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Public Health
Ryan Petteway, R. David Rebanal, Chad Raphael, and Martha Matsuoka
e eld of public health has made major contributions to community-engaged
research (CER) for environmental justice (EJ). is is especially true of research
that takes a population health perspective, as opposed to clinical, behavioral, or
biomedical approaches. Public health has a deep and rich history of engaging mat-
ters of social and health equity at the community and population levels, especially
as related to racial, class, and place-based environmental inequities. As this chap-
ter shows, public health research is well positioned to address EJ issues because of
the eld’s practical commitments to applying and translating research for social
action and policy change. In addition, public health researchers’ leadership in
developing community-based participatory research methods has inuenced CER
in many disciplines.
is chapter summarizes some important ways in which CER for EJ has
emerged from public health. We begin with an overview of the recently updated
Essential Public Health Services, a framework that puts health equity at the center
of the eld. We present an overview of the core areas of public health research and
practice that have especially advanced CER for EJ: community-based participatory
research, social epidemiology, place-health research, and health impact assess-
ments. For each area, we summarize core conceptual and procedural groundings,
citing some of the key literature and exemplary studies. Next, we identify three
broad directions public health research can take to strengthen CER to advance
EJ. ese directions include engaging more explicitly and purposefully with anti-
racism and decolonizing praxis and principles; redening what counts and gets
counted as “environmental”; and centering notions of placemaking and power in
the (re)production of spatialized and racialized environmental injustices. Table .
shows how the chapter’s major themes relate to the dimensions of justice common
to CER and EJ.
Petteway, Rebanal, Raphael, and Matsuoka
CER FOR EJ IN PUBLIC HEALTH
e 10 Essential Public Health Services
As a foundation for public health, the Essential Public Health Services (EPHS)
is a particularly relevant framework for CER to advance EJ—especially in the U.S.
context, where the EPHS is widely used in public health education and accredita-
tion, is cited in some state statutes, and helps dene the eld to the public. Federal
agencies and public health experts developed the EPHS doctrine in to help
distinguish the work of public health agencies and organizations from health care.
e EPHS framework was updated in to describe the eld of practice
more fully, center essential activities around equity, and identify the structural
injustices that cause health inequities (see gure .) e inuence of commu-
nity-based participatory research (CBPR) can be seen in the shi from the origi-
nal framework’s focus on the eld of “public health solving community problems”
(U.S. Centers for Disease Control, n.d.) to the current version’s call to “strengthen,
support, and mobilize communities and partnerships to improve health”
(EPHSFITF ). Equity is now a goal of each of the essential services,
from creating community partnerships, to engaging in policy and legal advo-
cacy, ensuring access to health and health care services, and developing a diverse
and competent workforce. An accompanying statement highlights the need to
“remove systemic and structural barriers that have resulted in health inequities
... includ[ing] poverty, racism, gender discrimination, ableism, and other forms
of oppression” (para. ). ese updates to the EPHS provide a stronger rationale
for engaging in CER for EJ, although, as we argue below, the eld has more work
to do to fulll this promise.
.. CER for EJ in Public Health
Dimension of Justice In CER for EJ in Public Health
Distribution
Who ought to get what?
Centering health equity by addressing the structural determinants
of health, and their roots in historic and ongoing environmental
injustices
Procedure
Who ought to decide?
Strengthening EJ communities’ participation in and inuence
over community-based participatory research and health impact
assessments, and in policy making and practices that aect health
Recognition
Who ought to be respected
and valued?
Expanding antiracist and decolonizing approaches to knowledge and
research, and recognizing sociospatial exposures to policing, spatial
stigma, White spaces, and Indigenous health as environmental justice
issues
Transformation
What ought to change,
and how?
Transforming public health through community-based participatory
research focused on health equity, and employing antiracist and
decolonizing praxis, to promote environmental justice
, , ,
Community-Based Participatory Research
Public health scholars developed CBPR to engage community partners in the
research process and share power with them, strengthen research with local
knowledge, ensure that communities benet, and produce research that results in
meaningful actions through interventions or policy change (see chapter ). Since
the s, the CBPR tradition has been a major contributor to the theory, meth-
odology, practice, and institutionalization of CER for EJ across many disciplines
and research topics.
