Systemic Inequalities Research Articles

Introduction to Confronting Teacher Preparation Epistemicide: Art, Poetry, and Teacher Resistance

In this special issue, we present different perspectives from a documentary project on curricular epistemicide. We view curriculum epistemicide —the annihilation of curriculum—as an embodied process. It limits ways of knowing, questioning, and envisioning the world, and it constricts multiplicity and erases identity and culture. Authors within this volume responded to two requests: 1) they examined some form of epistemicide; and 2) they did not reinforce current systems of power and inequity. Throughout the issue, poetry and photography weave through theoretical papers and empirical studies. A range of methodologies are considered within the articles.

Barriers to Transition from Pediatric to Adult Care in Adolescents and Young Adults with Sickle Cell Disease: A Mixed-Method Study on the Impact of Systems of Inequity

Introduction: Although over 95% of children with sickle cell disease (SCD) live into adulthood, the transition period between pediatric and adult medical care holds the highest rate of morbidity and mortality across the lifespan. Transition is also characterized by systemic inequities including limited access to care, implicit bias, and disease stigma. Many adolescents and young adults (AYA) are not successful in transferring to an adult hematology provider, further compounding barriers to care. The purpose of this study was to characterize barriers and facilitators of the transition from pediatric to adult care with an emphasis on how systems of inequity impact AYA with SCD transition readiness factors. Method: Pediatric and transferred AYA completed questionnaires and then participated in a semi-structured individual interview or focus group. Questionnaires assessed transition barriers by asking participants to rate the top 3 challenges to transition from a list of common transition-related stressors. In addition, AYA responded to two questions inquiring about the impact of discrimination on healthcare and transition with the option of elaborating in open-ended text responses, and they completed the Perceptions of Racism in Children and Youth (PRaCY) instrument which describes AYA experiences with discrimination outside of the medical system. Individual and focus group interviews were used to obtain detailed descriptions and examples of barriers to transition and how systems of inequity (e.g., racism, socioeconomic disadvantage, etc.) impact AYA expectations or experiences with adult care. Quantitative data were assessed using means and standard deviations. Qualitative data from open-ended questionnaire responses and interviews were analyzed using a deductive-inductive approach via a revised version of the Social-ecological Model of AYA Readiness for Transition (SMART) informed by the Health Equity Framework. Overlaps among systems of inequity and other transition barriers are reported here. Results: Ten AYA with SCD receiving pediatric hematology care (Mage = 18.6; 5 boys, 4 girls, 1 nonbinary; 9 HbSS/Sβ0, 1 HbSC) and 10 AYA with SCD who had transferred to adult care (Mage = 23, 2 men, 8 women; 7 HbSS, 3 HbSC/SD; M years since last pediatric hematology visit/transfer = 1.17) completed questionnaires. All AYA identified as Black or African American, and one AYA also identified as mixed-race. AYA ranked a comprehensive range of top 3 challenges to transition (see Figure 1). Systems of inequity was among the most endorsed barriers alongside skills in being independent in their healthcare, adult provider relationships, beliefs/expectations, and insurance. Overall, AYA reported an average of 2.0 (SD = 1.63) experiences with discrimination on the PRaCY (pediatric: M = 1.78, SD = 1.30, range = 0 to 4; transferred: M = 2.20, SD = 1.93, range = 0 to 6). Further, 10% of AYA reported that their personal identity has impacted their healthcare, and 20% endorsed expecting or experiencing their personal identity (i.e., race, gender, income, sexual orientation) negatively impacting their transition to adult care. Of the participants in the questionnaire portion of the study, 95% (10 pediatric and 9 transferred) were interviewed. All AYA reported that systems of inequity are relevant to transition, though transferred AYA provided more detailed examples of how systemic inequities amplify transition barriers than pediatric patients. Qualitative themes of how systems of inequity impact the quantitatively most endorsed barriers are described in Table 1. Themes emphasize the impact of inequities related to racism, sexism, and socioeconomic disadvantage during engagement in adult-oriented care. Conclusions: AYA across pediatric conditions experience barriers to transition; however, these barriers are amplified for AYA with SCD due to the pervasive impact of systems of inequity. Findings suggest that patients might under-report experiences with systemic inequities on quantitative measures relative to qualitative discussions. Systems of inequity should be incorporated into the SMART framework as a pre-existing factor to promote health equity during transition. Institutional and clinician-level interventions should address interpersonal barriers, implicit bias, and stigma, yet a focus on systemic change is necessary to reduce the compounded burden for this population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Working‐class Latina/o youth navigating stratification and inequality: A review of literature

