Michelle A. Tagorda-Kama*
Uday Patil
Jane J. Chung-Do
Lisa Kehl
Mapuana C. K. Antonio
Denise C. Nelson-Hurwitz- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI, United States
In 2020, the American Public Health Association declared structural racism a public health crisis acknowledging the long-lasting and harmful effects of prejudice, including relatively high rates of morbidity and mortality in many communities of color. Critical Race Theory (CRT) has become an essential lens to view and reconsider education’s role in perpetuating racial and ethnic discrimination. Debates over integrating CRT in higher education with the intent to acknowledge and address racial equality and justice are more present than ever, and the discussions held in public health classrooms are no different. We present a case study of CRT integration into the Bachelor of Arts in Public Health (BAPH) program at the University of Hawaiʻi at Mānoa. In line with Solorzano’s framework of CRT in education, initial goals of integrating CRT in instruction and advising included fostering discussions of race and racism, using a social justice framework to highlight opportunities to reduce health inequities, and validating the experiential knowledge of people of color. By engaging in active discussions with community leaders and participating in experiential learning throughout the program, students develop empathy and many underrepresented and marginalized students engage actively in their home communities. Specific examples of CRT integrated in the curriculum and examples of student projects that integrate a CRT lens are provided for educators and researchers.
1. Introduction
A bold statement by the American Public Health Association declared structural racism a public health crisis, worthy of immediate attention and research by public health practitioners and institutions (1). This 2020 policy was formed within the context of nationwide protests of racist law enforcement and criminal justice systems (2), an unprecedented presidential election mired in racist and xenophobic allegations (3, 4), and the heights of a pandemic which disproportionately affected people of color (5–9). These issues have been subsumed into an impassioned examination of Critical Race Theory (CRT) and its application.
Besides a robust body of scholarship examining American law and legal systems through a lens of historic and structural racism (10, 11), CRT has been used to reinterpret “colorblind” laws, policies, and systems that have paradoxically contributed to more discriminatory outcomes (12, 13). Fiery debates over integrating CRT in higher education with the intent to acknowledge and address racial equality and justice—particularly for Black, Indigenous, and People of Color (BIPOC) communities—are more present than ever (10, 14). Various opponents contend that shaping general education around the social construct of race and concepts of intersectionality creates a revisionist history hyper-focused on racial strife and unbalanced power structures (10, 15). In 17 states, laws restricting discussions of race and racism in primary and secondary school classrooms have been passed mainly to limit the discomfort of students (16). Others argue that the application of CRT is more important than ever in higher education as faculty seek to empower students with a more critical lens to examine the structures that continue to create social, health, and economic disparities across the country. Regardless, conversations on race continue to occur in academic spaces, the media, and everyday encounters.
The discussions held in medical and public health classrooms are no different (14, 17, 18). Since public health is grounded in the ethos of social justice and the collective stories of how people have survived and thrived, it is important to acknowledge those who have not thrived, often the disadvantaged and marginalized. Health inequalities remain rampant in this golden age of medical science (19). Racial and ethnic minority groups, throughout the US, are disproportionately more likely to suffer and die from a wide range of health conditions, including diabetes, hypertension, obesity, asthma, and heart disease, when compared to White counterparts. The life expectancy of non-Hispanic/Black Americans is 4 years lower than that of White Americans (20). The COVID-19 pandemic has exacerbated these disparities; racial and ethnic minority populations are disproportionately more likely to contract and die from the illness (6, 9). Public health pedagogy has integrated the social determinants of health (SDOH) model to highlight where, when, and among whom do inequalities arise.
The SDOH are the “conditions in the environments where people are born, live, learn, work, play, worship, and age.” (21) Communities of color are more likely to be born and live in unhealthy conditions. For example, there is a growing number of studies that confirm that unhealthy food outlets are more likely to be in Black and Native communities, while healthy food outlets are more likely to be available in predominantly white communities (22–24). But SDOH misses the larger historical context that continues to reinforce these inequitable conditions, thus requiring distillation through a framework grounded in socio-political realities, such as CRT (10, 14, 17, 25, 26).
Critical race theory provides students the tools to examine why these inequities are extant and perpetuated—and, subsequently, how they can address such inequities to improve community health. For example, CRT equips students to understand the historical policies and practices that have led to the conditions where Black and Native communities are more likely to live in communities with poor access to healthy foods and viable economic opportunities, quality schools, and safe neighborhoods. CRT allows us to understand how the US history of redlining and racially based mortgage loans have led to these inequitable conditions that have produced today’s health and socioeconomic disparities (27, 28).
The stories of the oppressed also serve as records of forced but invaluable contributions to the field of population health. For centuries, researchers have unethically experimented upon minoritized populations to discern the devastating effects of diseases—and yet these communities are woefully underrepresented in modern clinical trials of lifesaving pharmaceuticals (29, 30). CRT provides students with the capacity to question how these unethical breaches have occurred and why minorities are underrepresented in clinical research. Using the lens of CRT, students can investigate how research and science have been used to justify racist beliefs and policies, including justifying slavery, genocide, and colonization (31–33).
