Changing the Game in Reporting of Health Disparities
Many of us were drawn to health careers because we wanted to improve the lives of people in our communities. Our social justice orientations keep us engaged and fighting for the nation’s health in spite of budget cuts that threaten preventative services and health care safety nets for vulnerable populations. Public health and other health discipline’s journals and conferences often focus on social justice and health disparities.
Yet, our research reports often fall short of truly identifying the upstream social determinants of health and directly and honestly addressing health disparities. All too often, research reports rely on atheoretical research designs that examine associations between health outcomes and some human characteristic(s). These fishing expeditions for correlates of poor health, of course, sometimes yield surprising findings, but too often, the conclusions drawn are reported as:
“sexual orientation is a risk factor for (fill-in-the-blank health problem)”
“minority racial/ethnic identification was associated with lower income”
“gender was a predictor of slower job advancement”
“the lowest income group had the highest rates of obesity”
In these examples, it is most likely that sexual orientation, racial/ethnic identity, and gender were proxies for heterosexism, racism, sexism, and classism, and not the cause or contributor to the health issue. Without a theoretical framework in which to view identities, minority or majority, we can unintentionally blame the individual who has that identity for any social shortcomings (less educated) or health problems (those poor people have terrible diets). If we truly embrace an ecological view of the world, we should not tolerate simplistic and incomplete statements that link individual identities to health outcomes in direct fashion, but insist that our own research reports complicate these relationships. If we at least place our research questions within the larger context of a theoretical framework, we can show how our findings support or challenge those theories, without making sweeping and inaccurate generalizations such as “lesbian identity is a risk factor for obesity.” We would make sure that our study design accounted for or included measures of heterosexism and sexism, or we clearly outline why we are not measuring those critical factors. We take care in how we frame our conclusions so that right wing politicians do not take them as evidence that immigrants, women, people of color, LGBTQ folks, poor people, and others already at the bottom of the heap, are blamed for their poor health and punished by policies that even further limit their access to quality health care.
So I am calling for us to “name the ism” when we report health disparities and not inadvertently contribute to our own oppression.
How timely for this post, Mickey, since I have been addressing this issue so often recently! In 1991 there was a wonderful article in ANS by David Allen, Karen Allman and Penny Powerrs titled “Feminist Research without Gender” (see link below) that addressed this issue, but only now are we seeing a “readiness” to address this issue. I think you have framed this issue extremely well .. and welcome much more discussion on “best practices” to overcome the risks of even the best-intended research to be used as a tool of oppression.
Here is the long link: http://journals.lww.com/advancesinnursingscience/Abstract/1991/03000/Feminist_nursing_research_without_gender.7.aspx