AbstractReflecting broader systems of stratification and inequality, sociological research shows that working‐class Latina/o immigrant families experience multiple marginalizations that require their children and youth to transcend the bounds of normative childhood by prematurely taking on roles and responsibilities typically thought of as reserved for adults. Still, the work kids do is largely studied in isolation and treated as exceptional. This paper brings together empirical research on poor and working‐class immigrant Latina/o youth and families to show that, in the face of stratification and growing inequality, these youth's labor is commonplace, spanning across multiple spheres of society, and that it is so because these youth's labor is essential to their personal and familial stability in the short‐term and mobility in the long‐term. Through this review, we conclude that Latina/o immigrant youth's financial, legal, cultural, and emotional labor must be considered when assessing the social forces that determine youth's socioeconomic and socioemotional outcomes in adulthood. We offer this analysis to advance scholarship on Latina/o stratification, immigration, and children's and youth's role in their individual and familial life outcomes.

The Need for Understanding and Addressing Microaggressions in the Workplace

The special issue on microaggressions highlighted how subtle interpersonal bias is complex, harms its targets, and reinforces established systems of inequity. The aim of this commentary is to contribute an organizational science perspective to this insightful and important dialogue. Given that the workplace is a microcosm of the broader society where adults spend most of their waking hours, studying microaggressions in this context can shed light on their unique manifestations and consequences, as well as methods to address this unique source of workplace adversity. Unlike other social contexts, many employees do not have complete autonomy over whom they interact with (e.g., choosing one’s supervisor, officemates, or clients) and what they are able to convey authentically and safely in those interactions (i.e., choices about how one responds to microaggressions). As a result, people from minoritized backgrounds must often maintain professional relationships with colleagues or supervisors who harbor bias and (un)consciously convey it via microinvalidations, microassaults, and microinsults. Further, reward systems in the world of work (e.g., wages, promotions) may not only reflect but also reinforce systems of disadvantage (e.g., who experiences social mobility). In addition to understanding microaggressions in the workplace, there is a need to actively address them. We engage with Ong et al., Johnson et al., and Spanierman et al. to suggest that organizational understanding and remediation of microaggressions offers a viable avenue for challenging systems of oppression and fostering employee and organizational resilience to adversity.

A Survey of Female-Specific Cardiovascular Protocols in Emergency Departments in Canada

BackgroundCardiovascular diseases (CVD) remain the leading cause of death for women. However, systematic inequalities exist in how women experience clinical cardiovascular (CV) policies, programs, and initiatives. MethodsIn collaboration with the Heart and Stroke Foundation of Canada, a question regarding female-specific CV protocols in an emergency department (ED), or an inpatient or ambulatory care area of a healthcare site was sent via e-mail to 450 healthcare sites in Canada. Contacts at these sites were established through the larger initiative—the Heart Failure Resources and Services Inventory–conducted by the foundation. ResultsResponses were received from 282 healthcare sites, with 3 sites confirming the use of a component of a female-specific CV protocol in the ED. Three sites noted using sex-specific troponin levels in the diagnosis of acute coronary syndromes; 2 of the sites are participants in the hs-cTn—Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women (CODE MI) trial. One site reported the integration of a female-specific CV protocol component into routine use. ConclusionsWe have identified an absence of female-specific CVD protocols in EDs that may be associated with the identified poorer outcomes in women impacted by CVD. Female-specific CV protocols may serve to increase equity and ensure that women with CV concerns have access to the appropriate care in a timely manner, thereby helping to mitigate some of the current adverse effects experienced by women who present to Canadian EDs with CV symptoms.

Changing men and masculinities: a reply to Roberts, Elliott and Ralph

ABSTRACT In this short article I provide a response to Steven Roberts, Karla Elliott and Brittany Ralph’s reply to my recently published article, Men and masculinities: a continuing debate on change. I address Roberts, Elliott and Ralph’s critique over the limitations of comparing the frameworks of inclusive and hybrid masculinities, and I respond to their claims over the use of intersectionality to account for the lack of change among less privileged men. Throughout the article I highlight the need for analysing men and masculinities in relation to wider systems of inequality and power hierarchies between men and women on the one hand, and among men on the other. I also keep insisting that research on changing men and masculinities should rely on intersectional, multi-layered analyses that take into careful consideration the contextual, interactional and situational factors that may affect men’s practices and (re)constructions of masculinity.