Baseless race-based myths regarding pain tolerance to disease transmission are still prevalent in medical education and among practicing clinicians (34, 35). Minority communities continue to be targeted and susceptible to misinformation and disinformation campaigns. Patients and providers are susceptible to myths perpetuating suboptimal population health (8). Only by confronting these uncomfortable truths about trenchant prejudice in healthcare access, delivery, and utilization can we start to build an institution worthy of training the next generation of public health practitioners.
Hawaiʻi is one of the most racially and ethnically diverse states in the US. In 2019, 24.2% of Hawaiʻi’s population reported being multiracial compared to only 2.8% of the US population. Hawaiʻi is the ancestral home to the Indigenous population of Native Hawaiians or Kānaka Maoli, who comprise slightly over 10% of the population, including other Pacific Islanders who have migrated to Hawaiʻi (e.g., Samoans, Tongans, Micronesians). Asians, such as Japanese, Chinese, Korean, Filipinos, compose approximately 38% of the population. Hawaiʻi’s Hispanic and Black or African American populations are proportionally smaller than the continental United States (36). Although Hawaiʻi is often portrayed as one of the healthiest states in the United States, pervasive health disparities exist across these racial and ethnic groups. Factors such as colonization, structural racism, and assimilation contribute to inequitable access to housing, healthcare, education, and occupation. For example, Native Hawaiians and other Pacific Islanders have one of the highest rates of diabetes and hypertension compared with other major racial groups (37). Native Hawaiians have the shortest life expectancy—only 62 years—in their own homeland (38).
Training the next generation of Hawaiʻi public health leaders to address these social and health disparities will require a dynamic curriculum grounded in CRT’s social justice principles. We need to cultivate an increasingly diverse student body that reflects the communities who are most affected by these disparities. While the SDOH model does much to support curricula, it misses elements to identify rooted inequities that determine health. The addition of CRT tools is essential in any undergraduate public health program, even though the discipline claims to see and address inequity. Here we present a perspective of such a merger between philosophies in the Bachelor of Arts in Public Health (BAPH) program at the Office of Public Health Studies (OPHS) at the University of Hawaiʻi at Mānoa (UHM).
2. Program background
The University of Hawaiʻi at Mānoa was established in 1907 as a land-grant university on the island of Oʻahu. A part of UHM’s strategic plan is to become a Hawaiian place of learning. The university is also classified as an Asian-American, Native-American, and Pacific Islander-Serving Institution (AANAPISI) (39). Among the undergraduate student body, about 33% are Asian and 18% are Native Hawaiian and Pacific Islander (40).
Office of Public Health Studies, under the Thompson School of Social Work and Public Health, offers specializations in epidemiology, health policy and management, Native Hawaiian and Indigenous health, and social and behavioral health sciences (41). Degrees offered include the Bachelor of Arts (BA), Master of Public Health (MPH), Master of Science (MS), and Doctor of Philosophy (PhD). Proactive academic advising serves to promote the enrollment and retention of diverse students, while targeted recruitment and outreach efforts to underrepresented communities have been fruitful.
The BAPH program started in 2014, in response to a nationwide expansion in demand for undergraduate education (42–44), with inclusion in mind and using culturally relevant curriculum, aids, models, and examples taught by diverse faculty and staff. This curriculum, rooted in SDOH, has always included diverse perspectives, valued student lived experiences, and featured a range of locally relevant cultural examples. Beginning in the Fall 2020 semester, the curriculum expanded and scaled its previously fragmented application of CRT tools more intentionally and purposefully to respond to the need for anti-racist education. Since its inception, enrollment has grown from 35 students in 2015 to over 150 students in 2022. Our undergraduate student semester hours have been increasing since 2018, and enrollment in the public health minor has also grown since its launch in Fall 2018 to a consistent cohort size of roughly 30 students per academic year, demonstrating our department’s interdisciplinary reach. Approximately 50% of the BAPH student body is Native Hawaiian, other Pacific Islander, Indigenous, and/or Filipino ancestries, and 65% are Hawaiʻi residents (45).
3. Critical race theory in public health education
Solórzano provides five themes that guide CRT in education: (a) centering discussions of race and racism, (b) recognizing the dominant ideologies and challenging the claims toward a more just educational system, (c) using a social justice framework to end oppression, (d) validating the experiential knowledge of people of color, and (e) utilizing the interdisciplinary nature of CRT to frame racism within historical and contemporary contexts of people of color (46). As listed in Table 1, numerous examples in the BAPH program incorporate CRT within the courses and in advising and support. By centering race and racism in discussions throughout the BAPH curriculum, students begin to think critically about the systems of oppression that disproportionately impact people of color.
