Ode to Public Health Academy: Urgent Call to Reform and Go Beyond Pretty Words

by Ans Irfan, MD, MPH

Racism is a public health issue. Police violence is a public health issue. Social justice is a public health issue. Let us add a qualifying noun such as “structural” or “systematic” to strengthen our “response” to anti-Blackness and racism. Black lives matter.

With some wordsmithing, some variation of these lines basically constitutes large chunks of the “statements” and “responses” issued by most, if not all, institutions that constitute the public health industrial complex: public health academia; public health associations; public health publishing industry.

Words. Empty words and self-aggrandizing performative advocacy are all that they are. Words matter. What matters more, much more, is the actions that follow them.

America has never reckoned with its original sins of occupation, genocide, slavery, and perpetuation of those with sophisticated codification of oppression through public policies. Thousands upon thousands of Americans are protesting the egregious and inhumane law enforcement misconduct against Ahmaud Arbery, Breonna Taylor, Tony McDade, Nina Pop, George Floyd, and thousands more Black Americans whose names stretch back centuries. In this historical watershed moment, we are all reflecting on what can we do to do better? Classic Corporate America’s response is to hijack the social justice issues for self-promotion as they have done time and time again with movements such as LGBTQ+ rights as reflected in commercialized pride events. Response to the current outrage has been, as expected, the black squares on social media and hashtagging their way out of committing to action.

Public health has not been much different. It has to be different. It must be different. We must reckon with our collective failure to do more and do better. Do it the SMART way. Specific, measurable, achievable, realistic, and, time-bound action steps so we ourselves and our communities can hold us accountable. It is nice to be articulate and issue “powerful” and “moving” statements. However, that will not cut it. It is disingenuous to just offer word crumbs without an action plan on tangible policy changes. Public health knows better than to “thought and prayer” our way out of this. Unless seismic shifts in practices, policies, and strategic plans to achieve anti-racist goals are announced, all of the townhalls and surveys are nothing more than overburdening our Black community members.

These are difficult conversations. Difficult conversations that have been avoided for the longest to manage the comfort or egos of those with power and privilege. Difficult conversations that must be had. The beauty and strength of public health is the brilliance and passion that all of us bring to this field. We can harness that brilliance and come up with action steps to practice what we preach. The public health community collectively and the organizations within the public health research and practice must do some serious soul searching to find actionable anti-racist steps that can be taken to be a more equitable, fair, and just field. Although not an exhaustive list, here are a few suggestions, a starting point, for schools of public health and academia more broadly that can be taken to get a step closer to reforming the field of public health and be actively anti-racist and anti-Blackness.

Core Curriculum: Teaching Anti-Racism and Political Economy

Racism is a public health issue and structural racism is the root cause of many of the health disparities and inequities in public health. Intersectionality and critical race theory are not just buzzwords. Despite knowing this, we do not train our public health students to be critical thinkers who can analyze public health challenges through frameworks such as critical race theory and develop equitable solutions to the said challenges. Schools of public health must do an active job to incorporate race, equity, diversity, and inclusion in their foundational curriculum. Moreover, schools of public health must stop with the fallacy of being nonpolitical. Public health is non-partisan, but we are inherently political. Yet, we do not teach political economy as one of the core required areas for public health. Politics intersects all aspects of public health from research funding to public health programming and so on. We should teach political economy if we want to develop public health leaders and critical thinkers for the 21st century instead of people who can rely on root memorization and regurgitate formulas and statistics as if these exist in a vacuum.

Teaching Faculty How to Teach

Evidence-based theories and frameworks about anti-racism should be an overarching theme for all of the public health curricula. However, we need competent faculty to teach, talk, and engage in conversations around race. For a field that talks a lot of talk about competence and “skills,” we do not do a good job at ensuring the quality of teaching beyond subjective, oppressive (in the context of minority faculty promotions, for instance), and primitive measures such as student evaluations. We must acknowledge that most professors are not taught how to teach in their PhDs, let alone teach about racism. Assuming that being an underpaid, overburdened teaching assistant, and grading papers qualifies someone to be a competent teacher is not only disrespectful to the field of pedagogy, it is also a disservice to our students. Most faculty also do not receive mandatory training in learning how to teach. That onus is on the schools and not the faculty. Public health schools should do a better job at training faculty across the board and ensuring that they are engaging students in a meaningful way on public health crises such as racism. It is equally important to teach faculty about cultural differences, self-reflexivity, and humility so they can be better aware of the power dynamics when they engage Black students.

Diversify Curriculum Committees

Curriculum committees at different levels within many schools of public health are a classic example of  lack of humility and a system that glamorizes privilege and status quo over competence and evidence-based education. We must be more critical about who occupies these roles. What perspectives and blind spots do they bring? What training have they received in the theory and practice of pedagogy to determine what and how we teach our next generation of public health leaders? Additionally, there is the challenge of diversity and inclusion at these committees, not only that of skin color but also of thought — diversity of thought should not to be taken as an excuse for inaction — and lived experiences. We must make an active effort to think critically about the powerful role these committees do, could, and should play in educating public health researchers and practitioners. We should ensure that qualified, diverse — racially, culturally, and intellectually –, and competent people serve on these committees instead of abdicating our duty to ensure quality education for our students.

