Quarterly
- Jun 20
- 1 min read

Issue 9 - Theory to Practice

Updated: Jul 21

April 2023

Introduction

Welcome to the first Quarterly of 2023. Over the past two years, Race & Health has been building momentum on our work. At the end of last year, we proudly released our Lancet Series on racism, xenophobia, discrimination and health. This release ignited a new portfolio of work that we are excited to share with our audiences throughout 2023 and beyond.

This year, Quarterly will focus on the Series, and exploring how work from the Series impacts the field of public health and global health. Each issue of Quarterly will focus on themes from a paper in the Series. This quarter, we are drawing from Paper 1: Racism, xenophobia, discrimination, and the determination of health at applying theory to practice.

You can read Paper 1 and the rest of the Series here.

If you believe in our work, we ask that you join us, support us and importantly, if you can, fund us.

Looking Back: New Article in The Lancet

New article on data, health information and disaggregation: "Racism, xenophobia, and discrimination: data disaggregation is a complex but crucial step to improving child health" by Delan Devakumar and colleagues. Read more about how data disaggregation can advance health equity for children, and why our collection methods must consider power and injustice to better respond to child health.

Coming Up

Spotlight: Interview with Angela Saini, Series contributor and author of Superior

Learn more about Angela Saini and her writing on racism, biology, and science on her website.

Sonora: Angela, you are an award-winning science journalist and have written across such a diversity of topics, including books on the power of Indian science, how science has gotten women wrong, the rise of race science, and an upcoming book about the origins of patriarchy. You’re also a co-author on the recent Lancet series on racism, xenophobia, discrimination, and health. To start, can you tell me more about your work and how you approach these topics?

Angela: Well, a lot of my work is about understanding what goes on behind the scenes in science. I think that the science journalist’s job is not just to communicate what scientists are discovering or researching but to understand science and medicine as establishments of power that have a great deal of control over how we think about ourselves, how we imagine each other, and in the health space, over life and death. So, there is a responsibility to make sure that political bias and personal prejudices aren't getting in the way of the facts. I think science journalists are crucial in that layer of vigilance, in making sure that the public have a complete understanding of what motivates researchers to do what they do and say what they say.

Sonora: When we talk about science, many people may think of it as this objective thing, where the science tells us the truth of how things are. But, as you said, science doesn’t always present an accurate story. Why does science not always present an accurate story, particularly in the case of racism and racial categorisations?

Angela: You know the way that science works is to get things wrong sometimes, and to get things right sometimes, and to recognize when things are wrong, to be able to move forward and do things better next time. So, it shouldn't surprise us at all that scientists make mistakes, because that is absolutely a part of the scientific process. What's important is that when they make mistakes that they recognize them, correct them, and move forward, having learned from those mistakes. The science of race is a perfect example of where that hasn't happened. The establishment of European science, from the beginning, so from the enlightenment onwards, was built upon the premise that the human species could be divided up into races or breeds, and that there was a suite of physical and intellectual differences between us that could explain why the world looked the way it did at that particular moment in history. That was obviously a fallacious idea at the time. Yet, scientists stuck with it, and this myth became so deep rooted in the way that they imagined human difference, that by the nineteenth century you even had American physicians, claiming, for instance, that Black people have thicker skin than White people, and that they don't feel pain in the same way. So, the politics that were embedded within those early assumptions have cast a very long legacy over scientific research for hundreds of years. Part of the reason that that The Lancet series on racism, xenophobia, discrimination and health was so critical is because it is absolutely incumbent on us, if we're going to move forward and provide a science of human difference that is more accurate and medicine which is fairer, to understand ourselves as we actually are, and not how the myths have framed us for hundreds of years. It's a very, very slow process and there is still a lot of resistance to it, because these myths run deep and are still so politically powerful.

Sonora: You mentioned there the Lancet series, which is about the intersection of racism and health, and how these come together. How did you become interested in that nexus, and what have you found from your work in this area?

