Identity Should Not Take a Backseat in Health Justice

Over the years, I have found myself exploring what it means when people ask me, “Tell me about yourself.” There was always this knot in my stomach when the responses that came out of my mouth were immediately focused on what I do versus who I am. This feeling became more and more challenging as I found myself involved in various types of work that spanned research, evaluation, development, advocacy, and policy. Yet, who I am is also challenging to define due to the complexities of my journey as a Ghanian woman who immigrated to the United States. However, over time, I have learned that this complexity adds to, rather than detracts from, my work.

I am connected to my roots across generations and geography. However, a shift occurred when I moved to the United States.

Likewise, the broader fields that contribute to health justice—research, evaluation, service delivery, advocacy, and more—would be strengthened by an intentional identity-based approach that aims to liberate communities from the structural inequities embedded in more traditional practices.

My Identity in Practice

I am a lifelong generalist with many interests, endowed with experiences and expertise that support a varied and multifaceted approach to my work. Each time I was asked to tell someone about myself, the mental gymnastics of deciding which area of my work or affiliations should be the focal point became too much to bear. Then the lightbulb went off in my head; I am more than what I do. And, most crucially, what I do is informed by who I am. 

As an African in the diaspora, I grew up in a multigenerational home where I became grounded in my identity and ancestry as an African woman. I was also able to forge connections with family. I am connected to my roots across generations and geography.

However, a shift occurred when I moved to the United States, which resulted in a deeper interrogation of my African roots, because in this country I was reduced to a race. But I am more than a race because race is socially constructed and contextual. It is not a biologically real concept, but its consequences are real for people of structurally marginalized races. Systems of power, privilege, and oppression are fostered through this social construct of race, resulting in egregious inequalities. In the United States, like most other places, our identities and experiences are shaped by race and the hierarchies bound up within it, whether we are conscious of it or not. Since I came to the United States, exploring my identity has also involved understanding the nuances of colonialism and how it affects how I show up in the world and how other people see me. Therefore, my work calls for the need to reimagine health justice by focusing on empathy and our common humanity.

My immigrant experience as a Black woman from Ghana in the United States and the challenges of navigating complexities as a foreign-born person has informed how I confront dominant narratives of racial and ethnic “others,” which are often laden with stereotypes. These generalized notions of who and how people are can be detrimental to Black women, and can negatively impact their health outcomes. Within this vein, my work in public health service delivery allows me to bring my diverse perspectives as a Black woman and Ghanaian American woman into decision-making processes.

We, as a nation, are still grappling with the historic and constant erasure of Native peoples; we are now further erasing the cultures and identities of Black populations who were stolen from their land and forced into enslavement.

By honoring my intersectional identities and using the unique perspective they give me, I am able to replace traditional research and evaluation frameworks with culturally responsive and equitable practices. Part of my approach involves using the power of storytelling to decenter dominant narratives and invite in diverse lived experiences.

The Importance of Centering Identity amid Backlash

There is a constant erasure of Black history in our social systems, with some states—including Florida, Texas, and Iowa—enacting legislation to close diversity, equity, and inclusion offices or ban diversity training. Additionally, the College Board stripped down AP African American History on the first day of Black History Month in 2023.

By banning the history of a people, how do we learn from what’s happened in the past and how it affects our present? One of the key tenets of civilizations is communication. We, as a nation, are still grappling with the historic and constant erasure of Native peoples; we are now further erasing the cultures and identities of Black populations who were stolen from their land and forced into enslavement. By creating these structures of ignorance instead of structures of decolonization, we are perpetuating the cycle of colonialism, a form of White supremacy that works to dehumanize the colonized.

The wounds also need to be cleaned and disinfected…an essential part of the healing required to fully commit to antiracism and decolonization.

Recently, I discussed the need to redefine national security needs to include narratives of health for Black, Brown, and Indigenous people with some colleagues from Women of Color Advancing Peace, Security, and Conflict Transformation. Part of the dialogue was centered on systemic change. Taking this approach means we need to move beyond the status quo of reactivity to the social harms that affect structurally marginalized populations. This approach serves as a “Band-Aid effect” that wanes over time. Instead, initiatives that center power in the hands of Black women doing the work—such as Melinda Gates donating $240 million to Black women like Nobel Peace Laureate Leymah Gbowee and pioneering psychologist Dr. Alfiee—are what we need.