Public health scholars authored textbooks and handbooks that taught com-
munity-engaged theory and methods to EJ researchers in many elds (see, e.g.,
Blumenthal et al. ; Israel et al. a; Minkler and Wakimoto ; Wallerstein
et al. ). Researchers trained in public health helped forge an interdisciplinary
approach to CER for EJ—individually and in research teams spanning multiple
.. e Essential Public Health Services framework.
: 10EPHSFITF 2020.
Petteway, Rebanal, Raphael, and Matsuoka
research institutions and community organizations. is research provided
evidence used in early EJ struggles in the U.S. by conducting epidemiological stud-
ies in fenceline communities and industrial hygiene studies in workplaces (see
chapter ). is EJ research has expanded in scope to address law and policy
(see chapter ), food justice (see chapter ), and urban planning (see chapter ).
Public health researchers and their community partners have also led reexive
research on the CBPR process itself, advancing understanding of power and jus-
tice within knowledge production (e.g., Chávez et al. ; Muhammed et al. ;
Shepard et al. ; Wallerstein et al. ) and demonstrating the value of CBPR
methods for increasing the rigor, relevance, and reach of research (Balazs and
Morello-Frosch ).
Public health has also played a major role in developing the institutional infra-
structure for CER, especially in the U.S. From the s onward, schools and pro-
grams of public health launched new curricula, centers, and initiatives devoted
to CBPR, built long-term relationships with community partners, and recruited
a critical mass of graduate students of color committed to environmental and
social justice. Professional associations—from the renowned American Public
Health Association to newcomers such as Campus-Community Partnerships
for Health—promoted CBPR and promulgated standards for conducting and eval-
uating this kind of research to increase its acceptance in the eld. Health research-
ers secured foundation and government funding streams for CBPR on EJ from
the mid-s onward, including a -year federal interagency program that sup-
ported over CER projects for environmental and occupational health, led by the
National Institute of Environmental Health Sciences, Environmental Protection
Agency, and National Institute for Occupational Safety and Health (Baron et al.
). In the s, the National Institutes of Health, and some state environ-
mental and public health agencies, prioritized funding for CBPR to combat health
inequities (Blumenthal et al. ).
Social Epidemiology
Social epidemiology scholars and practitioners tend to be less concerned with any
one specic disease or illness, or any one specic cause. Rather, they are most
interested in explicating how broader societal power relations (re)produce the
inequitable sociopolitical, economic, legal, and environmental contexts that struc-
ture population distributions and patterns of health and illness (Krieger ).
Central to much of this scholarship are the health eects of various forms of social
exclusion, oppression, and inequality, including, for example, structural racism
(Agénor et al. ; Bailey et al. ), gender inequality and sexism (Borrell
et al. ), aspects of class inequality (Bor, Cohen, and Galea ; Fujishiro et al.
; Muntaner et al. ), and considerations of intersectionality therein (Agénor
; Bowleg ).
, , ,
Critical contributions of social epidemiology relevant to EJ-related research
also include work that explicates how these outside social and political expo-
sures “get under our skin” to aect physiological functioning across our lifes-
pans. is research has contributed several key concepts that help to illuminate
EJ and health. For example, allostatic load is a measure of the cumulative burden
of chronic stress and life events, as identied by biomarkers and clinical criteria
(Seeman et al. ). Weathering provides a metric of premature decline in health
from the cumulative impacts of experiencing social and political marginalization
and economic adversity (Geronimus et al. ). e concept of embodiment
describes the process through which social and physical environmental exposures
work their way inside of our bodies, revealing patterns of structural inequality
that are built into societal arrangements of power and risk (Krieger ; Vineis
et al. ). Life course approaches account for the origins of health inequities by
tracing how social, economic, and physical environmental exposures at each stage
of human development aect health within and across generations (Gee, Walse-
mann, and Brondolo ; Jones et al. ).
