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.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.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.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.
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.
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.
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.
Keywords poetry for the public's health, poetry as praxis, healthful narratives, counternarrative, resistance, healing, radical, health equity, arts in public health, public health futures