Engage Black Students

Engaging Black students should be a core value for any school of public health. Meaningful engagement goes beyond a reactionary town hall or two. We should engage our students in all aspects of teaching and research. Get their input on the courses, the syllabi, the content, the lectures, and the guest speakers to avoid micro and macro aggressions and hold ourselves to a higher standard. Remember, they do not owe us their engagement. It must be earned which requires sustained effort and humility to listen and take appropriate actions. Obviously, there has to be a concerted outreach and recruitment effort to cast a bigger net, recruit, admit, and retain more Black students. Remember, diversity and inclusion are two different constructs. Recruitment is only the first step. We must create an inclusive environment to welcome and retain Black students, an effort that goes beyond tokenization.

Leadership and Faculty Accountability

We must be candid about anti-racism work. We must hold our faculty, especially those who hold secure positions of power, accountable. Although not unique to schools of public health, Black and other students of color continue to express their frustrations about racist behavior from faculty. Toxic behavior that is often excused because of the tenure, amount of indirect funding, or simply because it is “not a big deal.” This is a moment to start reflecting on all those “are you sure they said/meant that?” and be more critical about engaging with students and holding our faculty to a higher standard. Given the pervasive implicit racism and anti-Blackness, these incidents could just be unintentional. That is not an excuse rather a teachable moment so we can all do better.

Faculty Recruitment, Promotions, and Tenure

One of the most difficult, challenging, elusive, and most impactful issues in public health academy is faculty recruitment, promotions, and tenures. The current status of Black scholars, especially Black women in faculty positions, is abysmal. The latest data show that Black public health faculty with the professor rank made up less than 3% of all public health faculty compared with 81% for White faculty members at the Association of Schools and Programs of Public Health member schools. Specifically for Black women faculty, the lack of acknowledgement of the interlocking systems of oppression is just insincere and sanctimonious. If we are sincere about our efforts to make meaningful changes in our practices to be actively anti-racist, we must talk about how we hire, retain, promote, and uplift faculty in schools of public health. We must do a better job at reaching out and making a concerted effort to incentivize, recruit, retain, and promote Black faculty.

Redefine Impact and Restructure Rewards 

The “impact” of schools of public health is reflective of its faculty’s scholarship and work, hence directly tied to the previous point. However, the way we currently define, quantify, and measure impact is primitive and needs a drastic overhaul. Schools of public health have largely lost sight of their true purpose of educating and creating change in favor of revenue generation by and for the ineffective, capitalistic public health industrial complex that encourages publications to collect proverbial dust and disincentives teaching and impactful work in practice. We must take this moment to balance our expectations and rethink our public health academy culture.  Incentivizing, hiring, and retaining Black faculty to teach, do community engagement, and translation of science into practice could be good starting points. It is critical to note that community engagement and health equity work should not be the tokenized burden for Black faculty alone. We should all actively engage in this work. Publications and citations, though important, should not be the only way to measure the impact of public health work. It is also important to call out and rectify the false equivalency of comparing difficult, impactful, and practical community engagement and equity work with churning out manuscripts with the sole purpose of career projection. We should create career pathways to uplift community engagement and health equity work. Schools of public health should take this moment to reflect on what they consider to be impactful work that goes beyond academic journal publications and citations, publications that community members still have to pay a hefty amount of money to access. We should redefine and balance the way we measure impact and give equal weight to community engagement, community service, practice, and mentorship work that some faculty may engage in. By having only the metrics that assess someone’s ability to get funding for Ivory Tower ideas and moving on to the next one without making an effort to translate that research to public health practice, policies, and programs only rewards those who treat or are forced to treat public health work as a business. This is an opportunity to reflect upon, in humility, that one size does not fit all, and we are part of the problem given the ineffective approach towards defining impact. We must reevaluate our practices and ensure that community engagement and practice work is rewarded equally through fair and just metrics and standards.

In conclusion, while there’s nothing wrong with taking a moment of reflection and offering healing words, do not forget the root causes and actions. These challenges are not unique to public health and this critique and suggestions apply to all of academia. These suggestions are equally applicable to other populations who experience vulnerabilities due to structural racism and inequitable policies: people with disabilities, indigenous populations, other people of color, and so on. However, it is critical to acknowledge the universality of anti-Blackness even among many other non-White communities so we can candidly move forward with appropriate policy changes. Racism and anti-Blackness are societal ailments ingrained in the fabric of our society and we must do our part to eradicate these. If academia treated racism with a 10th of the urgency it treat its budget shortfalls, things would be different. Racism is a public health issue — not news. It is easier to issue a statement condemning racism and police violence out of feeling obliged, political correctness, or even out of the goodness of an institution’s collective consciousness. If we want the social transformation that we claim we want, we must not let pretty words that pass the buck implicitly exonerate ourselves. What are we going to do about it?

“I am no longer accepting the things I cannot change. I am changing the things I cannot accept.” ~ 

Angela Y. Davis

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Ans Irfan, MD, MPH

Ans Irfan, MD, MPH, is a faculty member at George Washington University and a public health practitioner with expertise in equity, diversity, and inclusion. He is a Robert Wood Johnson Foundation Health Policy Research Scholar. Recent projects include: farmworkers health equity; the intersection of theology and public health; traffic wardens and climate adaptation in Pakistan; evaluation of physicians’ training on climate change and health; global and occupational health equity. He can be contacted at ansirfan@gwu.edu. Twitter:@phscientist

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