Introduction

The Health Equity and Racism Lab, H.E.R. Lab, at Elon University officially launched on April 11, 2021, the last day of National Public Health week, formerly known as Negro Health Week, and the first day of Black Maternal Health week. Lab cofounders and codirectors Dr. Stephanie Baker, associate professor of Public Health Studies, and Dr. Yanica Faustin, assistant professor of Public Health Studies, were intentional about that date, as the lab represented an intersection of public health and reproductive justice. The lab was created as a space to train undergraduate students in an analysis of “race” and racism and to create community around the work of health equity research and action. The mission of the H.E.R. Lab is “to intentionally and systematically center the analysis of ‘race’ and racism as the main contributors to health inequities and to utilize an antiracist approach (race-based, not race-neutral, solutions that focus on systems and structure change to address inequities) to research and science as an organizing tool to advocate and act for a more equitable society”.1 To accomplish this mission, the H.E.R. Lab organizes its work around three main focal areas: 1) research, 2) capacity-building, and 3) advocacy and action.

The Need

Along with the public outrage about the murders of George Floyd, Ahmaud Arbery, and Breonna Taylor in the summer of 2020 came increasing attention to the need to name racism, and to undo it in order to move toward a more equitable, just, and free society.2 While this increased attention brought more people into antiracist social movements, research endeavors, social media posting, and action and advocacy, there are many activists, scholars, organizers, community members, and academics who have been engaged in this work for years. Dr. Faustin and Dr. Baker, who are part of this community, were already committed to addressing racism and health in their research, teaching, and community engagement and were also supervising several students in one-on-one mentoring configurations. Dr. Faustin suggested the creation of a lab to make the siloed work more connected and efficient, and plans to develop the H.E.R. Lab began.

The Structure

The H.E.R. Lab includes three different types of membership in addition to the codirectors. Student members are Elon undergraduates who are interested in the lab’s mission, and they can be full-time members or auditing members. Students who are full members of the lab are actively working on their own student-initiated and student-led research projects that are mentored by a codirector, while others are working in partnership with the codirectors. Full-time members are required to attend lab meetings as well as one-on-one meetings with their research mentor. Students who are auditing members can attend lab meetings, but it is not a requirement, and these members work on a smaller group project over the course of a semester. Lab meetings include learning opportunities for capacity-building, guest speakers who share strategies for advocacy, and student presentations about research progress with opportunities to collect feedback. All student members are required to participate in the Racial Equity Institute’s Groundwater Presentation and Phase 1 Racial Equity Workshop at some point during their membership. This shared learning experience allows lab members to approach their work with a shared analysis and builds the capacity of the student members and codirectors to better understand the depth of racism and its impact on outcomes. Student members also plan and host journal clubs to share what they are learning with students who are not lab members, and plan and implement activities to build relationships and connections.

The second membership category includes community and agency members who currently work in topic areas that are connected to the H.E.R. Lab (e.g., educational equity, maternal and child health equity, racial inequities in the criminal legal system, birth justice). This membership category includes people who are already doing the work of research, advocacy, and/or capacity-building, but desire to strengthen one or more of those areas through participation in a collective group that is committed to improving their analysis of “race” and racism and their application of antiracism strategies to move toward health equity. Community and agency members meet bimonthly with codirectors and collaborate with one another outside of formal meetings. The community and agency member component of the lab is in development, with a goal of full implementation by spring 2023.

The third membership category is visionary members. Visionary members were previously mentors to the codirectors who impacted their career paths in significant ways. Visionary members represent expertise in public health practice, research, “race” and racism analysis, and antiracism community and institutional organizing. They include Deena Hayes-Greene, cofounder and managing director of the Racial Equity Institute (REI); Vijaya Hogan, adjunct professor of Maternal and Child Health at the UNC Gillings School of Global Public Health and owner of Vijaya K. Hogan Consulting; Camara Phyllis Jones, former president of the American Public Health Association and adjunct associate professor at Morehouse School of Medicine and Leverhulme Visiting Professor in Global Health and Social Medicine at King’s College London; Diane Rowley, professor emeritus in the Department of Maternal and Child Health at UNC Gillings; and Monica Walker, senior leader with the REI. Our visionary members participate in up to three meetings per year to provide guidance and mentorship in the development and direction of the H.E.R. Lab, and to interact with our students and community and agency members. This membership design allows the lab to model and engage with the intergenerational relationships that are necessary to learn from the past and innovate and strategize in the present, for the future.

Past and Current Projects

The H.E.R. Lab has several past and current projects that reflect its mission of centering the analysis of “race” and racism as the main drivers of racial health inequities.

