This installment is an interview with Dr. Kaleea Lewis, a postdoctoral fellow at the University of Missouri. Responses were provided during a one-on-one radio interview, and this transcription was reviewed and approved by the interviewee prior to publication.

First, let’s break down your research/research interests by discussing how you came into your work and what keeps you grounded in it.

It began with my master’s program at the University of South Carolina. It was a great program, but one of the things that I really had issues with was the way that it presented health issues as it relates to racial and ethnic minorities, which is a common critique across all schools of public health and their curriculum, particularly how they present information for racial and ethnic groups’ negative or poor health outcomes. They use a deficit-oriented outlook to talk about it, so when we say that African Americans have a higher rate of obesity, higher rates of diabetes, or hypertension, it’s always presented in a way that couches it as if ‘this’ group is inherently flawed so therefore they have these health outcomes. That brought me to studying social determinants of health to really explore how the social environment may exacerbate the health outcomes that these communities face without victim-blaming and saying that ‘these’ people cannot do X, Y, and Z and that this is why they are in the predicament they are in now. So understanding that the social environment is definitely related to the health of our entire nation, regardless of their racial and ethnic background.

What are your specific research interests?

I am a critical race theorist health scholar who studies social determinants of health to understand how race and racism impact health. If we want to break that down and unpack that a little bit – so I’m really interested in bringing in my sociological training of race and racism into conversation with the social determinants of health to understand how it is evolving in our American society, understand the ways in which race still impacts Black Americans or any other racial-ethnic minority group, though I focus on Black Americans. I look at how race operates as a social determinant of mental health. I’m really interested in how Black college students make meaning of their mental health when they attend a PWI, which is a predominantly white institution. So understanding how PWIs which were built upon racist and oppressive structures operate in a way that promotes either negative or positive mental health for Black students and how Black students navigate within the university, whether it’s for four, five, or six years. Hopefully, they will complete [their studies]. One thing we don’t really think about is how those four to six years is a pivotal time for young adults, and how what happens within those years will have reverberating effects later in life. It’s really important to catch them now, understand what’s going on, and be really patient with them.

What are you finding in your work? What is your research revealing?

In my dissertation, I conducted focus groups and individual interviews with Black students. As they talk about their mental health, they talk about their Blackness, how they conceptualize it and how that relates to mental health. One of the common themes was racism-related stress, so how the cumulative experiences of racism or racial discrimination was really stressful for them, and how that stress related to longer graduation rates – so it took more than four years, and led to more diagnostic outcomes of depressive symptomatology, anxieties, and sometimes suicidal ideation, and their sleeping. They would say things like, “I couldn’t get up and go to class because I was sad,” or, “It’s really hard for me to leave my room, besides going to class, because I don’t feel comfortable navigating the campus community.” It’s really important to understand how the campus climate impacts these students’ mental health and how this will impact them, not only for the years that they’re in school, but also later on in life.

What are students doing about this?

When we talk about race and racism, we typically analyze it as an interpersonal thing, so someone said something to me that I didn’t like because I was Black, but what the students were talking about were more insidious forms of racism and racial discrimination, which were more structural forms. Of course, they would talk about their experiences with students who did negative things to them because of their race, or they would even talk about faculty members, but one of the things that was really salient within their conversations was how the mechanisms within the university were set up to inherently make it harder for them to succeed or enjoy their college years. That could mean funding for Black student groups which was cut or significantly less in comparison to white student groups or opportunities for Black students that were cut, or hyper-surveilled by campus police when Black students would have events. It was these structural forms of racism that they talked about. That definitely impacted their mental health, but it also impacted how they navigated their community, and how they embody themselves. They would talk about how they would change how they looked. For example, making sure they presented a more respectable form of themselves because they know ‘these people’ already have thoughts about them that are negative, so how do I combat them? Research shows it will lead to weathering of their bodies, which is a mental and physical health outcome that definitely impacts Black Americans. Understanding what these college students are going through is important, not only for now and how we change the structures within universities, but how do we impact their health later on in life.