Angela: Healthcare is the one of the first places that everyday people are likely to encounter race science. Doctors still hold certain folk ideas about human difference that guide the way they diagnose and treat patients. And because we don't understand fully the mechanisms and reasons behind racial disparities in health, it can still be tempting for people to fall into this assumption that there is something biologically innate at play, perhaps something genetic or some underlying natural racial difference. The work that I did for Superior was about undermining that idea that there is some biological tangibility to these social categories that we call race. It was incredibly important for me to have that medical perspective in there, because, like I said, that is where it hits people hardest, that's where they encounter it in an everyday setting. The Lancet Race & Health series is important because it's a reminder, not just for the public, but also for medical researchers and professionals, that if we are to understand racial disparities in health, we need to understand it in that broader, historic way. We need to get to the root of the social determinants of health, of how racism affects health outcomes and not jump to that lazy, frankly racist, assumption that there is always some fundamental biological difference there. Sonora: What does that lazy assumption that there is this underlying biological difference do for racism?

Angela: It keeps biological ideas about racism alive. Racism doesn't require biological myths. Obviously, you can be racist and believe in profound cultural differences between populations that you think may prevent racial integration. But the biological myth of race still lives on to some degree. Those pseudo-scientific myths stay alive when we go to the doctor or we go to hospital and we are given the impression that because of our race, we are genetically or biologically more susceptible to certain conditions. While there are population level differences that play out at a health level when it comes to large groups of people, the vast majority of what see as racial disparities in health, including for example life expectancy differences between racial groups in the United States, is because of how we are treated, and how we live.

Sonora: As you’ve mentioned, this idea that there is a biological basis to racial categorisations has been quite sticky; it has stuck around within science, within health and healthcare, and in how science and health are perceived and communicated to people. How can that stickiness be combated from both within the scientific establishment and from outside of it?

Angela: It happens very slowly, and I think this is where journalists are particularly important. It's not just about presenting facts and helping people understand that race is a social construct. It's also about the broader narrative. When we think about class, we don't think about health differences between socioeconomic groups as a fundamentally biological problem, we don't think of those occupying the lowest socioeconomic groups as being genetically different from those in the highest socioeconomic groups. And that's essentially the narrative change that we need around race. When we see racial disparity data, we shouldn't jump to underlying biological conclusions. We should think more carefully about what could be going on underneath and what other factors might be at play to create the difference that we see. We don't have great research into the social determinants of health which makes doing that incredibly complicated. We saw that play out during the COVID-19 pandemic; there was this racial speculation happening, because people just didn't have access to very good data on the social determinants of health. So, what we need is a fundamental change in narrative that recognises that racial disparities is mostly social data, and that you should be treating it as social data. That would go a long way to helping to fix the problem.

Sonora: Thank you, Angela. Finally, you have a new book that has just been released called The Patriarchs. Can you tell us a bit about this book and your findings within it?

Angela: This book is answering what seems like a very big question. It's actually a very simple one: If we haven't always been male dominated as a species then how did we get to this? Why is patriarchy so widespread? The literature on this topic is surprisingly thin. You'd think that there'd be loads of books and people talking about this topic. There’s hardly anything. So, a few years ago I decided to explore this question, and I do think, with the historical data that we have now and the new lens that we've been applying to fields like anthropology and archaeology that we have access to evidence that can help us at least start to offer answers to this question. I hope that this book does that.

End of interview.

Popular Culture

Academic Highlights

Theories for social epidemiology in the 21st century: an ecosocial perspective Krieger (2001) As the title suggests, this is an article about theories in social epidemiology. Specifically, Krieger traces the development and expansion of social epidemiological theory from emergence to current trends and examines how differences in theory shape difference in understanding of health inequalities. To review the merits and limitations of key theories, Krieger explores how psychosocial theory, social production of disease/political economy of health, and eco-social theory each answer the question; “Who and what is responsible for population patterns of health, disease, and well-being, as manifested in present, past and changing social inequalities in health?”

Psychosocial theory: health inequalities between individuals are the result of differences in social environment (e.g., social disorganisation, rapid social change, marginalisation, etc.).

