Janis Faye Hutchinson Department of Anthropology University of Houston–University Park
Anthropologists often discuss the impor- tance of interdisciplinary collaboration. However, interaction between disciplines, let alone within anthropology, seldom oc- curs. This edited volume is an exception. Here, we have a set of articles that pro- vide perspectives of social science and public health to address a single and pressing issue: health disparities.
Often, edited volumes lack coherence. Certain key points, however, hold these articles together. First, all of the chapters examine race, gender, and class as social relationships that generate health inequal- ities. Second, authors in each chapter exam- ine the historical and social context in which knowledge is shaped and illness, health, and
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inequality are understood. Third, the au- thors examine the ways that institutions structure health care and access based on race, class, and gender. Last, the authors consider how to reduce or eliminate inequal- ities in health outcomes. With these themes running through each chapter, this edited book is a cohesive collection of articles on health inequality.
The approach used by all of these re- searchers, whether from public health or the social sciences, is intersectional theory. With roots in feminist scholarship, especially black womanist research, intersectional the- ory examines dimensions of race, class, gen- der, and sexuality in terms of differential power and social relations. Intersectional feminism, according to Lynn Weber, “inter- rogates the institutionally structured power relations shaping the process of knowl- edge production itself, the social inequali- ties of health, and the relation between the two” (p. 30). This edited volume does not belittle the importance of the biomedical model but argus that examination of alter- native paradigms in conjunction with the dominant model can generate new knowl- edge and contribute to shaping policy about health disparities.
In the introduction, Schulz and Mullings state the goals of the book: to understand how gender, race, and class interact to pro- duce differences in health, illness, and well- being. The editors hope to create critical dialogue between public health and social scientists that can bridge the gap between theory and practice and inform efforts to eliminate social inequalities that drive dis- parities in health.
The second section deals with the pro- duction of knowledge. Weber compares the biomedical and intersectional frameworks stressing the importance of collaboration. Weber acknowledges that the power imbal- ance between the two traditions must be addressed. In this chapter, it is also argued that “outsiders-within” such as women of color can make important scholarly contri- butions to understanding the intersection of gender, race, and class. In all of the chapters it is stressed that race, gender, and class are
not just additive but are “mutually constitu- tive.” In the same section, Martin provides a case study of the intersectional approach using mood disorders. She interrogates di- agnosis of mood disorders among racial groups at different points in time and il- lustrates how diagnoses changed over time. Last, Daniels and Schultz examine the con- struction of whiteness in interpreting racial disparities and the implications of this con- cept for eradicating health inequalities. In particular, they investigate racial differences in health due to differences in social envi- ronments rather than differences in innate characteristics of groups.
The third section is entitled “The Social Context of Health and Illness.” Here, au- thors provide case studies of health within particular social and historical contexts. For instance, Jackson and Williams examine “the Intersectional Paradox” by which the black middle class are better off economi- cally but just as sick as blacks in the lower class. The authors focus on resources and power differentials because black middle- class status does not entail the resources and power expected for that group. Caldwell et al. examine identity theory and psycho- logical well-being where experiences with discrimination are associated with lowered self-esteem. The epidemiological paradox of good health in Latinas is also examined; it is shown that once the data is disaggregated, Latinas do not have improved health. Zam- brana and Dill argue that the ways groups are depicted in society and the expectations associated with these depictions are impor- tant in health status. Instead of personal characteristics, these authors focus on ac- cess to social capital or social resources. Brown’s discussion of immigrants shows how they were marginalized in the most haz- ardous jobs. Although language and culture differences are used in biomedical models as barriers, these authors locate barriers within historical and local settings.
“Structuring Health Care,” the fourth section, examines access to quality health care. In particular, authors in this section focus on structural racism and the privileg- ing of some groups while access to resources
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is denied to others. Geiger examines the quality, intensity, and comprehensiveness of medical care for people of color. He dis- cusses bias, a pseudonym for racism, in health care among physicians, nurses, and other health providers. In particular, the clinical encounter is examined as the focal point for “bias.” In similar fashion, Mwaria suggests that prejudgments by physicians based on race, gender, and class may lead to assumptions about patients’ ability to un- derstand or follow protocols. Although it is often stated that people of color are un- willing to participate in clinical trials, she found that patients of color valued the op- portunity to participate in such trials. Gate- keeping by physicians, however, plays a ma- jor role in maintaining differential access to clinical trials by gender, class, and race. An- glin probes how gender, race, and class dif- ferentially impact health because of differ- ential diagnosis, treatment, and illness for breast cancer. She argues that the national breast cancer movement is not as effective as it could be because it does not incorporate those with less access to quality health care, including advanced technological medicine (i.e., women of color), into the movement. Again, the focus is on structural racism op- erating within or through the intersections of race, gender, and class.
The last section deals with “Resistance, Disruption, and Transformations” of health inequalities based on race, class and gen- der. Although certain experiences may ex- acerbate health problems, others reduce the negative health effects of inequalities. So- cial movements such as the women’s health care movement are examined. Mullings, for instance, discusses the activism of Harlem residents to improve the quality of health in their community. Mullings examines as- pects of life that are not usually directly discussed in connection to poor health. She uses the “Sojourner Paradox” as a frame; this conceptual frame draws atten- tion to the responsibilities that black women must perform while experiencing racial and gender oppression. The Sojourner Paradox addresses the structural constraints that im- pact health as well as strategies for resis-
tance and transformations. Mullings also notes that a consequence of being a black woman is an unstable class status. In other words, “race dilutes the protection of class” (p. 363).
Interventions were also addressed in this section. For instance, using a case study of the social context of HIV infection among young men of color, Schulz et al. show that race, gender, and class are linked by struc- tures that enforce differential access to re- sources such as decent housing, and that racist residential and employment policies and symbolic representations such as me- dia portrayals of young men of color influ- ence mobilization and policy affecting their health. Through activism, communities in Los Angeles and New York City illustrate factors that maintain inequality. Moreover, mobilization and activation in these neigh- borhoods prevented health-damaging facili- ties from being developed. Morgen’s com- plementary chapter examines the role of grassroots activists in keeping health dis- parities in the forefront. Using movement- grounded and intersectional theories, she focuses on the importance of women of color activists in interrogating race, gender, and class as mutually constitutive and in- tertwined rather than simply additive.