Navigating the societal systems that must be torn down and needing to survive within them until we build something better is tiring and traumatic. However, it can also serve as a locus of inspiration for the work of individuals with lived experiences in colonialism and racism. It takes bravery to dismantle ideologies rooted in White supremacy when forced to navigate unequal and unfair systems rife with health equity tourists who are not invested in the work. To decenter White supremacy and colonialist narratives, it is crucial that we affirm the collective identity of Blackness as a human experience and ensure everyone sees themselves represented. Therefore, I urge organizations to recognize the role of identity in health justice efforts.

I acknowledge that this is hard work for organizations. But we cannot put Band-Aids on wounds forever. The wounds also need to be cleaned and disinfected, and that is an essential part of the healing required to fully commit to antiracism and decolonization. Evidence already supports the return on investment in diversity programs for organizations, and this is even more critical as US Census data show growing diversity among Black immigrant populations in our nation. Organizations need to recognize that their workforce will increasingly include Black immigrant populations and that the immigrant experience differs across cultures.

In a society plagued with zero-sum thinking narratives of one group winning at the expense of another, part of my approach to teaching is to encourage students to show up as they choose. As I reflect on the question posed by Peggy McIntosh in her groundbreaking essay on White privilege, “Having described [White privilege], what will I do to lessen or end it?” I believe the answer lies in centering empathic, wholesome identity rituals, which are Indigenous engagement processes that encourage people to ground conversations both from the mind and heart and to foster the building of antiracist and decolonized systems. I therefore argue for an approach that breaks the cycle of ineffective and inappropriate methods of understanding socially minoritized people that further exacerbate the “Band-Aid effect.”

Proposed Framework to Embed Identity within Health Justice

A framework that can be adapted for such work embodies the principles of culturally responsive and equitable evaluation, rooted in systems thinking, equity, Indigenous ways of knowing, and collective power. The IMPACT (Inclusive, Manumit, Practice-based, Accessible, Community-focused and Timely) framework serves as a guide to foster a community-first approach to systems change and heighten the value and merit ascribed to practice-based, culturally relevant, and experiential learning.

Each IMPACT component has corresponding reflection questions and a brief description of its value for health justice work:

• Inclusive

To truly foster inclusivity, practitioners must ask themselves: For whom am I working, and how are their identities centered? Inclusive work also honors members of the community holistically, geographically, culturally, and historically. The intersectional ways of being that drive the way communities perceive life and specific experiences are also honored and respected.

• Manumit

Practitioners must privilege liberatory and affirming conceptualizations of identity over racist, colonialist, and other limiting perspectives. Due to the ubiquity of false and limiting stereotypes, and the pain they can cause historically underrecognized people, practitioners must do the work of examining how we see our own identities and community members’ identities. This work involves interrogating our biases about these communities and contextualizing societal issues. Therefore, practitioners should ask: What is important for a community to see, receive, accept, or believe about their identity? And how will this help liberate them?

• Practice-based

Our approach to practice can influence communities’ interest in participating in health justice work as well as the trust communities hold for researchers and other practitioners. Can we engage in identity-centered practices? How do we keep from misusing resources that only address symptoms rather than the root causes of a problem? By aligning our practice with community needs and interests and addressing root causes, we can advance health justice work with communities rather than for them.

• Accessible

Are the voices of community members and their needs informing the work? Honoring the wholeness of people and ensuring processes include their various ways of being, irrespective of abilities, can support accessibility. Accessibility is key to the sustainability and utility of the work, and honors the time and resources needed to bring a project into fruition.

• Community-focused

How does our sense of identity affect how we relate to and see the community and, consequently, the world? We must be mindful of the representation of various identities when accounting for community members’ perspectives. Without such an excavation, without being acutely aware of the subjectivities that show up in our work, we cannot understand the full impact of our efforts or genuinely address the needs of the communities we serve.

• Timely

How will our findings impact people in the present and in the future? When privileging community perspectives, timeliness means working on pace with the community’s readiness and based on their preferences. Projects end and practitioners who work closely with communities eventually have to move on. Therefore, timeliness goes beyond addressing immediate needs by empowering community members to manage future needs on their own terms.

Implementing the IMPACT framework allows mission-driven organizations to account for lived experiences in their approach to health justice work. More importantly, the framework serves as a tool to consistently and sustainably center identity within health systems and ensure people feel respected.

By embracing this framework, we can build more equitable and culturally responsive approaches to health and wellbeing that genuinely reflect diverse and intersectional identities and lived experiences. Ultimately, centering identity in health justice is not only an ethical imperative—it is essential for creating lasting and meaningful change within our society.