Informing much of the work in these areas are broader theories and frame-
works that situate health within its wider social, political, and economic contexts
and power relations, which fundamentally shape who is exposed to what, and
when. Core theories and frameworks for EJ include social production of health
and political economy orientations (Harvey ; McCartney et al. ), ecoso-
cial theory (Krieger ), fundamental causes (Phelan and Link ), and mod-
els of social, macro, and commercial determinants of health (de Lacy-Vawdon
and Livingstone ; Naik et al. ). Non-CER studies informed by these
frameworks have explored EJ exposures, oen in relation to the broader struc-
tural foci of social epidemiology (e.g., structural racism, gender inequality, class
inequality). is has included, for example, work demonstrating links between
ambient air pollution and racial residential segregation (Jones et al. ; Morello-
Frosch and Jesdale ); air and noise pollution and neighborhood deprivation
(Saez and López-Casasnovas ); noise pollution and racial and economic
segregation (Casey, Morello-Frosch, et al. ); neighborhood racial composition
and annual exposures to toxic waste emissions (Hipp and Lakon );
intersectionality and cancer risks related to air toxics (Alvarez and Evans );
neighborhood racial composition, income, and urban greenness (Casey, James,
et al. ); and neighborhood racial composition, tree canopy, and cardiovascular
and respiratory health (Jennings et al. ). ese currents in social epidemiol-
ogy have inuenced and inspired CER studies of EJ, which can add a valuable
complementary approach to the statistical analyses of large data sets mentioned
here. Integrating CBPR and social epidemiology oers an especially promising
avenue for applying CER to advance EJ, especially when employing a place-health
approach to research (Petteway et al. a; Wallerstein, Yen, and Syme ).
Petteway, Rebanal, Raphael, and Matsuoka
Place-Health Research
As a subdiscipline of social epidemiology, place-health research focuses on place-
based exposures as encountered within specic geographies and sociopolitical
spatial contexts, and represents a well-developed area for advancing EJ through
CER. is research draws on complementary disciplines—such as human geo-
graphy, health geography, urban planning—to understand the natural, built, eco-
nomic, and social environmental contexts of specically dened places (Arcaya
et al. ). Oen, outside researchers work collaboratively with residents to
uncover and address potential EJ-related concerns. e place-focused and envi-
ronmental-oriented nature of this particular public health work lends itself well to
adopting core CER principles for advancing EJ knowledge production and social
action. As Petteway, Mujahid, and Allen () discuss, such work can leverage the
“practical and procedural translational advantages of much place-based research
(e.g., space-bound, locality- and/or jurisdiction-specic), while simultaneously
capitalizing on the scientic and political translational advantages of harnessing
place-based knowledge, insight, and expertise of the people whose lives unfold
within the ‘place’ being studied” ().
CBPR in this area has examined issues related to neighborhood food environ-
ments (Breckwich Vásquez et al. ), parks and greenspaces (Peréa et al. ),
tobacco environments (Petteway, Sheikhattari, and Wagner ), and aspects
of neighborhood built and social environments (Petteway, Mujahid, and Allen
). Other work has focused on more traditional EJ exposures. For example,
Madrigal et al. () worked with Latinx youth in a farmworker community to
examine environmental concerns using photovoice. Johnston et al. () worked
with youth co-researchers who used multiple participatory methods, including
participatory GIS and personal air-monitoring devices to document exposure to
airborne particulate matter, while Nolan et al. () completed similar work with
youth researchers to study nitrogen dioxide and sulfur dioxide exposures. Other
scholars have conducted participatory survey-based environmental research
within fenceline communities (Cohen et al. ), and survey and water sampling
work with residents of a heavily polluted Latinx community (Sansom et al. ).
is body of work not only oers valuable empirical evidence, but also enhances
community participants’ agency, strengthens the transparency and accountability
of the research to the community, and disseminates the results to residents and
leaders in ways that facilitate their eorts to remedy EJ concerns.
