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.

定性研究可以阐明白人的种族化社会制度如何以不容易通过调查数据捕捉的方式影响美国白人的健康信念。该次要分析借鉴了口述历史访谈（n=24) 于 2019 年在北卡罗来纳州西部阿巴拉契亚农村地区与白人进行。受访者讨论了个人生活史、社区文化、健康信仰以及医疗保健系统和服务的经验。主题分析传达了健康和医疗保健的两个不同方向：（1）引导视角，和（2）结构视角。白人并没有统一塑造受访者对健康和医疗保健的看法，相反，他们生命历程中的个人经历和种族化的社会制度促成了这些阿巴拉契亚居民对谁负责健康和医疗保健的评估。无论教育水平、年龄或性别认同如何，生活故事都反映了精英理想的受访者对《平价医疗法案》的不满尤为突出。他们将强烈的职业道德视为核心社区价值，假设个人对社会系统的贡献与个人努力所获得的回报相匹配。相反，主要在阿巴拉契亚农村以外社会化的受访者承认一些宏观层面的健康社会决定因素，并表示支持全民医疗模式。调查结果表明，在阿巴拉契亚地区没有一种统一类型的“农村白人”。旨在增加对促进健康公平的政策和计划的支持的干预措施应考虑区域和基于地方的因素如何影响美国白人的认同感以及随后的健康信念、态度和投票行为。在这个阿巴拉契亚地区，