Health System Performance Assessment: how equitable is the Belgian health system?

Abstract Access to and delivery of effective, high quality and affordable healthcare are fundamental objectives that have shaped health policy and the universal health insurance system in Belgium. A health system should be evaluated against these objectives. Monitoring equity within a health system - an equitable distribution of healthcare use and of payments for healthcare - is a core component of a health system performance assessment. We use the horizontal equity principle to evaluate equity in healthcare use in Belgium. Unfair inequality in healthcare use is measured by the fairness gap, comparing actual use and expected use corrected for needs. The empirical analysis was conducted using a linked dataset which contains data from the European Union Statistics on Income and Living Conditions (EU-SILC) and administrative data. Two sets of results are reported for a selected set of indicators of use: the deviation between the average fairness gap in the population and the average fairness gap in a subgroup of interest and an assessment of systematic socioeconomic inequity in the fairness gap using the absolute concentration index. We show that important socioeconomic inequities in healthcare use exist. Inequities differ by type of care, e.g., the use of hospital care and medications is more equitable than the use of GP, outpatient specialist and dental care. When accounting for healthcare needs, we find that use among high-income groups and individuals with a high educational attainment is higher compared to financially vulnerable groups (individuals at risk of poverty or with severe material deprivation, unemployed, singles). Also, individuals who are entitled to an increased reimbursement of healthcare costs, show a lower use of outpatient specialist care than expected based on their care needs. On the other hand, increased reimbursement is effective in improving accessibility to GP care, while for other financially vulnerable individuals we find a lower use of GP care.

Anti-Feminism: four strategies for the demonisation and depoliticisation of feminism on Chinese social media

ABSTRACT Anti-feminism and misogyny online have intensified globally over the last decade, bringing substantive challenges to feminist identification and activism. This article explores the strategies for silencing and expelling feminists via the deployment of an anti-feminist discourse online, in response to feminism’s increasing visibility in China. Data was collected via observation of 23 influential feminist accounts on Weibo. This was bolstered by data from 10 semi-structured interviews with feminist Weibo account contributors. By applying critical discourse analysis (CDA), four strategies used to demonise feminists and depoliticise feminism online in China are identified: feminists as deviant women, as betraying the nation, as connected to Islamists, and as “fake-feminists.” The article highlights a kind of intertwined anti-feminism that draws power from distinct features—nationalism and Islamophobia. It argues that by interlocking Chinese historical and structural conditions as well as cultural context, anti-feminism diverts public attention away from systematic gender inequality, and onto antagonisms between feminists and anti-feminists, which further restricts the discussion of intersectional oppressions that affect women’s lives.

Fictions of Race: Racecraft, Reproduction, and Whiteness in Titus Andronicus

Fictions of Race: Racecraft, Reproduction, and Whiteness in <i>Titus Andronicus</i>

From the State to the Street: The Segregated Loss of Childcare and the Institutional Origins of Organizational Deprivation

The inequitable distribution of social service organizations contributes to embedded systems of racial and economic inequality. But while the relationship between neighborhood disadvantage and organizational deprivation is well established, explanations for how these patterns originate are less so. Departing from the community and organization as analytical focal points, this article draws on a series of recent childcare center closures within Boston’s nonwealthy, majority-Black communities to elucidate the role of the state in processes of organizational deprivation. Informed by a multiyear, multimethods study, the author documents the disruption of one vital organizational cross-subsidization strategy brought on by the unanticipated intersection of two discrete public institutions. Findings reveal that, especially under conditions of limited welfare state expansion, understanding community-level patterns of deprivation requires elevating attention to institutional field-level dynamics.

Critical collaboration across three transnational literacy autobiographies

AbstractHistorically, language and literacy education has overemphasized the ability to listen, speak, read, and write in one standard language (Campbell, 2005; Clark, 2013) without taking personal, historical, and contextual literacy experiences into account. Undertaking autobiography writing as a critical reflexive practice, this study analyzes three transnational literacy autobiographies or TLAs (Canagarajah, 2020) by each author that center critical engagement with an artifact (Pahl &amp; Rowsell, 2010) to learn how experiences within transnational contact zones have shaped their trajectories as literacies scholars. Merging pluriversality and transnational literacies as conceptual frameworks for analyzing their autobiographies, the authors conduct an interactive elicitation strategy and identify colonialism, emotion, and identity as emergent themes. Finally, the authors suggest using TLAs through critical collaboration to center transnational literacies and pedagogies, develop a transnational ethic of care, and imagine changes in current systems of inequity in literacy education.