Table 1. Applications of critical race theory in public health classroom settings.
The introductory core series at the BAPH program provides students a broad-based foundation of public health knowledge and skills (83). These courses also offer an opportunity to introduce fundamental concepts that allow students to build their character and discover their whole selves, empowering them to engage in anti-racist critical thinking in public health through community work and advocacy.
For example, in PH 201: Introduction to Public Health course, CRT frameworks are utilized while introducing topics such as health disparities, ethical research, climate change, and the built environment. The course highlights the impact of colonization on the health of Native Hawaiian people through facilitated discussions on health disparities and Native Hawaiian health. Examples of ethical violations center on the marginalization of BIPOC communities and women. The lived experiences of Pacific Island communities allow students to connect the injustices these populations face. The historical experiences of Black communities—where U.S. redlining policies and lack of community investment continue to prevent economic mobility—are discussed within conversations about inequities found in Hawaiʻi.
PH 202 is a course focused on Public Health Issues in Hawai‘i. With UHM committed as an Indigenous-serving institution (39), it is important to have a course that ties together the lived experiences and historical context of the Native Hawaiian people as it relates to public health. The course covers key historical events of Hawai‘i, including pre-western contact, impact of land tenureship as a result of external forces such as the arrival of missionaries, plantation culture, and the illegal overthrow of the Hawaiian kingdom, and how these events impact Indigenous peoples and their land (58). In more recent history, increased attention is paid to inequities among Pacific Island communities of migrants from Compact of Free Association (COFA) countries, who participate in the labor force and have waning access to federal healthcare and assistance programs yet face harsh discrimination from other groups (84, 85). Guest speakers from these communities are intentionally invited to share their stories, research, and expertise that centers their experiential knowledge.
The course weaves the topic of colonial impact throughout PH 203: Introduction to Global Health Issues. By providing the historical and contemporary impacts of colonization on BIPOC communities, students learn to identify and associate systemic oppressions as the direct consequences of colonization and historical trauma. These consequences include dietary shifts from traditional food systems contributing to rises in non-communicable diseases; impacts of climate change disproportionately impacting people of color, especially island communities; internalized racism as illustrated by shifts towards western beauty standards driven by colonization; and losing cultural practices that once maintained community wellness.
Throughout the semester, students engage in active discussions and experiential learning activities such as water-carrying exercises to illustrate negative consequences of water access on BIPOC communities and the disproportionate burden of water-carrying on women and girls. Women and girls are overwhelmingly responsible for unpaid domestic work including water collection. In fact, globally, women spend a large proportion of their time and energy waiting for, securing, and transporting water (86). Students also develop written policy and role-play policy-making discussions through a modified Model United Nations process. These activities help empower students to identify examples of systemic racism and associated health disparities, then locate or develop policy proposals to dismantle existing systems. The course also shares documentaries portraying lived experiences of BIPOC communities to spur continual student reflection. Students also learn about the impacts of climate change that led to migration of climate change refugees.
With a strong foundation in the introductory core, students are well-positioned and prepared for the applied learning experience (APLE). Students in the BAPH program complete a three-course capstone series where they apply classroom knowledge and associated skills to real-world applications in the public health field (87). The first course of the APLE series allows students to reflect on their own experiences and complete a literature review in an area of public health of their choice. The instructors introduce key research skills using a social justice framework, with the intent of helping students identify selection and publication biases in literature, and the dangers of misclassifying underrepresented minorities in academic studies. In the second course, students complete a 100-h field experience with a community or faculty mentor, then in the third and final course, reflect on and finalize a written paper and academic poster. All three courses are centered on a public health issue of the student’s selection (87).
The power of choice and supporting theories of student self-authorship empower students to think critically about different communities’ issues and explore public health solutions to address them. Baxter Magolda defines self-authorship as the ability to control and orient one’s beliefs and identity through concurrent membership in multiple communities like families, workforces, and student bodies (88). Encouraging underrepresented and marginalized students to engage actively in their home communities is a validating experience that raises their consciousness of the cultural capitals they bring as leaders. Table 2 highlights various student APLE projects integrating a CRT lens.
Table 2. Examples of bachelors of public health student-developed capstone projects, 2021–2022: applying themes of critical race theory.
4. Critical race theory in advising and student support
Many factors can impact a student’s sense of belonging and success in higher education. Advisors play a crucial role for students, especially those of underrepresented backgrounds, by providing a relationship and environment to help affirm, support, and advocate for students’ needs (89). Advisors are gatekeepers of information and opportunities that can provide equitable experiences for students of marginalized backgrounds. The BAPH program focuses on recruiting and supporting students from underrepresented populations in higher education, including Native Hawaiian, Pacific Islander, Filipino, and other Indigenous backgrounds who are more likely to be first-generation college students. The advisor and faculty members who support the BAPH program are from underrepresented backgrounds themselves (e.g., first-generation college graduates, and ethnic or religious minorities) and possess a deep understanding of the structural barriers these populations face in accessing and pursuing higher education. These faculty members are able to contribute their own lived experiences and, by doing so, are better equipped to support students in finding their own voice and language to share their stories. By centering students’ lived experiences, a CRT approach in advising encourages dialogue that highlights students’ strengths rooted in their cultural capitals (90).