Here, the focus is on individuals and their biological response to stressors. This theoretical framework has been very influential, including concepts such as allostatic load and the lifecourse model. However, it broadly ignores the causes of psychosocial stressors, and how their distribution is shaped by social, political, and economic policies.

Social production of disease/political economy of health: economic, political and social structures (e.g., neoliberal policies, structural adjustment programmes, or racism) that create social inequality are the root cause of health inequalities on the community level.

This social epidemiological framework focuses on the community level and emphasises that achieving social justice is essential to improving population health. Theories and analysis in this area have been critical to identifying how policies that ignore social equity have been bad for health. However, the framework is also limited in elucidating direct impacts on biology, thus missing out how economic, political and social structures impact health.

Ecosocial theory (and related multi-level dynamic perspectives): health inequalities are the result of biological, ecological, and social organisation, in interaction with each other.

Ecosocial theory is broader and more complex than those above, looking at each level of biological, ecological, and social organisation, and moving beyond purely psychological, economic, or social risk factors. Ecosocial analyses include consideration of pathways of embodiment, cumulative interplay between exposure, susceptibility and resistance, and accountability and agency.

Categorisation and Minoritisation Selvarajah et. al., (2020) In this comment piece, Selvarajah and colleagues discuss the origins and impacts of terminology used for racial categorisation in the UK, US, and South Africa. They first trace the origins of terms such as BAME, BIPOC, and Coloured, drawing links to colonial histories, Apartheid, Jim Crow laws, and other discriminatory policies that have relied on racial categorisation. They then highlight four key impacts of prevailing racial categorisation terminology and discourse:

Whiteness and Eurocentrism: Many racial categorisations create separation between White and non-White people by drawing attention to difference and centring Whiteness as the norm and default ‘reference population’.
Homogenisation: Racial categorisations such as BAME and BIPOC flatten important social and cultural differences between groups and disregard the unequal power structures within these categories.
Heterogeneity - furthering differences in opinion: Racial categorisations have the potential to create further divisions between non-White groups, pitting them against each other.
Hierarchical power at the heart of categorisation: Hierarchical power is central to the creation of racial categorisations, meaning that these phrases are not neutral. For example, minority does not refer only to population size, but rather is a function of power and how people are treated and valued in a particular society.

Considering these impacts, Selvarajah and colleagues encourage use of the term minoritised instead, where minoritised refers to: “‘individuals and populations, including numerical majorities, whose collective cultural, economic, political, and social power has been eroded through the targeting of identity in active processes that sustain structures of hegemony.” This terminology recognises active processes, shifts beyond binary majority/minority discussions, and emphasises the centrality of power to discrimination. Is Racism a Fundamental Cause of Inequalities in Health? Phelan & Link (2015) In this article, Phelan and Link set out to explore whether racism is a fundamental cause of inequalities in health between Black and White Americans. Fundamental-cause theory was first developed by Link and Phelan to explain the persistence of health and mortality inequalities by socioeconomic status (SES) over time because SES confers access to financial and non-financial resources such as knowledge, power, prestige, and beneficial social connections, that allow individuals with higher SES to engage in prevention and treatment more readily than people with lower SES. As a result, SES is a fundamental cause of health inequalities, regardless of the cause of ill-health. In this article, Phelan and Link conclude that racism is a fundamental cause of health inequalities as 1) a fundamental cause of racial inequalities in SES, and 2) a fundamental cause of racial health inequalities independent of SES. The authors draw on theories of structural racism to demonstrate the fundamental role that racism has in determining SES. However, as racial health inequalities persist even after controlling for SES, racism also acts as fundamental cause of health inequalities independent of SES by shaping distribution of resources such as prestige, power, beneficial social connections, and freedom. As racism is a fundamental cause of health inequalities, racial health inequalities cannot be eradicated through action on intervening mechanisms alone. Meaningful reduction in health inequalities requires reducing inequalities in flexible resources such as knowledge, money, power, prestige, and beneficial social connections.