They also talked about coping mechanisms like using familial ties. As it pertains to my research here, a lot of students talked about mental health services, or the lack thereof, or the hardships that they faced connecting with those mental health services. As a new part of my research, I wanted to help students understand, not only how to connect to services that we have on campus, but how to make sure that the campus services we do have are focusing on them and doing it in an equitable way – in a way that shows they understand the ramifications of race and racism and how its structured within the campus community.

What do you recommend they do about it?

Whether it’s through my research or public speaking, I don’t really force them to do anything. I present the information because it’s out there, and you can’t assume that everyone can access it because not everyone has access to the internet and not everyone knows how to use a computer. I like to be a vessel that hopefully represents them and also to combat these deficit ideas people have about Black Americans, and internalized racism by showing it through empirical literature (factual data and knowledge) and information that we don’t deem as empirical, because it’s just as valuable. As it relates to mental health, just getting them to understand the systems within the university, connecting them to those systems, and also helping them navigate those systems when they can be inherently oppressive, further marginalize them, or exacerbate whatever issues they’re going in there with. Basically, just show them that they have support through opportunities on and off campus.

Based on your research, what are your recommendations for how higher-ed institutions should be responding?

When you’re talking about centering the voices of marginalized populations, it can be difficult to accept what those students are saying. We currently don’t and have been socialized not to value those voices. So how do we take a step back and look at what students are saying and accept it? There are really tough conversations that we need to have about race and racism to dismantle the structures within the University [of Missouri] that are perpetuating these negative or poor mental health outcomes for Black students, but also that’s a really tricky thing to do because we’re a public university. If we do too much will there be pushback? How do we deal with that constant struggle of wanting to do more because you value the students, their academic success, their health overall, and not just value the dollars that they bring in.

What are some specific results from your research that you did not expect?

That it takes, on average, between two and six months to get your initial appointment at the [mental health] center. You call them and there’s a waiting list. Another thing that I didn’t know students were doing was taking a year off or taking classes online so they don’t physically have to be on campus. So you can go home and escape the structures within the campus community to cope and build your mental health. When we see graduation rates that say Black students take four to six years to complete school, the common narrative is that they come from these low economic schools that were lacking in funding so they couldn’t catch up, or they’re [the students] inherently flawed, their schools didn’t train them well enough, or they’re not focused on school because they want to work. When we look at this through a social determinants of health perspective, we see how flawed and how deficit oriented this is. Black students have to work because they have to supplement their income or have money to do the common things college students like to do, for example, eat. There’s a lot of homeless as it relates to students that we don’t talk about. When we see them, it’s “Oh, well you’re not trying hard enough. You’re not taking opportunities available to you through the campus community…” not understanding that there may be obstacles and structures that prevent them from taking opportunities available to them. So how do we take these intersections of health, race, class, gender and assess how they impact their lives? 

What makes you hopeful about your work? What do you hope comes out of your research?

Definitely using my privilege as someone with faculty standing to center their voices and put them in the places they should be to get their voices heard. I also hope to absorb some of the pushback that students would usually receive so they are healthier. It’s just letting them know that I’m here to help in the most simple way.

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Kaleea R. Lewis, MSPH, PhD is a Preparing Future Faculty for Faculty Diversity Postdoctoral Fellow at the University of Missouri-Columbia. She holds a joint appointment in the Department of Public Health and Women’s and Gender Studies. Dr. Lewis received her Master of Science and Doctorate of Philosophy in Public Health, with a concentration in Health Promotion, Education, and Behavior from the University of South Carolina. As a scholar trained in the social and health sciences, Dr. Lewis’ research explores how race and racism intersect to produce health inequities among Black Americans. She draws from critical race theory (CRT) and a social determinants of health framework to help her gain a better understanding of how systems of power and oppression adversely impact health. Her interdisciplinary research agenda uses mixed-methods to understand, confront, and challenge the ways in which race and racism operate as a social determinant of health for Black Americans.