Advising public health students with a CRT approach includes honoring students’ narratives and histories while providing a space to discuss altruistic, prosocial sociocultural goals. Conversations in the classroom provide rich opportunities during advising sessions to reflect on key public health topics. Within a CRT approach, advisors affirm students’ experiences and any injustices suffered while focusing on students’ strengths and commitments to serving the community and contributing to the greater good. The overall goal of advising is to ensure students’ academic, emotional, familial, and economic needs are addressed and supported through trust built on advisor-student rapport.
5. Discussion
Centering the lived experiences of the oppressed and marginalized is essential to address the public health issues that exist due to injustices and inequities throughout history and those in the present day. The levels of racism that contribute to the race-associated differences in health outcomes is a recognized practice in health equity work (91). Public health research and practice continue integrating CRT to develop programs and interventions (92, 93). Undergraduate public health education is well-positioned to integrate the frameworks of CRT into the curriculum. In turn, programs will develop future public health leaders equipped to recognize the impact of dominant racist ideologies and powers that lead to systemic racism and health disparities.
Curriculum reform through a CRT lens can support the development of students’ global identities and skills to communicate, respect, and understand others (94). A special issue of the Australian Journal of Indigenous Education highlights higher education’s role in building an Indigenous health workforce (95), including addressing curriculum gaps in Indigenous public health (96). Our case study contributes to the growing literature on social justice and antiracism pedagogy in public health education (97).
The following are recommendations for integrating CRT in a public health curriculum. Normalizing conversations about race is essential in public health work. Beyond competencies needed to fulfill accreditation, faculty should include anti-racism training as a learning outcome in various courses. Providing students with these experiences in introductory courses can help to prepare them for deeper, more critical applications of the theory in later courses and in practice. Furthermore, the curriculum should be intentional about the examples in lectures and assignments. Faculty should also invite guest speakers to share voices and stories from underrepresented communities. Holding our faculty, staff, and students to an anti-racist ideal will normalize the practice of addressing racism as a fundamental public health issue.
6. Conclusion
Students study public health at the undergraduate level to become public health professionals but also as a complement to other health professional pathways. Many students will study public health and then engage in direct community service; others will continue on in allied health fields, such as nursing, medicine, and pharmacy. In any event, applications of critical race and related educational theories are essential to surround students with the indispensable context of historical and current systemic barriers to the principles of community health, equity, and social justice. Integrating CRT frameworks into undergraduate public health education creates a more anti-racist, socially aware, and empowered public health workforce vital to addressing ongoing community challenges and promoting health equity.
Data availability statement
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
Author contributions
MT-K, UP, and DN-H contributed conception and design of the project. UP and MT-K wrote the first draft of the manuscript. MT-K, UP, JC-D, LK, MA, and DN-H wrote sections of the manuscript. All authors contributed to the manuscript revision, read, and approved the submitted version.
Acknowledgments
We acknowledge our mentors who have paved the way and inspired us in our teaching philosophies to incorporate critical race theory in our classes. We also acknowledge that without the commitment of current and past BAPH students at the University of Hawai‘i at Mānoa, as well as the support of Office of Public Health Studies leadership, Eric Hurwitz, and Tetine Sentell, this program would not be possible. We gratefully acknowledge their contributions.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. American Public Health Association . Structural Racism is a Public Health Crisis: Impact on the Black Community [internet]. Washington, DC: American Public Health Association (2020).
2. American Public Health Association . Violence is a Public Health Issue: Public Health is Essential to Understanding and Treating Violence in the U.S. [internet]. Washington, D.C.: American Public Health Association (2018).
3. Anderson-Nathe, B , and Gharabaghi, K . Trending rightward: nationalism, xenophobia, and the 2016 politics of fear. Child Youth Serv. (2017) 38:1–3. doi: 10.1080/0145935X.2017.1277125
4. Darling-Hammond, L . Teaching for social justice: resources, relationships, and anti-racist practice. Multicult Perspect. (2017) 19:133–8. doi: 10.1080/15210960.2017.1335039
5. Büyüm, AM , Kenney, C , Koris, A , Mkumba, L , and Raveendran, Y . Decolonising global health: if not now, when? BMJ Glob Health. (2020) 5:e003394. doi: 10.1136/bmjgh-2020-003394
6. Centers for Disease Control and Prevention . Introduction to COVID-19 racial and ethnic health disparities [internet]. Ctr Dis Control Prev. (2020)
7. Kendi, IX . We still Don’t know who the Coronavirus’s victims were. The Atlantic [Internet]. (2021)
8. Quint, JJ , Van Dyke, ME , Maeda, H , Worthington, JK , Dela Cruz, MR , Kaholokula, JK, et al. Disaggregating data to measure racial disparities in COVID-19 outcomes and guide community response—Hawaii, March 1, 2020–February 28, 2021. MMWR Morb Mortal Wkly Rep. (2021) 70:1267–73. doi: 10.15585/mmwr.mm7037a1
9. The Atlantic Monthly Group . About the racial data tracker [internet]. The COVID Tracking Project. (2022)
10. Delgado, R , Stefancic, J , and Harris, A . Critical Race Theory: An Introduction [internet]. Third. New York, NY: New York University Press (2017).