Even so, signicant conceptual, methodological, and procedural challenges
remain for place-health research (Arcaya et al. ; Petteway et al. a).
Documenting environmental threats may contribute to stigmatizing places and
the people who inhabit them (discussed below). is research can also be lim-
ited by choosing short-term temporal measures, and narrow and static spatial
, , ,
designations (such as census tracts), that do not adequately measure long-term
and cumulative exposures across the spaces people actually traverse. An important
response to these problems is to measure environmental exposures across a per-
son’s activity space, which includes all of the places they go to, pass through, and
encounter on a routine basis. Unlike most exposure-related research that focuses
on one spatial location (e.g., air pollution in one’s residential neighborhood), an
activity space approach can provide a more comprehensive picture of exposures
based on people’s mobility patterns—between home, work, school, places of recre-
ation, shopping locations, transportation routes, and so on. Park and Kwan ()
have applied this approach to studying air pollution, while others have applied it
to research on noise pollution (Tao et al. ), greenspace (Bell ), and aspects
of local food, alcohol, and tobacco environments (Lipperman-Kreda et al. ;
Widener et al. ). While promising, this activity space work would be greatly
enriched in rigor, relevance, and reach by taking a more participatory approach
that more thoroughly centers community knowledges, experiences, and spatial
perceptions of exposures, and enlists community partners in disseminating the
ndings and implementing responses.
Health Impact Assessment
Another area of public health that plays a promising role within EJ-related research
and practice is health impact assessment, or HIA. HIA is an analytic process and
tool developed to generate evidence regarding the potential health harms and ben-
ets of proposed policies, programs, projects, or plans (Harris-Roxas and Harris
). Originating in and extending the use of environmental impact statements
(EIS) in construction and development projects, HIA is
a systematic process that uses an array of data sources and analytic methods and
considers input from stakeholders to determine the potential eects of a proposed
policy, plan, program, or project on the health of a population and the distribution of
those eects within the population. (National Research Council 2011, 5)
HIA generally consist of six stages: () screening whether the decision-making pro-
cess can benet from an HIA, () scoping potential health eects of the proposal
and parameters of the study, () assessment of the health impacts, () recommend-
ing mitigations and alternatives to protect health, () reporting and communi-
cation to stakeholders and decision makers, and () monitoring decisions and
health outcomes (Bhatia ). A core feature of HIA is that it can be used to assess
any type of policy, program, project, or plan—including zoning, land use, com-
munity development, transportation, and housing—and all elements that shape
distributions and patterns of place-based environmental exposures, experiences,
and opportunities. Ideally, HIAs are completed prior to any nal decision making
regarding a potentially harmful environmental change, policy, or practice so that
potential health impacts are assessed by health ocials and policy makers. us,
Petteway, Rebanal, Raphael, and Matsuoka
by its very nature, HIA is a tool designed to promote EJ by providing evidence
to preempt environmentally detrimental actions before they can produce health-
harming exposures.
While HIA has been practiced for decades, explicit connections to notions
of health equity, racial equity, and environmental and social justice have only
become core aspects of HIA work more recently (Buse et al. ; Heller et al.
), prompting increased community engagement and centering community
knowledge(s) within all assessment activities. While much HIA work has focused
on topics like transportation and housing (Cole, MacLeod, and Spriggs ;
National Center for Healthy Housing ), applications have evolved to examine
a more expansive range of EJ-related topics, including racism, community polic-
ing, and mental health (Human Impact Partners et al. ), and tobacco licensing
(Upstream Public Health ).
While HIA has done well to advance EJ in public health, HIA remains relatively
limited outside of academic and university-led contexts. For example, in a review
of all documented HIAs conducted in the U.S. between and , Petteway
and Cosgrove () found just of ( percent) in which local health depart-
ments served as a lead or authoring partner—suggesting that public health has far
to go in making HIA part of routine practice to advance EJ. HIAs can also expand
community participation by welcoming local organizations and residents more
fully into the research process.