Student-directed and student-led mentored projects include 1) Centering the Margins: Applying Critical Race Praxis to Exploring Black Adolescent and Young Adult Fatherhood, led by student member Kiara Hunter (mentored by Dr. Baker); 2) Racism, Quality of Care, and Maternal Health Outcomes for Black Birthing Persons, led by student member Victoria Colbeck (mentored by Dr. Faustin); 3) Data Justice: MENA Women, Preterm Birth, and Ethnic Discrimination, led by student member Nazaneen Shokri (mentored by Dr. Faustin); 4) The Intersections of Physical Disability and Racism in Birthing Outcomes of African American Birthing Persons, led by student member Coral Clark (mentored by Dr. Faustin); and 5) Boroughs Matter: Examining Maternal Morbidity by Race/Ethnicity, led by student member Shauna Galvin (mentored by Dr. Faustin). Additionally, one of our graduates, Deena Elrefai '22, completed a student-directed and student-led mentored research project titled, “To us, we’re different, to them, we’re the same”: Dimensions of diversity and health in the Latinx Communities. Elrefai, mentored by Dr. Baker, worked with a community advisory board to create a qualitative research project that sought to highlight the diverse experiences of the many Latinx communities living in Alamance County. The goal of the project was to demonstrate the loss of valuable information about Latinx communities that comes from assuming homogeneity instead of acknowledging and learning about heterogeneous histories, backgrounds, and experiences. The results of Elrefai’s project were highlighted in Alamance County’s 2021 Community Health Assessment and covered by the local newspaper and by Elon University.3,4

Students also collaborated with lab codirectors on their projects. Mia Wilson '22 and Min Stanwyck '21 worked with Dr. Faustin on a project titled: Defunded and Disregarded vs. Resourced and Recognized: Inequities in Severe Maternal Morbidity, focused on hospital-level factors, structural racism, and inequities in severe maternal morbidity. Nyla Rivers '22 worked with Dr. Faustin on her Black Nativity and Birth Outcomes Project (in press), which investigates inequities in infant health across the African diaspora living in the United States. Queen Assata Stephens '22 collaborated with Dr. Baker on a continuing qualitative research project titled Out of Hospital Births Among Black Women, in which 30 Black women were interviewed about the decision-making process and experience of home birth and birthing center births. This project started before the lab was founded with Elon alumni Camaya Miller '19, and Stephens initially joined to assist with data analysis. In spring 2021, Assistant Professor of Dance Keshia Wall joined Dr. Baker to collaborate on an interdisciplinary documentary-dance film project. The project combined themes from the qualitative findings with dance as an innovative approach to communicating and sharing study results.5 Stephens worked on the team from the development of the concept to the editing and execution of the film.

Lab codirectors are also engaged in research projects separate from those of the students. Dr. Faustin’s current research is interdisciplinary and investigates the diversity in Black diasporic women’s perinatal experiences and structural barriers to health equity. Dr. Baker’s research involves community partnerships and includes the work of the Greensboro Health Disparities Collaborative, of which she is a nine-year active member, and the Alamance County Health Equity Collective, of which she is a founding member.

State of the Lab

In just over a year and a half of existence, the H.E.R. Lab has made much progress. In the first year alone, there were seven active research projects and nine members joined the lab. The lab hosted a webinar teaching the R4P framework, an antiracist program planning and evaluation tool that includes five components: 1) Remove, 2) Repair, 3) Remediate, 4) Restructure, and 5) Provide.6,7 The lab held an event to premier the docu-dance film that came out of Dr. Baker’s research, as well as an event featuring Dr. Sharrelle Barber, a social epidemiologist and scholar-activist at Drexel University who researches the intersection of place, race, and health. The lab celebrated the graduation of five members in May 2022 and recruited an additional six new members in fall 2022. Students and faculty have presented at several professional conferences, including the American Public Health Association Conference, the University of North Carolina Minority Health Conference, the City MatCH Maternal and Child Health Leadership Conference, and the National Conference on Undergraduate Research. They have also shared their work at Elon University at the Intersect Conference and the annual Spring Undergraduate Research Forum. Additionally, manuscript development for projects that were started since the founding of the lab is in progress, with expected publications in 2023.

Conclusion

The H.E.R. Lab is a robust model for how to integrate antiracism organizing for health equity into higher education, particularly in an environment that is teaching-intensive and does not have the level of research support that comes with R1 universities that spend approximately $5 million yearly in their research budgets.8 Building students’ capacity to engage in antiracist research, advocacy, and action before they enter their careers provides a rich opportunity to bring what they learn into their future organizations and institutions and advocate for the structural and institutional changes necessary to create a more equitable and just society.

Disclosure of interests

The authors report no disclosures.