11. Crenshaw, KW . Twenty years of critical race theory: looking Back to move forward. Conn Law Rev. (2011) 43:103.
12. Johnson, TR . How conservatives turned the ‘color-blind constitution’ against racial Progress. The Atlantic [Internet]. (2019)
13. Annamma, SA , Jackson, DD , and Morrison, D . Conceptualizing color-evasiveness: using dis/ability critical race theory to expand a color-blind racial ideology in education and society. Race Ethn Educ. (2017) 20:147–62. doi: 10.1080/13613324.2016.1248837
14. Lightfoot, AF , Efird, CR , and Redding, EM . Developing an antiracist Lens: using photography to facilitate public health critical race praxis in a foundational MPH course. Pedagogy Health Promot. (2021) 7:317–26. doi: 10.1177/23733799211045712
15. Neville, HA, Gallardo, ME, and Sue, DW eds. Introduction: Has the United States Really Moved Beyond Race? In: The Myth of Racial Color Blindness: Manifestations, Dynamics, and Impact [internet]. Washington, DC: American Psychological Association (2016). 3–21.
16. Pendharkar, E . A school openly discusses race in a state that bans it. Education Week [Internet]. (2022)
17. Zaidi, Z , Young, M , Balmer, DF , and Park, YS . Endarkening the Epistemé: critical race theory and medical education scholarship. Acad Med. (2021) 96:Si–v. doi: 10.1097/ACM.0000000000004373
18. Fletcher, FE , Jiang, W , and Best, AL . Antiracist praxis in public health: a call for ethical reflections. Hast Cent Rep. (2021) 51:6–9. doi: 10.1002/hast.1240
19. Walensky, RP . Director’s Commentary [internet]. Bethesda, MD: Centers for Disease Control and Prevention (2021).
20. Centers for Disease Control and Prevention . Racism and Health [Internet]. Bethesda, MD: Centers for Disease Control and Prevention (2021).
21. Office of Disease Prevention and Health Promotion . Social Determinants of Health - Healthy People 2030 [Internet]. (n.d.). [cited 2022 Jan 14]. Available from: https://health.gov/healthypeople/objectives-and-data/social-determinants-health
22. Cooksey Stowers, K , Jiang, Q , Atoloye, AT , Lucan, S , and Gans, K . Racial differences in perceived food swamp and Food Desert exposure and disparities in self-reported dietary habits. Int J Environ Res Public Health. (2020) 17:7143. doi: 10.3390/ijerph17197143
23. Fleischhacker, SE , Evenson, KR , Rodriguez, DA , and Ammerman, AS . A systematic review of fast food access studies. Obes Rev. (2011) 12:e460–71. doi: 10.1111/j.1467-789X.2010.00715.x
24. Lee, S , Oshiro, M , Hsu, L , Buchthal, OV , and Sentell, T . Neighborhoods and health in Hawai‘i: considering food accessibility and affordability. Hawaii J Med Public Health. (2012) 71:232–7.
