Antiracism in Action: How Bystanders Can Transform Health Research and Practice

By Khadijah Ameen

Bystander behavior change interventions are designed to encourage all members of a community to transition from inaction to action if they witness violence. Such interventions are designed to extend responsibility of violence mitigation and prevention to third parties who may otherwise be reluctant to act. In the context of racial violence, the conventional way of thinking of a proactive bystander is someone who intervenes against an overt act of interpersonal racism, like Darnella Frazier courageously video recording the unjust murder of George Floyd. However, racism in health research, pedagogy, and practice often shows up more covertly, like through racial inequities in health research funding, race-based clinical algorithms, top-down health intervention design, and deficits-based framing of communities of color. We aim to expand and reimagine how we think about bystander behaviors, racial violence, and antiracism actions in the context of public health and healthcare.

In health research, pedagogy, and practice-based settings, a bystander can be anyone from a clinical staff member to an associate professor to a collective of students who are empowered to act against racism. Perpetrators can be individual actors or the health institutions themselves. Racism in these settings is not limited to a physical act of racial violence at the interpersonal level, and in fact is more likely to be covert, engrained in disciplinary cultural norms that uphold racial hierarchies.

To address the impact of racism on health, there must be a collective commitment to disrupting racism within and between health institutions. Fortunately, there is an existing toolbox of multi-level antiracism frameworks, measures, and tools designed to identify and intervene against racism’s harm in health research, practice, and pedagogy. One such framework is the Public Health Critical Race Praxis developed by Chandra Ford and Collins Airhihenbuwa, which outlines a semi-structured methodological approach for advancing race consciousness in health equity knowledge production and research. Another is the PEN-3 Cultural Model developed by Collins Airhihenbuwa, which offers a framework for understanding cultural meanings of health beyond the western paradigm. This ever-growing collection of antiracism tools can be used to build the knowledge, skills, self-efficacy, and collective efficacy of health professionals and students as proactive bystanders to intervene on racism across levels and within various health settings.

Behavioral interventions designed to promote prosocial bystander actions are not new to the fields of healthcare and public health. The existing scholarship and practice around bystander behavior interventions to address medical emergencies, youth mental health, and sexual violence may provide some insight into how these approaches can be adapted to the context of racial violence and health. We advocate for extending bystander behavior interventions that have already been socialized in health-related fields to identifying and mitigating racial violence within health research, pedagogy, and practice-based settings. The more bystanders there are within a health institution that are equipped with antiracism tools, the more likely normative behaviors that uphold white supremacy within and across these institutions can shift and systems change can occur.

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Article details

Expanding Bystander Behavioral Approaches to Address Racial Violence in Health Research, Pedagogy, and Practice
Khadijah Ameen, MPH and Collins Airhihenbuwa, PhD, MPH
DOI: 10.1177/15248399241269996
First Published: August 13, 2024
Health Promotion Practice

About the Author

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Khadijah Ameen (she/her) is a public health scholar and practitioner with multiple years of experience integrating racial equity solutions into health research, policies, and practices. Khadijah is currently a PhD candidate at Georgia State University School of Public Health in the Health Policy and Behavioral Sciences department, a Robert Wood Johnson Foundation Health Policy Research Scholars Program doctoral fellow, and a Georgia State University Second Century Initiative doctoral fellow. Khadijah is also a Co-Founder and Director of Policy & Research at BLKHLTH, a Black-led Atlanta-based non-profit with a mission of advancing health equity in Black communities through antiracist education, advocacy, research, and programs. In her role, she manages the organization’s research advisory, antiracism capacity building, and policy advocacy workstreams. Khadijah received her Bachelor of Arts in Cultural Anthropology and Global Health from Emory University College of Arts and Sciences, a Master of Public Health in Health Policy and Management from Emory University’s Rollins School of Public Health, and a Graduate Certificate in Interdisciplinary Qualitative Studies from University of Georgia.