REENVISIONING CER FOR PUBLIC HEALTH
Public health—especially through the prism of place-health research—can further
embrace and rene CER principles and praxis to advance EJ in three ways. First,
building upon the complementary conceptual groundings and goals of CBPR and
social epidemiology, we call for deeper engagements with antiracist and decolo-
nizing praxis and principles. Second, we encourage deeper, more deliberate and
explicit engagement with placemaking and power in historic and present processes
and practices that make, unmake, and remake our daily place-health contexts.
ird, we invite reection and dialogue regarding what counts as “environmental”
within EJ-related work in public health, briey highlighting some promising areas
that deserve closer attention.
ese directions amplify strengths of place-health research by deepening
engagements with notions of power, inclusion, and representation within knowl-
edge production processes—re-(en)visioning place-health research as a site of
resistance, contestation, and transformation to change embodied contexts and
consequences of environmental injustices. Moreover, public health research
needs to engage more fully with the theories mentioned here, which may be
widely known but are not yet deeply practiced. Faced with pressures to conduct
ever more empirical research, while appearing to address pressing issues of
, , ,
justice and community participation, empirical researchers can be tempted to
poach theoretical concepts and apply them shallowly. In the mid-s, Green
et al. () issued a similar critique of the co-optation of participatory research
by many studies that failed to develop substantive community partnerships and
co-conduct research on equal and mutually benecial terms. Today, we see the
need for a comparable reckoning with antiracist, decolonizing, and EJ theories,
to achieve a more deeply transformed focus and practice of CBPR in public
health, rather than a hurried and transactional relationship to these theories. e
mid-s critique led funding agencies and others to adopt stronger and more
specic requirements for community participation in health research, and we
hope that the kind of thorough reection that we can only sketch out here will
prompt a similar response.
Engaging Antiracism and Decolonizing Praxis
While CBPR researchers have considered racism and power dynamics within
research collaborations (e.g., Chávez et al. ; Muhammad et al. ; Waller-
stein et al. ), public health can move further towards a CBPR that centers
antiracist and decolonizing praxis and principles. We noted earlier that revised
EPHS implores the eld to address structural inequities and their causes. As Alang
et al. () write, dismantling the upstream barriers to delivering essential public
health services “requires building alliances across systems to address the range
of social determinants of health caused by White supremacy” (). is much-
needed reckoning can be oriented by frameworks such as Ford and Airhihenbu-
wa’s () articulation of a public health critical race praxis (PHCRP) and Alang
and colleagues’ () explication of strategies for how the EPHS can contribute to
dismantling White supremacy. Each draws from critical race theory and merges it
with theories and concepts from social epidemiology. While the entirety of these
frameworks demands concentrated attention from the eld, several elements are
particularly relevant to CER for EJ.
Most broadly, these frameworks call for opening avenues of “disciplinary
self-critique”—understood as “the systematic examination by members of a
discipline of its conventions and impacts on the broader society” (Ford and Airhi-
henbuwa , ). Alang et al. () recommend many strategies to this end,
including the need for the eld to incorporate critical race theory and antiracist
methodologies across the public health curriculum, and set measurable goals for
faculty and student racial equity competency. ese are certainly prerequisites
for faculty and students who plan to do CBPR, along with learning to assess their
own individual, institutional, and disciplinary positionality in relation to the
community (see chapter ). Public health can also prioritize research and policy
development that explicitly targets indicators of White supremacy and structural
racism (Adkins-Jackson et al. ; Hardeman et al. , Agénor et al. ).
Petteway, Rebanal, Raphael, and Matsuoka
Another core principle is honoring “voice”—that is, “prioritizing the perspec-
tives of marginalized persons”—to enable the (co)production and inclusion of new
knowledges (Ford and Airhihenbuwa , ). is must extend beyond the
traditional practice of including community “voice” on advisory boards, to more
intentionally and thoroughly “center the margins” within all aspects of EJ research
and knowledge production. Public health can also “ensure equitable allocation of
resources and redistribution of power in community partnerships” (Alang et al.
, ) by moving from models in which community organizations are junior
partners toward fully collaborative and even community-owned and community-
led approaches (see Wilson, Aber, et al. ).
