Journal of Urban Health

, Volume 83, Issue 6, pp 1004–1012 | Cite as

The Art and Science of Integrating Undoing Racism with CBPR: Challenges of Pursuing NIH Funding to Investigate Cancer Care and Racial Equity

  • Michael A. Yonas
  • Nora Jones
  • Eugenia Eng
  • Anissa I. Vines
  • Robert Aronson
  • Derek M. Griffith
  • Brandolyn White
  • Melvin DuBose
Article

Abstract

In this nation, the unequal burden of disease among People of Color has been well documented. One starting point to eliminating health disparities is recognizing the existence of inequities in health care delivery and identifying the complexities of how institutional racism may operate within the health care system. In this paper, we explore the integration of community-based participatory research (CBPR) principles with an Undoing Racism process to conceptualize, design, apply for, and secure National Institutes of Health (NIH) funding to investigate the complexities of racial equity in the system of breast cancer care. Additionally, we describe the sequence of activities and “necessary conflicts” managed by our Health Disparities Collaborative to design and submit an application for NIH funding. This process of integrating CBPR principles with anti-racist community organizing presented unique challenges that were negotiated only by creating a strong foundation of trusting relationships that viewed conflict as being necessary. The process of developing a successful NIH grant proposal illustrated a variety of important lessons associated with the concepts of cultural humility and cultural safety. For successfully conducting CBPR, major challenges have included: assembling and mobilizing a partnership; the difficulty of establishing a shared vision and purpose for the group; the problem of maintaining trust; and the willingness to address differences in institutional cultures. Expectation, acceptance and negotiation of conflict were essential in the process of developing, preparing and submitting our NIH application. Central to negotiating these and other challenges has been the utilization of a CBPR approach.

Keywords

Breast cancer Community-based participatory research  Health disparities Institutional racism. 

References

  1. 1.
    Geiger HJ. Health disparities: What do we know? What do we need to know? What should we do? In: Schulz A, Mullings L, eds. Gender, Race, Class, and Health: Intersectional Approaches. San Francisco, CA: Jossey-Bass; 2006:261–288.Google Scholar
  2. 2.
    Smedley BD, Stith AY, Nelson R. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: National Academies; 2003.Google Scholar
  3. 3.
    Smith-Bindman R, Miglioretti DL, Lurie N, et al. Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med. 2006;144(8):541–553.PubMedGoogle Scholar
  4. 4.
    Bickell NA, Wang JJ, Oluwole S, et al. Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol. 2006;24(9):1357–1362.PubMedCrossRefGoogle Scholar
  5. 5.
    Griffith DM, Childs EL, Eng E, Jeffries V. Racism in organizations: the case of a county public health department. J Commun Psychol. In press.Google Scholar
  6. 6.
    Jones CP. Levels of racism: A theoretical framework and a gardener's tale. Am J Public Health. 2000;8:1212–1215.CrossRefGoogle Scholar
  7. 7.
    Israel BA, Shultz A, Parker EA, Becker A. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202.PubMedCrossRefGoogle Scholar
  8. 8.
    People’s Institute for Survival and Beyond. Dedicated to training and organizing with intelligence and integrity-with values and vision. (2006) Available at http://www.pisab.org. Accessed on October 2, 2006.
  9. 9.
    Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical discussion in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117–125.PubMedGoogle Scholar
  10. 10.
    Ramsden I. Cultural safety: Implementing the concept. The social force of nursing and midwifery. In: Te Whaiti P, McCarthy M, Durie A, eds. Mai i Rangiatea: Maori wellbeing and development. Auckland, New Zealand: Auckland University Press and Bridget Williams Books; 1997:113–125.Google Scholar
  11. 11.
    Crampton P, Dowell A, Parkin C, Thompson C. Combating effects of racism through a cultural immersion medical education program. Acad Med. 2003;78(6):595–598.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2006

Authors and Affiliations

  • Michael A. Yonas
    • 1
  • Nora Jones
    • 2
  • Eugenia Eng
    • 1
  • Anissa I. Vines
    • 3
    • 6
  • Robert Aronson
    • 4
  • Derek M. Griffith
    • 5
  • Brandolyn White
    • 3
  • Melvin DuBose
    • 2
  1. 1.Department of Health Behavior and Health Education, School of Public HealthUniversity of North CarolinaChapel HillUSA
  2. 2.Greensboro Health Disparities CollaborativeThe Partnership ProjectGreensboroUSA
  3. 3.Program on Ethnicity, Culture, and Health OutcomesUniversity of North CarolinaChapel HillUSA
  4. 4.Department of Public Health EducationUniversity of North CarolinaGreensboroUSA
  5. 5.Department of Health Behavior and Health EducationUniversity of MichiganAnn ArborUSA
  6. 6.Department of EpidemiologyUniversity of North CarolinaChapel HillUSA

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