25. Tsai, J , Lindo, E , and Bridges, K . Seeing the window, finding the spider: applying critical race theory to medical education to make up where biomedical models and social determinants of health curricula fall short. Front Public Health [Internet]. (2021) 9. doi: 10.3389/fpubh.2021.653643/full
26. Carroll, SR , Suina, M , Jäger, MB , Black, J , Cornell, S , Gonzales, AA, et al. Reclaiming indigenous health in the US: moving beyond the social determinants of health. Int J Environ Res Public Health. (2022) 19:7495. doi: 10.3390/ijerph19127495
27. Yearby, R . Racial disparities in health status and access to healthcare: the continuation of inequality in the United States due to structural racism. Am J Econ Sociol. (2018) 77:1113–52. doi: 10.1111/ajes.12230
28. Nardone, A , Chiang, J , and Corburn, J . Historic redlining and urban health today in U.S. Cities Environ Justice. (2020) 13:109–19. doi: 10.1089/env.2020.0011
29. Lefor, AT . Scientific misconduct and unethical human experimentation: historic parallels and moral implications. Nutrition. (2005) 21:878–82. doi: 10.1016/j.nut.2004.10.011
30. Hussain-Gambles, M . Ethnic minority under-representation in clinical trials. Whose responsibility is it anyway? J Health Organ Manag. (2003) 17:138–43. doi: 10.1108/14777260310476177
31. Harvard Library . Scientific racism [internet]. Harvard Library (2022). Available at: https://library.harvard.edu/confronting-anti-black-racism/scientific-racism
32. Weigmann, K . In the name of science. EMBO Rep. (2001) 2:871–5. doi: 10.1093/embo-reports/kve217
33. Brave Heart, MYH , Chase, J , Elkins, J , and Altschul, DB . Historical trauma among indigenous peoples of the Americas: concepts, research, and clinical considerations. J Psychoactive Drugs. (2011) 43:282–90. doi: 10.1080/02791072.2011.628913
34. Chapman, EN , Kaatz, A , and Carnes, M . Physicians and implicit Bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. (2013) 28:1504–10. doi: 10.1007/s11606-013-2441-1
35. Hall, WJ , Chapman, MV , Lee, KM , Merino, YM , Thomas, TW , Payne, BK, et al. Implicit racial/ethnic Bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. (2015) 105:e60–76. doi: 10.2105/AJPH.2015.302903
36. Research Economic Analysis Division. Hawaii Population Characteristics 2019 [Internet]. (2020). Available at: https://census.hawaii.gov/wp-content/uploads/2020/06/Hawaii-Population-Characteristics-2019.pdf
37. Look, MA , Soong, S , and Kaholokula, JK . Assessment and Priorities for Health and Well-being in Native Hawaiians and Pacific Islanders [internet]. Honolulu, HI, US: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaiʻi (2020).
38. Wu, Y , Braun, K , Onaka, AT , Horiuchi, BY , Tottori, CJ , and Wilkens, L . Life expectancies in Hawai‘i: a multi-ethnic analysis of 2010 life tables. Hawaii J Med Public Health. (2017) 76:9–14.
39. University of Hawaiʻi at Mānoa . About UH Mānoa [Internet]. (2023). Available from: https://manoa.hawaii.edu/about/
40. University of Hawaiʻi at Mānoa, Office of Student Equity, Excellence and Diversity . Mānoa’s Racial and Ethnic Diversity Profile [internet]. Honolulu, HI: University of Hawaiʻi at Mānoa (2016). 7 p.
41. Office of Public Health Studies . About [internet]. University of Hawaiʻi at Mānoa. (2022). Available at: http://manoa.hawaii.edu/publichealth/about
42. Leider, JP , Castrucci, BC , Plepys, CM , Blakely, C , Burke, E , and Sprague, JB . On academics: characterizing the growth of the undergraduate public health major: U.S., 1992–2012. Public Health Rep. (2015) 130:104–13. doi: 10.1177/003335491513000114
43. Resnick, B , Leider, JP , and Riegelman, R . The landscape of US undergraduate public health education. Public Health Rep. (2018) 133:619–28. doi: 10.1177/0033354918784911
44. Riegelman, RK . 2022 Update On Undergraduate Public Health [internet]. Burlington, MA: Jones & Bartlett Learning (2022).
45. Mānoa Institutional Research Office . University of Hawaiʻi at Mānoa enrollment trend report [internet]. (2022). Available at: https://manoa.hawaii.edu/miro
46. Solorzano, DG . Critical race theory, race and gender microaggressions, and the experience of Chicana and Chicano scholars. Int J Qual Stud Educ. (1998) 11:121–36. doi: 10.1080/095183998236926
47. Vargas, T . Guinea pigs or pioneers? How Puerto Rican women were used to test the birth control pill. Washington Post [Internet]. (2017); Available at: https://www.washingtonpost.com/news/retropolis/wp/2017/05/09/guinea-pigs-or-pioneers-how-puerto-rican-women-were-used-to-test-the-birth-control-pill/
48. Wong, A. People with leprosy were exiled there—Should it be a tourist destination? The Atlantic [internet]. (2015); Available at: https://www.theatlantic.com/health/archive/2015/05/when-the-last-patient-dies/394163/
49. Centers for Disease Control and Prevention . Tuskegee Study [Internet] (2021). Available at: https://www.cdc.gov/tuskegee/timeline.htm
50. Lombardo, PA , and Dorr, GM . Eugenics, medical education, and the public health service: another perspective on the Tuskegee syphilis experiment. Bull Hist Med. (2006) 80:291–316. doi: 10.1353/bhm.2006.0066
51. Hutch, DJ , Bouye, KE , Skillen, E , Lee, C , Whitehead, L , and Rashid, JR . Potential strategies to eliminate built environment disparities for disadvantaged and vulnerable communities. Am J Public Health. (2011) 101:587–95. doi: 10.2105/AJPH.2009.173872
52. Jackson, C. What is redlining? The New York Times [Internet] (2021); Available at: https://www.nytimes.com/2021/08/17/realestate/what-is-redlining.html
53. Branas, CC , South, E , Kondo, MC , Hohl, BC , Bourgois, P , Wiebe, DJ, et al. Citywide cluster randomized trial to restore blighted vacant land and its effects on violence, crime, and fear. Proc Natl Acad Sci. (2018) 115:2946–51. doi: 10.1073/pnas.1718503115
54. Ritchie, H , and Roser, M . Environmental impacts of food production. Our World Data [Internet]. (2020); Available at: https://ourworldindata.org/environmental-impacts-of-food
55. Gon, S , and Winter, K . A Hawaiian renaissance that could save the world. American Scientist [Internet]. (2019) 107:232. doi: 10.1511/2019.107.4.232
56. University of Northern Iowa . Farming for public health | evidence-based farming! [internet]. (2022). Available at: https://farmingforpublichealth.org/
57. Anonymous . History of Hawaii’s public health [internet]. (2015). Available at: https://www.youtube.com/watch?v=rJEIqGMaasw
58. McDermott, JF, and Andrade, NN eds. People and Cultures of Hawaiʻi: The Evolution of Culture and Ethnicity [internet]. Honolulu: University of Hawaiʻi Press (2011). 347 p.