Taken together, principles of “voice” and “disciplinary self-critique” can help
bring techniques of counter-storytelling and counter-mapping into the fold of
CBPR, policy, and public communication for EJ (see chapter ). As Delgado
() explains, counter-stories “can show that what we believe is ridiculous, self-
serving, or cruel . . . can show us the way out of the trap of unjustied exclu-
sion ... [and] can help us understand when it is time to reallocate power” ().
Counter-mapping “challenge[s] dominant ways of conceiving the landscape and
the socio-political interests they represent” (Willow , ). ese approaches
are both destructive and productive: they help us to interrogate and dismantle
narratives that curate and incubate exclusion and oppression, and (re)imagine and
act to pursue just and anti-oppressive alternatives. For example, these approaches
can reframe the structural determinants of environmental health as the product
of ongoing colonization, racism, and exploitation, rather than individual genes,
lifestyles, and bad fortune.
is capacity for counternarratives could enable deeper engagement with the
PHCRP principle of “social construction of knowledge”—referring to “the claim
that established knowledge within a discipline can be re-evaluated using antira-
cism modes of analysis” (Ford and Airhihenbuwa , ). And in this regard,
public health researchers working on EJ projects would do well to reect more on
Smith’s () work on decolonizing knowledge production and curation. Particu-
larly, Smith’s reections on notions of (mis)representation and commodication
of knowledge(s), which resonate with PHCRP, oer guidance on how to “unsettle”
research power dynamics that oen function to silence, erase, or co-opt commu-
nity knowledges for outsider benet. Core areas for decolonizing considerations
include decisions about which EJ research topics get studied (i.e., who sets EJ
research agendas), which methods are chosen and who choses them, which forms
of data are prioritized, whose knowledges and perspectives are centered/valued,
who owns and/or has access to EJ research data, and who materially benets most
from the research, for example, nancially, professionally, socially. In short, decol-
onizing demands consideration of far-reaching changes in control over research
agendas, methodologies, and research ethics, as well as reconciling dominant and
, , ,
traditional ecological knowledges and reconceiving just relations among people
and other nature.
Simultaneous with these considerations is the imperative of more expressly and
thoroughly orienting CBPR for EJ around intersectionality. e ten PHCRP prin-
ciples emphasize intersectionality within EJ, which requires that researchers not
only “center the margins,” but center the intersections. is means recognizing that
varying congurations of overlapping environmental and social oppressions—for
example, along race, class, and gender lines—necessitates varying congurations
of “voice,” methods, and knowledges to be centered within any one specic EJ
concern. Engaging the antiracist and decolonizing principles discussed here can
help public health researchers become more responsive to EJ scholars who have
called for greater attention to matters of intersectionality (Alvarez and Evans
; Ducre ; Malin and Ryder ). Deeper consideration of these concepts
should prompt CBPR to pursue new research designs, methods, and forms for
communicating results and recommendations.
Centering Placemaking and Power
As discussed above, CBPR-oriented place-health research represents perhaps
the best expression of public health research for EJ. However, much place-health
research tends to de-place EJ relationships, failing to examine how they are rooted
in economic, political, and social processes that shape the spatial distributions
of environmental risks and opportunities. For example, de-placing research
might measure cross-sectional exposure to air pollution but not track historic
and present policies and practices related to environmental deregulation, land
use, transportation policy, greenspace, and housing. Cross-sectional research
that ignores the mechanisms and manners through which place is actively made,
unmade, and remade over time presents as ahistoric, apolitical, and power blind—
ignoring critical aspects of how environmental exposures are (re)structured over
time and space.
In response, recent theorizing emphasizes how the process of placemaking is
shaped by physical, material, symbolic, and discursive policies and practices, with
“place” understood as an inherently political site of continual contestation (Allen,
Lawhon, and Pierce ; Petteway ). us, placemaking must be understood
as social, political, material, and symbolic/representational, with processes that
structure fundamental relations of space, property, and capital that undergird
place-health contexts across communities and geographies. In settler-colonial
states such as the U.S., the (un/re)making and taking of place are highly racialized,
which shapes the spatial sorting and organization of environmental privilege and
risks in residential, occupational, and recreational places (Kent-Stoll ; Neely
and Samura ; Powell ). ese interrelated notions can help guide CER in
naming power and explicating the many factors that shape the place-based con-
texts of health inequities and EJ over time.
