODUCTION OF RESEARCH

Recent social movements around improving diversity, equity, and inclusion in public health have led to a new interest in understanding the role of racism and community context in addressing major ongoing health epidemics among people of color, including substance abuse and HIV in the United States.^10,11 We argue that research to achieve health equity in the United States must continue to incorporate community (e.g., community engagement, community resources), cultural, and structural (e.g., discrimination, racial/ethnic trauma) contexts to understand health behavior using appropriate and valid research designs, such as qualitative, quasiexperimental, and mixed methods designs.^12–15 These designs, especially qualitative and mixed methods, have been applied to underlying research questions about community engagement, discrimination, and racial/ethnic trauma to understand health inequities using rigorous approaches.^16,17

Despite the decades-long emphasis on the need to incorporate more of these designs into social and behavioral research in the United States, academic systemic racism and bias continue to undermine how these designs are incorporated into mainstream scientific research. Previous research that has used these designs, including research led by researchers from minoritized populations,¹⁸ and has been published in scientific journals that do not have high impact scores (e.g., Journal of Black Psychology, Journal of the National Medical Association) is largely ignored by nonminoritized researchers.

Over the 10 years of our training program, we have heard from our scholars that they are told not to publish in racial/ethnic minority–related journals for fear of not being seen as serious scientists and then not progressing academically. Community, cultural, and structural contexts are essential for understanding health behavior, yet many journals that focus on these phenomena are devalued in the mainstream scientific community.^19,20 They are not as widely cited as other journals; hence, their impact scores are low (an example of academic systemic racism and bias).

The history of these journals is often overlooked or not even known: many of these journals were created by investigators of color in response to the rejection of their research by mainstream scientific journals as not being rigorous or empirical. Despite the key and novel contributions of research published in these journals, high-impact journals and some White researchers add community and cultural context to their research instead of citing existing research, and suggest that the addition is new and innovative.²¹ Many publications in the social and behavioral sciences that highlight race have not typically been written by people of color, leading, for example, to “systemic inequality … within psychological research.”^22(p1295) Scientific acknowledgment will go to those high-impact journals and researchers publishing in them, but will this push public health to achieve diversity, equity, and inclusion? Will this work really lead to health equity?

Black and Brown researchers are not consistently viewed as subject matter experts.¹³ Furthermore, expertise on community and cultural context is sometimes not viewed as valid.¹³ Black and Brown researchers who focus primarily on community and cultural contexts may not be viewed as scientists, decision-makers, or thought leaders, which contributes to persistent disparities in National Institutes of Health (NIH) funding.^23,24 These gaps, along with the structural factors that shape them, likely contribute to the disproportionate HIV incidence and prevalence in racialized communities.²⁵ We encourage our scholars to interrogate the interlocking structural systems of oppression that affect their funding prospects and the consequences of the disparities in funding.

EMBRACING CULTURAL HUMILITY

The work of mentoring to dismantle structural racism is not the responsibility of investigators of color only. It is also critical that White investigators guide their mentees to use more participatory, nonhegemonic research designs and to establish their careers strategically, acknowledging the biases they will face. Using alternative research paradigms requires humility among White investigators, who need to recognize their privilege and their responsibility to support and foster intersectionality praxis,¹ not perpetuate or exacerbate the problem. More than 25 years ago, Tervalon and Murray-Garcia suggested that “cultural competence” evokes a “detached mastery of a theoretically finite body of knowledge,”^(p117) whereas “cultural humility” incorporates a “lifelong commitment to self-evaluation and self-critique, to redressing power imbalances … and developing mutually beneficial and non-paternalistic … partnerships with communities.”^26(p123) With its emphasis on acknowledging power differentials and personal accountability, cultural humility challenges public health researchers—particularly White public health researchers—to explicitly address inequalities and examine their own contributions to these inequalities.²⁷

Our mentoring approach has incorporated cultural humility into the faculty’s respective research agendas and into our professional modeling for our scholars; for example, mentoring them on how to do ethical work in communities in which they are not members and how to tell people’s stories with clarity and compassion, particularly when their lived experiences differ from the researcher’s. Furthermore, we align our approach with that of Metzl and Hansen, who propose “structural competency,” that is, “attention to forces that influence health outcomes at levels above individual interactions,”^28(p127) consistently pushing ourselves, our scholars, and public health research toward broader structural changes that will ultimately dismantle structural racism.

CONCLUSIONS

To promote public health research that will help eliminate health inequity and improve health equity for better population health in the United States, we recommend the following:

• 1.Greater valuing of diversity in scientific research, including research designs that foster engagement in research by building trust with participants (e.g., community-based participatory research), focusing on strengths rather than deficits, and creating research teams that include diverse colleagues with different perspectives and life experiences;
• 2.Greater attention to intersectional within-group comparisons (e.g., gender, disability, socioeconomic status, sexual and gender minority status), with a strengths-based orientation;
• 3.Identifying appropriate comparison groups that expand beyond simplistic racial/ethnic group comparisons (e.g., by including country of origin, colorism, and immigration status);
• 4.Mentoring on cultural humility and structural competence and advancing strategies to dismantle structurally racist scientific methods and assumptions, for example, by changing medical curriculum education to incorporate “structural awareness”²⁸ and by ensuring that research teams have members with lived experiences in multiple roles; and
• 5.Longer funding periods for R01 grants (Research Project Grant, the original and historically oldest grant mechanism used by the NIH) that address health equity, to provide time and support for co-design of interventions and more equitable engagement practices for researchers (e.g., acknowledging and dismantling power differentials in community-engaged work).

An African proverb says, “Until lions have their own historians, the history of the hunt will always glorify the hunter.” It is time for social and behavioral researchers to become the lions’ historians, to abandon setting standards according to the hunter and instead foster standards that recognize the diversity of lived experiences and complex community, cultural, and structural contexts of people’s health behaviors and outcomes.