Children's thinking about group-based social hierarchies.

Wealth, power, and status are distributed unevenly across social groups. A surge of recent research reveals that people being recognizing, representing, and reasoning about group-based patterns of inequity during the first years of life. We first synthesize recent research on what children learn about group-based social hierarchies as well as how this learning occurs. We then discuss how children not only learn about societal structures but become active participants in them. Studying the origins and development of children's thoughts and behavior regarding group-based social hierarchies provides valuable insight into how systems of inequity are perpetuated across generations and how intergroup biases related to wealth, power, and status may be mitigated and reshaped early in development.

Addressing Anti-Black Racism through the Social Work Curriculum: Informed, Prepared and Competent?

ABSTRACT Racism is a pervasive system that permeates all social activity within U.S. society and for over four hundred years has constantly reproduced systems of inequality and disparate outcomes for Black people. Increasingly, attention has been given to integrating anti-racist content and methods into social work education and practice. By integrating concepts from racial equity and liberatory education theories, and providing a case example of one university’s process of critically assessing students’ experiences of how anti-racist pedagogies manifest within social work’s implicit and explicit curriculum, this paper offers insights into potential strategies to prepare social work students to adequately address the needs of Black clients upon graduation.

Perceptions of Sexual Risk and HIV/STI Prevention Among Black Adolescent Girls in a Detention Center: an Investigation of the Role of Parents and Peers.

Black American adolescent girls constitute approximately one third of the US youth legal system population. Their overrepresentation in the youth punishment system is an indicator of significant physical, sexual, and/or behavioral health needs. Since less is known about perceptions of HIV/STI risk among Black girls with juvenile justice histories, we used intersectionality theory to explore the following: (1) how a sample of Black girls in detention endorse their perceptions of sexual safety given the multiple intersections of their race, gender, and SES and (2) how their endorsements align with interlocking systems of social inequality for system-involved Black at the social structural level. We examined relational and behavioral factors associated perceived HIV/STI risk. Among a sample of 188 Black girls (ages 13-17 years), we examined parent and partner sexual communication, fear of condom negotiation, a positive STI test, and partner risk profile as significant correlates. Major findings indicated that greater partner communication was associated with higher perceived HIV/STI risk, whereas having had a risky sexual partner, fear of condom negotiation, and having had a positive STI test were correlated with lower perceived risk. The significant factors identified in this study can be the focus of STI prevention and intervention programs for Black girls with youth punishment histories.

The Personal is Political and so is Discomfort: Intersectional, Anti-Racist Praxis in Feminist Criminology

The phrase “the personal is political” is commonly associated with 1970s feminists, for whom it denoted the relationship between personal experiences and broad systems of inequality. However, considering bell hooks’ argument that feminists have lost the power analysis fundamental to the relationship between the personal and the political, we assess the relevance of the notion the ‘personal is political,’ to our work as feminist criminologists. Building on hooks’ insight, we argue there is a need to take up an intersectional and anti-racist feminist praxis that centers multiple forms of oppression in scholarship and seeks greater accountability for sexism, racism, and transphobia both within and beyond academic spaces. We elaborate our ideas by, first, outlining the intellectual history and evolution of feminist criminology. Second, we examine how the relationship between the personal and political figures in the work of minoritized scholars. Third, we discuss the necessary discomforts associated with working towards an intersectional and antiracist feminist criminology.

How change agents mobilise masculinities to support gender equality in academia

This paper theorises the role of men and mobilising masculinities in organisational change towards gender equality by investigating how change agents in academia give meaning to their involvement in such change. Via narrative inquiry I compare the working of emotions and affective solidarity in narratives of 15 male and female change agents at nine universities in four countries. The analysis shows that both male and female change agents mobilise different types of masculinities to foster gender equality: chivalrous masculinity, disruptive masculinity and inclusive masculinity. This paper contributes to the gender equality change literature by theorising masculinities as not only hindering but also potentially transforming organisations in the direction of gender equality. The interplay between knowledge and affect in the narratives of gender equality change agents suggests that interventions should aim to move emotions and support affective solidarity through recognising and understanding participants’ experiences with systems of inequality.