Petteway, Rebanal, Raphael, and Matsuoka
Reimagining What Counts as “Environmental”
Public health can further advance CER for EJ by expanding its focus on
decits-oriented physical and chemical exposures to include more sociospatial
exposures, including positive “exposures” to places and spaces of joy, inclusion,
love, healing, and resistance. Sociospatial exposures are inclusive of a broad range
of social interactions and relations that can act as environmental stressors or
destressors, from experiences of discrimination based on gender, race, disability,
and sexuality, to aspects of gentrication, displacement, dispossession, and place-
attachment and memory. We limit ourselves to discussing just a few potentially
important EJ-related examples here.
Policing. As Simckes et al. () outline, the population health impacts of
exposure to various aspects of policing can be quite substantial—especially given
historic and present contexts of racialized police violence. e near omnipres-
ence—or potential/threat of presence—of police within neighborhood, work,
retail, recreation, and education environments makes policing a rampant, even
continuous, environmental exposure. e physical and psychological harms of
racialized policing—both direct and indirect—are well-documented in public
health scholarship (Bor et al. ; Lett et al. ; Turney and Jackson ), as are
harms from policing of racialized immigration status (Asad and Clair ; Patler
and Laster Pirtle ). If people of color can be surveilled, harassed, pursued,
apprehended, and killed in any place for any reason, then policing must be recog-
nized as a toxic environmental exposure—one that harms health, for example, via
stress pathways related to anticipatory anxiety and allostatic load.
Alang et al. () urge public health to integrate measures of exposure to
police brutality and other indicators of structural racism and White supremacy
into routine health surveillance research. We can imagine the development of a
policing-related version of the well-known Toxic Release Inventory (TRI)—a toxic
police inventory, which maps, tracks, and monitors spatialized practices of (racial-
ized) police surveillance and aggression as duly acknowledged environmental
exposures. ere would be an important role for CER in creating this inventory,
which could include crowdsourced maps of street-based police harassment, GIS
data that show routes and locations of experiences of “driving while Black,” and
crowdsourced location data for mapping police encounters in residences, work-
places, and recreational and educational spaces.
Spatial Stigma. Public health researchers would also do well to closely examine
spatial stigma (Halliday et al. ; Keene and Padilla ). Notions of stigma are
well-known and researched within public health in relation to issues such as HIV,
obesity, smoking, sexuality, and disability. Spatial stigma, however, presents a par-
ticularly important form of stigma for EJ because stigma associated with a place
, , ,
or space can act as an environmental stressor (Keene and Padilla ; Tran et al.
). Moreover, the ways a place or space is (mis)represented in research can
function to amplify or counter such a stigma (Cairns ; Graham et al. ).
is last point is especially important within public health research, which has a
proclivity to focus on decits and problems of places. In research on Black com-
munities, for example, the representation of place can be “swallowed up by the
very death and decay that is bolstered by the hard empirical evidence of Black
geographic peril” (McKittrick , ).
Some CER partnerships have grappled with the dangers of stigmatization by
prioritizing community partners’ control over how potentially damaging infor-
mation is disseminated (Minkler, Pies, and Hyde ), or by choosing projects
that actively destigmatize communities (Gutberlet and Jayme ; Tremblay and
Jayme ). At a minimum, public health research needs to begin each CER proj-
ect by exploring potentially stigmatizing impacts on relevant communities with
community partners, and incorporating their considerations to shape the research
agenda, questions, and dissemination plan from the start.