59. Wikipedia Authors . Picture Bride (film). In: Wikipedia [internet]. (2022). Available at: https://en.wikipedia.org/w/index.php?title=Picture_Bride_(film)&oldid=1096673329
60. Hofschneider, A. Pacific islanders, Filipinos have highest COVID-19 rates in Hawaii. Honolulu Civil Beat [Internet]. (2020); Available at: https://www.civilbeat.org/2020/06/pacific-islanders-filipinos-have-highest-covid-19-rates-in-hawaii/
61. Fields, S. Decolonizing the map: Creating the indigenous mapping… [internet]. PBS Education. (2022). Available at: https://www.pbs.org/education/blog/decolonizing-the-map-creating-the-indigenous-mapping-collective
62. Anonymous .High on the hog: how African American cuisine transformed America [internet] (2021). Available at: https://www.netflix.com/title/81034518
63. United States Holocaust Memorial Museum . Herero and Nama Genocide [Internet] (2022). Available at: https://www.ushmm.org/collections/bibliography/herero-and-nama-genocide
64. Lenzer, J . Secret report surfaces showing that Pfizer was at fault in Nigerian drug tests. BMJ. (2006) 332:1233. doi: 10.1136/bmj.332.7552.1233-a
65. McNeil, DG . A failed trial in Africa raises questions about how to test H.I.V. Drugs The New York Times [Internet] (2015); Available at: https://www.nytimes.com/2015/02/05/health/failed-trial-in-africa-raises-questions-about-how-to-test-hiv-drugs.html
66. Clark, K . Clinical trials in developing countries: the new “Tuskegee.”. WR J Arts Sci Writ Program [Internet]. (2011) 4
67. Annas, GJ , and Grodin, MA . Human rights and maternal-fetal HIV transmission prevention trials in Africa. Am J Public Health. (1998) 88:560–3. doi: 10.2105/AJPH.88.4.560
68. Brewster, D . Science and ethics of human immunodeficiency virus/acquired immunodeficiency syndrome controversies in Africa. J Paediatr Child Health. (2011) 47:646–55. doi: 10.1111/j.1440-1754.2011.02179.x
69. Cunningham, B . Partially treated: AIDS, inequality and ethics: The controversy over the short course AZT trials [Internet] [Dissertation]. [Ann Arbor, MI, US]: University of Michigan. (2006). Available from: https://www.proquest.com/dissertations-theses/partially-treated-aids-inequality-ethics/docview/305278829/se-2
71. Singmaster, H. The legacy of Michelle Obama and the let girls learn initiative. Education Week [Internet] (2017); Available at: https://www.edweek.org/leadership/opinion-the-legacy-of-michelle-obama-and-the-let-girls-learn-initiative/2017/01
72. Sanchez, E , and Rodriguez, L . Period poverty: everything you need to know [internet]. Global Citizen (2019). Available at: https://www.globalcitizen.org/en/content/period-poverty-everything-you-need-to-know/
73. UNESCO . Puberty Education and Menstrual Hygiene Management [internet]. Paris, FR: UNESCO (2014). 58 p.
74. Lusk-Stover, O , Rop, R , Tinsley, E , and Rabie, TS . Globally, periods are causing girls to be absent from school [internet]. (2016). Available at: https://blogs.worldbank.org/education/globally-periods-are-causing-girls-be-absent-school
75. Alexander, LL , LaRosa, JH , Bader, H , and Garfield, S . New Dimensions in Women’s Health Jones & Bartlett Learning (2020). 504 p.