Experiences of Civic Participation Among Older African American and Latinx Immigrant Adults in the Context of an Ageist and Racist Society.

In the past 20years, older adults' civic participation has received considerable attention. Current literature shows that rates of voting and volunteering have been consistently lower among African Americans and Latinx older adults compared to White older adults. However, little research has explored civic participation in the context of historical structures of inequality that influence how Black and Latinx populations participate in civic life. I draw from an intersectional life course perspective and phenomenological methods to examine experiences of civic participation through participants' lens. Findings draw our attention to how race/racism and age/ageism shape how, where, and with whom participants participate. Findings demonstrate how civic participation is embedded within systems of inequality that inform individual behavior as well as available opportunities for engagement. These findings call attention to the need to re-conceptualize and support civic participation that centers the experiences of historically ethnoracially oppressed populations.

Intersectionality: a means for centering power and oppression in research.

Intersectionality theory examines how matrices of power and interlocking structures of oppression shape and influence people's multiple identities. It reminds us that people's lives cannot be explained by taking into account single categories, such as gender, race, sexuality, or socio-economic status. Rather, human lives are multi-dimensional and complex, and people's lived realities are shaped by different factors and social dynamics operating together. Therefore, when someone occupies multiple marginalized intersections, their individual-level experiences reflect social and structural systems of power, privilege, and inequality. And yet, knowing that people occupy different social locations that afford them unique experiences is not the same as knowing how to analyze data in an intersectional way. Intersectional analyses are rigorous, and require the use of theory at multiple levels to see theoretical connections that are often only implicit.In this paper, we ask "How does one actually do intersectional research and what role does theory play in this process?" In an effort to make intersectionality theory more accessible to health professions education research, this article describes the simpler version of intersectional analyses followed by the more complex version representing how it was originally intended to be used; a means to fight for social justice. Using pilot data collected on first-generation medical students' professional identity experiences, we demonstrate the thinking and engagement with theory that would be needed to do an intersectional analysis. Along the way, we describe some of the challenges researchers may find in using intersectionality in their own work. By re-situating the theory within its original roots of Black feminist thought, we hope other health professions education (HPE) researchers consider using intersectionality in their own analyses.

183 Advancing Structural and Systematic Equity in Epidemiological Analyses of Large Datasets

OBJECTIVES/GOALS: Health inequities represent complex structural and systematic processes that lead to disparate outcomes for populations or subgroups within populations. This project aims to improve the available structural and systematic approaches to the study of such inequities at the population level. METHODS/STUDY POPULATION: Using examples from diabetes research, two critical factors that may impact the validity or utility of health equity models will be examined; and proposed methodological approaches to offsetting potentially resulting biases will be offered. The factors include: (1) inequitably missing and misclassified data in large datasets and (2) the presumed positioning of socially constructed variables such as race, ethnicity, and gender within modeled structural and systematic mechanisms. This examination intersects theories and praxis in epidemiological modeling and health equity promotion with the goal of advancing rigorous, equity-focused epidemiological methods. RESULTS/ANTICIPATED RESULTS: Inequitably missing and misclassified data are generally expected to obscure inequities. Treatment of missing or misclassified data as informative measures of inequity is expected to partially offset this bias. The implicitly modeled components of socially constructed variables are expected to be non-uniform across structural and systematic mechanisms of inequity. Models that apply these variables as informatively heterogeneous constructs, using multi-phase analyses to test modeling assumptions and to assess intersectionality, may provide better context about the mechanisms by which inequity has been distributed and, perhaps, by which equity may be achieved. DISCUSSION/SIGNIFICANCE: Equitable epidemiological methods are essential to the advancement of evidence-based health equity on the population level. Potential structural or systematic inequities in large-scale datasets and traditional data analyses should be thoughtfully reviewed through a health equity lens.

GENDER AND THE CITY: NEGOTIATING CULTURE IN URBAN SPACES

The relationship of women with the cities they reside in is not determined simply by the physicality of the space they occupy and traverse but is established by the socio-cultural patterns of relationships and the beliefs that have created systems of inequity, exclusion and marginalisation. This article attempts to provide linkages between existing traditions and practices that direct/restrict the presence of women, girls and others in public spaces, the culture of violence that prevails across cities globally, the response of civic society and government agencies, the marginalization of citizens as participants in the making of their own cities, and the provision of urban infrastructure and spaces that enable gender safety and belonging. In this article, the term gender is not restricted only to women (or men) but to all other genders.