Related to, yet distinct from, spatial stigma is the notion of “the white space,”
which Anderson () describes as “settings in which Black people are typically
absent, not expected, or marginalized when present” (). e racialization of
spaces in countries such as the U.S. means that Black, Brown, Indigenous, and
other people of color will oen be seen as the potential environmental threat
when moving through White-dominated or White-associated spaces. e White
gaze of fear and stigma attaches to and travels with people of color, who are oen
well aware of this surveillance when moving through space. is of course has
direct implications for considerations of policing as an environmental expo-
sure, but also for considering White space itself as a discrete exposure. Here, we
can imagine community-engaged place-health research at the intersections, for
example, of structural racism, intersectionality, allostatic load, and life course—
making use of activity space approaches to assess White spaces as an EJ exposure,
building on the work of Kwan (), Wong and Shaw (), and Candipan
and colleagues (), and using community-led methods like participatory
GIS and photovoice.
Indigenous Lands and Spatial Healing. Ancestral and Indigenous knowledges
reveal that connections to land and nature are healing (Redvers ). However,
due to colonization, Indigenous peoples now endure some of the gravest health
disparities in the U.S., which include cancer, cardiovascular disease, infant and
maternal mortality, substance abuse, and depression (Echo-Hawk ; Paradies
). Public health CER can recognize historical and ongoing injustices for Indig-
enous people, and work to reclaim and reimagine their relationship to land, food,
medicinal plants, and sacred sites. According to the Urban Indian Health Institute
Petteway, Rebanal, Raphael, and Matsuoka
(UIHI), EJ and health equity eorts have overemphasized Western cultural norms,
focusing on the role of institutional and structural barriers to health care with
little attention to cultural and traditional knowledge systems (Echo-Hawk ).
Instead, UIHI is working toward health equity for American Indian / Alaska Na-
tive populations by “breaking barriers, building beauty, and restoring culture,” by
supporting tribal communities in “exercising self-determination and reclaiming
their unique cultural knowledge systems for the health of the future generation.”
In their work, “data, research, and evaluation are cultural values and ancestral
practices, and we are reclaiming them to be used for Indigenous people, by Indig-
enous people” (para. ).
As one of Tribal Epidemiology Centers providing research services to tribal
governments and U.S. governmental agencies, UIHI is one example of the grow-
ing Native American health infrastructure. Within this infrastructure, tribes and
intertribal organizations have developed their own extensive research capacities,
including tribal institutional review boards with their own research ethics proto-
cols. Native and other researchers in academia and government can collaborate
with these organizations, and should expect to do so as junior partners or co-
principal investigators.
CONCLUSION
is chapter has sketched out several ways in which public health can evolve into
a more courageous, politically attuned partner to communities struggling for EJ.
e eld has established a solid base for this work in the newly centered goal of
equity in the Essential Public Health Services, and traditions of CBPR, social
epidemiology, place-health research, and health impact assessments. Now, public
health CER must engage in deeper and more creative thinking about how to enact
antiracist and decolonizing principles; enrich social epidemiology with the study
of placemaking and activity spaces; expand conceptions of environmental health
to include EJ issues provoked by sociospatial exposures to policing, spatial stigma,
and White spaces; and take inspiration from Indigenous eorts to reclaim their
lands, cultures, and health infrastructures.
is requires imagining new futures for both the science and practice of public
health for EJ—including research translation and political engagement (e.g., Galea
and Vaughan ; Morgan-Trimmer ; Schwartz et al. ). is involves
remembering that public health research is ultimately about healing bodies,
lives, and communities, not merely analyzing samples and specimens. is will
be facilitated by recruiting and training a new generation of researchers whose
lives are rooted in embodied experiences of environmental injustice. is also
demands that all researchers develop capacities to question their own positional-
ity in relation to the EJ communities with whom public health should collaborate
, , ,
Petteway, Rebanal, Raphael, and Matsuoka
reciprocally and respectfully, and to the eld. Who is producing EJ knowledge,
taking up the discourse space, and driving (or stiing) policy and research pri-
orities? Who has the power to use, (mis)represent, and discuss whose bodies and
lives in research? Do researchers possess the care and courage—not just the scien-
tic curiosity and capital—to ght for environmental justice?