How to Address Disparities? Prioritize Participatory Research and Practice.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Jamila Michener, PhD, an assistant professor of government at Cornell University, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Michener is an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program at the University of Michigan, Ann Arbor.
In my undergraduate class on the politics of poverty, there is an uncomfortable yet persistent question that looms whenever the conversation turns to racial and ethnic disparities: why? The students generally (and rightly) believe that biological distinctions are not the answer and in the search for other solutions, culture frequently emerges as a likely suspect. In response, I challenge these young people to think more conscientiously about cultural explanations of poverty. I push them to problematize the notion that racial and ethnic groups are homogenous bearers of a common and undifferentiated culture. I prompt them to consider how social, economic, and political institutions constitute and are constituted by various elements of culture.
As National Minority Health Month comes to a close, I offer similar (if unsolicited) counsel to scholars, policy-makers, and practitioners who would turn to cultural explanations in grappling with vast and persistent racial and ethnic health disparities. Given the destructive purposes for which the concept of culture has been deployed (namely, to caricature and stereotype marginalized populations), my first instinct is to urge caution, care, and nuance. This means avoiding the trap of viewing culture as a “unitary and internally coherent set of attributes that characterizes a social group,”and instead recognizing it as a diverse assortment of shared understandings that shape (and are shaped by) how varying arrangements of people think, feel, and act in response to their environments. While cultural meanings are heterogeneous both between and within groups, at times they interact with economic and social processes in ways that are especially relevant to group-based inequalities. It is only through systematic analysis of such interactions that we might gain a cultural cognizance that advances our wherewithal for reducing health disparities.
Racial and economic inequalities are a consequence of cumulative and cascading disadvantages that span a gamut of issue areas. The neighborhoods that people of color and poor folks live in, the education they receive, the occupations they work and the hardships they endure condition both the physical resources they access and the narratives, networks, and institutions that they navigate. This is the stuff of culture, and it is most effectively tackled with comprehensive policy centered on the life worlds of the least privileged.
One promising approach that has emerged in recent decades moves precisely in this direction by emphasizing the social determinants of health (SDOH). A SDOH perspective is built on the recognition that factors beyond the individual play a vital role in influencing health outcomes. Social determinants encompass a wide array of life spheres in which distinctive and often debilitating experiences generate idiosyncratic meaning making processes for disadvantaged persons. SDOH are thus fundamentally connected to culture. Given this, research and policy on this topic must be rooted in knowledge of how the multifaceted realities impinging upon the development of shared understandings (both across and within racial groups) impact health inequities.
Community-based participatory research and practice is one way to push us down such a path. The Center for Disease Control and Prevention’s Urban Research Centers (URC’s) exemplify this. URC’s engage various actors in designing public health interventions, paying particular attention to how community members define their own needs and how they perceive the options for addressing them. While it is certainly no panacea, a participatory strategy that privileges the voices of those we seek to help can sensitize us to frames, repertoires, symbolic boundaries, and other cultural processes that we simply cannot afford to overlook when crafting and implementing policy for those most in need.