The interesting thing about imposter syndrome is that there usually is evidence of competence in the form of educational, personal and professional accomplishments, however, we often attribute those to our ability to fool people into believing that we are smarter/more capable than we believe ourselves to be.
Read MoreMy school recently had an essay contest. This was my submission. I didn’t win.
Update August 2018: I turned some of my thoughts into a commentary. It was published here.
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Public health scholars and practitioners have a firm grasp on understanding that some populations disproportionately bear the burden of disease, injury, and premature death.1,2 However, despite its focus on eliminating health disparities, the field of public health often relies on nondescript language when referring to target populations. For example, the prompt for this essay asks students to write about “how to bring people together […] to advance health for all.” Which led me to interrogate what we mean when we say “all”—who is included in “all” and more importantly, who is not. “All” in principle does not translate to “all” in practice. In fact, research suggests that interventions developed to “advance health for all” most benefit privileged people and thereby increase rather than decrease health disparities.3 When public health strategists aim to “advance health for all,” without addressing health disparities, they are implicitly expressing a disinterest in focusing efforts on communities in most need. For example, consider the futility, dishonesty, and erasure in the phrase “All Lives Matter” as a response to an epidemic of state violence against Black people.
Today, the field of public health sees its mission as fundamentally rooted in social justice.4 However, a historical analysis of the role of public health agencies informs us of the field’s racist and xenophobic roots.5 Historically, many public health officials in the US were only concerned about the health of racial minorities to the extent that it impacted the white majority. Thus, the very definition of ‘public’ in ‘public health’ was exclusionary. Arguably this definition has changed over time, but this example illustrates the restrictive nature of universal language. Alternative to the guise of universal language, public health strategies focused on ‘centering the margins’ may have the greatest impact on reducing health disparities.
‘Centering the margins’ is a key concept of intersectionality, a theoretical framework that emphasizes the importance of acknowledging multiple intersecting identities on the micro-level and intersecting oppressions on the macro-level to better understand lived experiences of marginalized people. By centering the margins, intersectionality theorists critique and respond to the insufficiency of universal language in policies and interventions that work to exclude and further marginalize Black women in mainstream feminist and antiracist movements.6–8 The process of ‘centering the margins,’ however, expands beyond race and gender to include class, sexuality, age, disability, and gender identity.9 In a public health context, this process requires [1] explicitly prioritizing populations and communities most in need and [2] targeting social structures that create and sustain the foundation for health inequities.
In this section I present three tiers of recommendations to address disparities and achieve health equity: public health research, practice, and education. Research funding should be allocated to projects that address socio-structural factors (e.g. racism) as determinants of health.[10] Also, researchers should involve community members throughout the entire research process to better understand marginalized communities and the lived experiences of the people within them. Regarding practice, addressing institutional racism and other forms of intersecting oppressions (sexism, hetereosexism, xenophobia, ableism, ageism, transphobia etc.) in federal, state, and local policies as well as in health care organizations is essential to reducing health disparities. Moreover, federal funding agencies should fund community-based organizations led by and created for communities of interest. With regard to education, schools of public health should use an intersectional framework11 as a foundation for public health training. Additionally, public health curricula must name racism and other forms of inequality that undergird health disparities as failing to do so may lead trainees to falsely attribute inequalities to individual-level factors. Finally, schools of public health should emphasize learning from communities. Ultimately, we cannot develop solutions if we don’t have a clear understanding of the people we are trying to serve.
References
1. Smedley BD, Stith AY and Nelson AR. Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: confronting racial and ethnic disparities in healthcare. 2003.
2. Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404-416.
3. Mechanic D. Disadvantage, Inequality, And Social Policy. Health Aff. 2002;21(2):48-59.
4. Krieger N, Birn A-E. A Vision of Social Justice as the Foundation of Public Health: Commemorating 150 Years of the Spirit of 1848. Am J Public Heal . 1998;88(11):1603-1606.
5. Abel EK. “Only the Best Class of Immigration” Public Health Policy Toward Mexicans and Filipinos in Los Angeles, 1910–1940. Am J Public Health. 2004;94(6):932-939.
6. Hooks B. Feminist Theory from Margin to Center. First. New York: South End Press; 1984.
7. Crenshaw K. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. Univ Chic Leg Forum. 1989;(1):139-167.
8. Crenshaw K. Mapping the Margins: Intersectionality, Identity Politics, and Violence Against Women of Color. tanford Law Rev. 1991;43(6):1241-1299.
9. Davis K. Intersectionality as buzzword: A sociology of science perspective on what makes a feminist theory successful. Fem Theory. 2008;9(67):67-85.
10. Williams DR, Costa M V, Odunlami AO, Mohammed S a. Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities. J Public Health Manag Pract. 2008;14 Suppl:S8-17.
11. Bowleg L. The Problem With the Phrase Women and Minorities: Intersectionality— an Important Theoretical Framework for Public Health. Am J Public Heal. 2012;102(10):1267-1273.
