Perspectives on Health Equity and Social Determinants of Health (2017) / Chapter Skim
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1 Health Inequities, Social Determinants, and Intersectionality
1 Health Inequities, Social Determinants, and Intersectionality
Pages 9-30
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From page 9... ...
Whether reframing existing conceptualizations of power, implementing empirical research studies, or working with community organizations and global social movements, intersectional inquiry and praxis are designed to excavate the ways a person's multiple identities and social positions are embedded within systems of inequality. Intersectionality also is attentive to the need to link individual, institutional, and structural levels of power in a given sociohistorical context for advancing health equity and social justice.
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From page 10... ...
that departs from the understanding that intersecting systems of oppression, including race/structural racism, class/capitalism, ethnicity/ethnocentrism, color/colorism, sex and gender/patriarchy, and sexual orientation/heterosexism, nationality and citizenship/nativism, disability/ableism, and other systemic oppressions intersect and interact to produce major differences in embodied, lived race-gender that shape the social determinants of health? How can we as scholars, researchers, and practitioners concerned with child and family well-being take seriously the reality of how intersecting systems of power produce lived race-gender-class and other social locations of disadvantage and develop an intersectionality health equity lens for advancing health equity inquiry, knowledge projects, and praxis?
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From page 11... ...
Second, by focusing on power relations at the individual, institutional, and global levels and the convergence of experiences in a given sociohistorical context and situational landscape, it serves as an anchor to advance equity and social justice aims for marginalized communities that have experienced and continue to experience structural inequalities (Collins, 2008, 2009, 2015; Crenshaw, 1993; Weber, 2010)
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From page 12... ...
The report of the Commission on the Social Determinants of Health (CSDH, 2008) points to the importance of being attentive to the overlapping effects and simultaneity of intersecting inequalities and their implications for social determinants: The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of people's lives -- their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities -- and their chances of leading a flourishing life.
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From page 13... ...
and Collins and Bilge's (2016) ideas about equity and intersectionality we define an intersectionality health equity lens as ongoing critical knowledge projects, inquiry, and praxis that can include research, teaching, and practice approaches that are attentive to the ways systems of inequality interlock to create conditions for either health equity or health inequities (Collins, 2008, 2015; Collins and Bilge, 2016; Crenshaw, 1993)
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From page 14... ...
For instance, if the idea that racialized health inequalities are simply a matter of individual behavior, food ways, and choice, and that we live in a meritocracy, where your station in life is simply a matter of individual effort, then we are subscribing to what Bonilla-Silva refers to as "colorblind" racism or the belief that present-day realities of race gaps in health only mirror individual deficits of individuals or defective cultures. The last arena where Collins and Bilge interrogate the dynamic of power includes the "structural" level or at the level of institutional arrangements, which interrogates how intersecting systems of institutionalized power, whether in the economy and labor market in terms of whose labor is valued and who is exploited, or at the political level in who is granted substantive citizenship rights and privileges and who is not, as well as at the level of who has access to structures of political power and influence, shapes the institutionalization of the conditions for health equity.
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From page 15... ...
In the next section, we focus on the contributions of an intersectionality health equity lens for research and for promoting health equity. AN "INTERSECTIONALITY HEALTH EQUITY LENS" FOR SOCIAL JUSTICE When developing or applying an intersectionality health equity lens, the researcher engages in deep self-reflection that contextualizes and recognizes the ways race, gender, class, sexual orientation, disability, and other axes of inequality constitute intersecting systems of oppression.
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Crenshaw (1993) points to the entrenched nature of inequity, underscoring the need for a useful paradigm in which to locate the issues faced by African American women and other racially stigmatized, visible minority women of color.
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From page 17... ...
suggest, understanding the social determinants of health requires a broad reach to identify, and respond to, the embedded and entrenched inequities of policies that are situated in place and context. Intersectionality health equity lenses help us understand that every person's experience is fundamentally different than the experience of others, based on their unique identity and structural positions within systems of inequality and structural impediments (Feagin and Sikes, 1994; López, 2003, Nakano Glenn, 2002, 2015; Weber, 2010)
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From page 18... ...
and other intersectional identities such as immigrant and Spanish speaker. The mental health costs of feeling racially stigmatized may become embodied by many youth who also feel what sociologist W
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The constellation of social determinants of health that my cousin faced was starkly different than my own and could account for the fact that while I am in my late 40s, married, and the mother of two children, my cousin passed in New York City due to a chronic liver disease before reaching the age of 45 (Cuevas et al., forthcoming; Johnson et al., 2017; Ortiz et al., 2015)
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From page 20... ...
To what degree do our current systems of data collection make her cousin's intersecting lived oppressions vis-à-vis race, national origin, class, sexuality, gender identity, and nativity invisible? If we collect data only on gender identity and not class, nativity, citizenship, ethnicity, language, and/or national origin, do we make some social locations invisible?
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From page 21... ...
also call upon health disparities researchers to take advantage of the benefits of qualitative data methods that "radically contextualize" the sociohistoric contexts that fuel the social determinants of health. They argue that qualitative methodologies such as participant observation, ethnography, and interviews can serve to demystify the link between structural, institutional, community, and individual processes that contribute to health inequities by shedding light on the social practices, interactions, policies, mechanisms, and processes that undergird manufactured health inequities.
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From page 22... ...
At the same time, it acknowledges the ways these historically situated policies and practices reinscribe positions of power, dominance, and oppression that contribute to the social determinants of health, education, and well-being. DEVELOPING AN INTERSECTIONALITY HEALTH EQUITY LENS: CHANGING THE NARRATIVE FOR SOCIAL JUSTICE What happens when health research takes an intersectional stance in producing and using knowledge to effect positive practice and social change and advance equity?
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By diversity within an intersectionality health equity lens, we are referring to research scientists whose own awareness of their intersectional identities -- that is, ethnicity, race, gender, class, sexuality, nativity, and disability -- pushes them to design research that produces greater knowledge and clarity about the conceptualization of sound intersectionality-grounded studies and the range of methods to ensure new knowledge, better applications of knowledge, and effective uses of knowledge to guide our understanding of human development and health. Initiatives focused on advancing social cohesion through intentional efforts to increase the diversity and number of research scientists with lived experiences that reflect multiple intersecting systems of oppression may take different forms.
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From page 24... ...
An intersectionality health equity lens offers enormous possibilities for research projects that take seriously the multiple identities of children, youth, and families in the study of health and human development. One might argue that a relationship exists between social-ecological models of human development and health that highlight the intersections and interactions between and across contexts and discussions of intersectionality that consider social statuses.
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Ruth Zambrana, Director http://crge.umd.edu Matrix Center for the Advancement of Social Equity and Inclusion, established 2005 University of Colorado, Colorado Springs Dr. Abby Ferber http://www.uccs.edu/~matrix University of New Mexico New Mexico Race, Gender Class Data Policy Consortium, established 2014 Institute for the Study of "Race" and Social Justice, established 2009 Dr.
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From page 26... ...
At a minimum, they suggest a revisioning of policies that cut across relevant areas of health, education, social services, and law. In developing our focus on intersectionality and social determinants of health, we attach our analysis to the goals of advancing social justice, where commitments to equality and equity reside and power is shared.
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From page 27... ...
357–383. CSDH (Commission on Social Determinants of Health)
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From page 28... ...
2013. Contextualizing lived race-gender and the racialized gendered social determinants of health.
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From page 29... ...
2012. More than culture: Structural racism, intersectionality theory, and immigrant health.
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30 | Perspectives on Health Equity Weber, L
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