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‘DIFFERENT THAN A REGULAR WHITE’

Exploring Health-related White Identity Politics in Rural Appalachia

Published online by Cambridge University Press:  09 September 2021

Caroline R. Efird
Caroline R. Efird*
Affiliation:
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, USA
*
Corresponding author: Caroline R. Efird, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, North Carolina27599. E-mail: caroline.efird@unc.edu
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Abstract

Qualitative research can clarify how the racialized social system of Whiteness influences White Americans’ health beliefs in ways that are not easily captured through survey data. This secondary analysis draws upon oral history interviews (n=24) conducted in 2019 with Whites in a rural region of Appalachian western North Carolina. Interviewees discussed personal life history, community culture, health beliefs, and experiences with healthcare systems and services. Thematic analysis conveyed two distinct orientations toward health and healthcare: (1) bootstraps perspective, and (2) structural perspective. Whiteness did not uniformly shape interviewees’ perceptions of health and healthcare, rather, individual experiences throughout their life course and the racialized social system contributed to these Appalachian residents’ assessments of who is responsible for health and healthcare. Dissatisfaction with the Affordable Care Act was salient among interviewees whose life stories reflected meritocratic ideals, regardless of education level, age, or gender identity. They apprised strong work ethic as a core community value, assuming that personal contributions to the social system match the rewards that one receives in return for individual effort. Conversely, interviewees who were primarily socialized outside of rural Appalachia acknowledged some macro-level social determinants of health and expressed support for universal healthcare models. Findings suggest that there is not one uniform type of “rural White” within this region of Appalachia. Interventions designed to increase support for health equity promoting policies and programs should consider how regional and place-based factors shape White Americans’ sense of identity and subsequent health beliefs, attitudes, and voting behaviors. In this Appalachian region, some White residents’ general mistrust of outsiders indicates that efforts to garner more political will for health-promoting social programs should be presented by local, trusted residents who exhibit a structural perspective of health and healthcare.

Keywords

WhitenessRural HealthWhite Identity PoliticsAppalachiaQualitative Research
Type
State of the Art
Information
Du Bois Review: Social Science Research on Race , Volume 19 , Issue 1 , Spring 2022 , pp. 107 - 128
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Hutchins Center for African and African American Research

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