“Racism has an impact on health, and we want to look at the bigger picture,” says Ameena Batada, associate professor of health and wellness at UNC Asheville. To accomplish this, Batada has joined forces with Je’Wana Grier-McEachin, executive director of the Asheville Buncombe Institute of Parity Achievement, and Jill Fromewick, a research scientist at the Mountain Area Health Education Center. Armed with a three-year, $350,000 Interdisciplinary Research Leaders fellowship from the Robert Wood Johnson Foundation, the team aims to connect directly with rural African-Americans in Western North Carolina, and with the organizations and institutions that are significant in their lives, in order to deconstruct and combat the ways that racism has contributed to the myriad health challenges they face.
Structural racism, notes Fromewick, can discourage people from seeking medical care — and hamper the effective delivery of that care. It’s essential, she maintains, for providers to understand the health beliefs, cultural practices and needs in the communities they serve. Accordingly, the research team will work to earn the trust of rural community leaders.
“A lot of times, people don’t tell their stories for fear of pain,” Grier-McEachin points out. “They don’t want their children to experience the hurt they remember. We want to explore history, so it can be used not to inhibit but to inform us and to ignite change.”
The first step, they say, is reaching out to these residents through surveys, conversations and community meetings to learn about the day-to-day difficulties they face in the health care arena and their perceptions of how racism has contributed to those experiences. Based on what they learn from these primary sources, the researchers will create educational materials designed to raise awareness and reduce racism in the health care delivery system in rural WNC.
“We’ll further elucidate stressors, support greater awareness and create real change,” Batada explains.
“It’s important to work together in this region to hear people’s voices, so that the historically unheard can be heard as we correct the health disparities in North Carolina,” Grier-McEachin maintains. “It’s a long-term process, and the dedicated work will continue beyond the scope of any one project.”
Numerous studies have documented serious health discrepancies between rural and urban residents, and between African-Americans and whites. A 2017 report from the Centers for Disease Control and Prevention found higher incidences of suicide, obesity, tobacco addiction, Type 2 diabetes and dental troubles among rural Americans compared with their urban counterparts. African-Americans, meanwhile, experience more heart disease, cancer, diabetes, AIDS and hypertension than whites and have the highest prevalence of cardiovascular disease of any demographic group in the U.S. Nationwide, more than 8 percent of rural and small-town residents are African-American, census data show. Closer to home, a 2015 study in the WNC Healthy Impact database found that 4 percent of the region’s population is African-American.
What’s been lacking up till now, however, are statistics specific to rural African-Americans in WNC. “By using a community-based, participatory approach, we will discover the needs in our region,” says Fromewick, adding, “We’ll share our findings with communities, health care institutions and educators.”
To that end, the multidisciplinary team intends to treat these residents as partners and primary sources in defining what needs to change. The researchers also plan to approach community groups and churches.
“We want to illuminate what churches are doing and have continued to do to make the African-American community cohesive and able to withstand the structural racism in this area,” Batada explains.
The team will also consider the continuing impacts of historical oppression on human health. The damage done by racism stretches beyond individual experience via intergenerational trauma, says Fromewick, underscoring a deeper need for acknowledgment, exploration and remediation. Batada agrees, noting that the pressures racism has imposed on the lives of African-Americans and other racial minorities may have resulted in elevated levels of illness and death.
“This project highlights that we can’t forget history,” she declares. “History can teach us how we can work toward facing the major challenges of today. We can use the lens we have now to look back, as we truly and deeply listen, learning from the lives people have lived and determining how to proceed.”
Socio-economic factors, Batada points out, often lead people to delay getting health care. Those factors, she says, include geographic or sociological reasons beyond an individual’s control.
Fromewick, meanwhile, cites a 2017 University of Minnesota study which found that more than half of rural counties in the U.S. have no hospital where a woman could give birth. Families in these areas, which tend to be geographically isolated and have higher percentages of residents living in poverty, may face extreme challenges in getting timely access to the health care they need, particularly if they lack reliable transportation. Often born too small or too soon, African-American babies die before their first birthday at twice the rate of white infants, according to National Center for Health Statistics data.
“The percent of the county-level population that is African-American is quite low in WNC, ranging between about 0.5 percent and 10 percent depending on the county,” notes Batada. “One of the challenges that we have observed is that because the number of African-Americans is so small in some counties, surveys may not obtain a large enough sample to be representative.” The researchers hope to address this problem through their community-based approach.
Shifting the tide
The three team members inspire one another, says Grier-McEachin, and combining their respective skill sets enables them to find a greater bandwidth of possibilities. Batada and McEachin previously worked together on the PRAISE Project, which works with African-American churches to promote sustainable health measures. In the current effort, these two women chose Fromewick for her medical research expertise.
“We’re working with an attitude of mutual respect, as community-driven researchers and members of the public health community,” says Batada. “I feel aligned with my colleagues as we investigate health disparities and work to achieve health equity.”
That respectful attitude, they maintain, will help them serve as catalysts for positive, ongoing change.
“The more we talk to people, the more leads we get and the more relationships we will build,” says Grier-McEachin. “These stories need to be told, so we can fill in the gaps. We would love to end racism and its impact; by entering into this conversation, we hope to keep racism from being perpetuated continuously within these structures as we shift the tide.”
Interested in participating in the research? Email the team at firstname.lastname@example.org or call 828-232-5164.