76. Artiga, S , Orgera, K , Pham, O , and Corallo, B . Growing data underscore that communities of color are being harder hit by COVID-19 [internet]. Kaiser Family Foundation; (2020). (Disparities Policy Brief). Available at: https://www.kff.org/coronavirus-policy-watch/growing-data-underscore-communities-color-harder-hit-covid-19/
77. Srikanthan, A , and Reid, RL . Religious and cultural influences on contraception. J Obstet Gynaecol Can. (2008) 30:129–37. doi: 10.1016/S1701-2163(16)32736-0
78. Anonymous . Shout Gladi Gladi [Internet]. (2015). Available at: https://www.shoutgladigladi.com/
79. Motherland [Internet] . CineDiaz. (2017) [cited 2023 Aug 13]. Available from: https://www.imdb.com/title/tt6333078/
80. Ryder, M. The media’s racial bias is also happening off screen. Fortune [internet]. (2022); Available at: https://fortune.com/2022/03/10/racial-bias-ukraine-war-reporting-media-diversity-trust-marcus-ryder/
81. Ali, L. In Ukraine reporting, Western press reveals grim bias toward “people like us.” Los Angeles Times [Internet] (2022); Available at: https://www.latimes.com/entertainment-arts/tv/story/2022-03-02/ukraine-russia-war-racism-media-middle-east
82. Mba Abogo, CA . Racism in Western reporting of the Ukraine war. How should we respond? New African Magazine [Internet] (2022); Available at: https://newafricanmagazine.com/27904/
83. Nelson-Hurwitz, DC , Tagorda, M , Kehl, L , Buchthal, OV , and Braun, KL . Developing an undergraduate public health introductory Core course series. Front Public Health. (2018) 6:155. doi: 10.3389/fpubh.2018.00155
84. Blair, C . Micronesian immigration an “important civil rights issue” facing Hawaii—Honolulu civil beat. (2015); Available at: https://www.civilbeat.org/2015/08/micronesian-immigration-an-important-civil-rights-issue-facing-hawaii/
85. Hofschneider, A . Report: battling discrimination against Micronesians requires policy changes. Honolulu Civil Beat [Internet]. (2019)
86. Adams, EA , Adams, YJ , and Koki, C . Water, sanitation, and hygiene (WASH) insecurity will exacerbate the toll of COVID-19 on women and girls in low-income countries. Sustain Sci Pract Policy. (2021) 17:85–9. doi: 10.1080/15487733.2021.1875682
87. Nelson-Hurwitz, DC , and Tagorda, M . Developing an undergraduate applied learning experience. Front Public Health [Internet]. (2015). doi: 10.3389/fpubh.2015.00002/abstract
88. Baxter Magolda, MB . Self-authorship. New Dir High Educ. (2014) 2014:25–33. doi: 10.1002/he.20092
89. Lee, JA . Affirmation, support, and advocacy: critical race theory and academic advising. NACADA J. (2018) 38:77–87. doi: 10.12930/NACADA-17-028
90. Puroway, A . Critical advising: a Freirian-inspired approach. NACADA J. (2016) 36:4–10. doi: 10.12930/NACADA-15-015
91. Camara, PJ . Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. (2000) 90:1212–5. doi: 10.2105/AJPH.90.8.1212
92. Petteway, RJ , and González, LA . 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. Int J Environ Res Public Health. (2022) 19:8187. doi: 10.3390/ijerph19138187
93. Amani, B , Cabral, A , Sharif, MZ , Huỳnh, J , Skrine Jeffers, K , Baptista, SA, et al. Integrated methods for applying critical race theory to qualitative COVID-19 equity research. Ethn Dis. (2022) 32:243–56. doi: 10.18865/ed.32.3.243
94. Azzahrawi, R . A Look at the approaches to multicultural and anti-racist education through the lenses of critical race theory: the reported benefits and failures. J Adv Res Educ. (2023) 2:1–9. doi: 10.56397/JARE.2023.01.01
95. Bond, C , and Kajlich, H . Introduction to the special issue: critical conversations on higher education as an enabler to building an indigenous health workforce. Aust J Indig Educ. (2020) 49:108–9. doi: 10.1017/jie.2020.12
96. Lee, N . Addressing the knowledge gap of indigenous public health: reflections from an indigenous public health graduate. Aust J Indig Educ. (2020) 49:110–8. doi: 10.1017/jie.2020.15
Keywords: public health education, health professionals, critical race theory, racism, undergraduate education, underrepresented minority
Citation: Tagorda-Kama MA, Patil U, Chung-Do JJ, Kehl L, Antonio MCK and Nelson-Hurwitz DC (2023) Shaping undergraduate public health education through critical race theory: a case study. Front. Public Health. 11:1192771. doi: 10.3389/fpubh.2023.1192771
Edited by:
Stefano Orlando, University of Rome Tor Vergata, ItalyReviewed by:
Yousef Khader, Jordan University of Science and Technology, JordanCopyright © 2023 Tagorda-Kama, Patil, Chung-Do, Kehl, Antonio and Nelson-Hurwitz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Michelle A. Tagorda-Kama, tagordam@hawaii.edu