As some of you know, I am working on my Master of Public Health, with a focus on social inequities in health. Basically, this is exploring why and how some groups of people are doing worse than everyone else. For the most part, the men, the rich, the heterosexuals, the educated, the people who are not challenged by their abilities, and the Caucasians are doing better.
Who is doing worse?
- In the United States, studies find that women have a 26% chance of being sexually assaulted during their lifetime.
- In Canada, Aboriginal peoples make up 4% of the total population, but account for 23% of those who come into conflict with the law and become incarcerated.
- American sexual minority youth (LGBTQ?) are 2 to 3 times more likely to attempt or commit suicide than youth who identify as heterosexual.
- 42% of people living with a disability in Canada are unemployed.
- Those who identify as transgender are far less likely to have access to health care.
- Globally, 1 BILLION PEOPLE live in abject poverty, most of whom are women. That is 1 out of every 7 people on the planet.
What is social inequity?
I think about social inequity like this:
Imagine you are in a house filled with people and this house is also full of poison gas. Some people are given gas masks, while others are invited to a safe room where there is no gas. Some have better masks than others, others have none at all.
The gas mask represents most interventions created to address negative health outcomes. The gas itself represents the different social structures that create inequity and create power imbalances, such as colonization, oppression, the gender binary, patriarchy, etc… To help people get better, we need to get rid of the gas, not just give people gas masks.
This video also nicely demonstrates the principles of inequity. These monkeys are treated in an unequal way that was avoidable and unfair, and they were not impressed:
An Ethical Framework
I am currently taking the final course for the social inequities stream of my Master of Public Health program. My instructor has challenged us to create an ethical framework for practice. Simply put, an ethical framework will provide guidance and standards for practice. There are 2 main reasons why such a framework is useful to the kind of work I will be doing:
- When working with social inequities, one does not want to become part of the problem and accidentally recreate or reinforce social inequity. An ethical framework will provide strategies to reduce this possibility.
- Challenging social inequity can be overwhelming and sometimes the prospect of real change seems bleak. An ethical framework will provide strategies to ensure one can bring a social inequity perspective to practice without becoming overwrought or burned out. For me, after doing all this work, it would be unethical not to bring what I have learned into my future practice.
Why use a blog platform:
- A good framework needs to be flexible. What better medium than a blog? I can add to this framework, or take away from it, anytime I want.
- It is interactive. This framework is for me, but maybe it is for you dear reader too? I also love being able to add hyperlinks, polls, pictures, and videos to supplement my ideas.
- Being public keeps me real. By sharing this with the world, I feel more accountable to what I have shared here.
- Writing this piece for the both the public and academic arena gives it a different flavour. It feels less sterile and careful, more tangible and accessible. I didn’t want to write something that only a handful of people from my class would want to read.
The Change I See
Examining gender roles, stereotypes, and inequities is my passion. This is partly because I identify as female and feel this is where I should focus my efforts. I also take great interest in the way gender controls our lives because I have two daughters and I want better for them.
In the future, I hope to work with local organizations that deal with the effects of gender violence. Violence against women is the result of gender inequity and reproductive injustice, but this lens is often not applied to programs and services that aid women who are in crisis and trying to escape violence in their lives. I would like to work with local organizations to create frameworks that will bring a gender violence and reproductive justice perspective to care and services. The main idea of the reproductive justice perspective is that acknowledging the context of violence helps empower women to make changes in their lives, which in turn will give them the tools to challenge the inequities that produce gender violence in the first place.
Having an ethical framework that I can apply in doing this work is vital. It will provide the tools I need to ensure I am not reproducing gender inequity in my work and to be able to have the strength and courage to talk about these issues in my personal life. Gender inequity is deeply embedded in our society, which makes it difficult and contentious to talk about. It is important to me to be able to point out the way society controls women’s bodies, when it is happening. I need strategies that will help me effectivley communicate my ideas about gender inequity.
Ethical Framework Elements
My ethical framework has two essential elements (reflexivity & communication) that shape how I will be an agent of change and address social inequities in my work.
1. Being Reflexive
One method to create ethical practices where the probability of reproducing social inequities is reduced is Self-Reflection or Reflexivity.
Being reflexive means that you locate yourself within the issues you are exploring. We are not objective observers. We all live within a context. The choices we make and the thoughts/beliefs we have are constrained by the context of our lives.
However, it is not enough to just think about who you are and the identities you occupy. For if we just list our social locations (Me for example, white, heterosexual, female, middle class, etc) as static categories we inhabit, we concede that these categories are real and end up recreating the spaces where inequities emerge.
Barbara Heron (2014) encourages us to think of ourselves as co-constructors of our reality and to examine not only our identities, but the privilege and power associated with that identity. It is also important to question the categories that we have created in our society. For example, we have made it so that our gender and race are essential components of our identity, but do these categories really exist?
How does being reflexive help social inequities?
By being aware of how power and social relations play out and our role within them, we build tools to address the processes that create inequity in the first place. Public health literature likes to use the upstream analogy, that something is happening upstream to create sickness downstream, we just need to travel upstream to figure out what is causing the problem. But, there is seldom any mention of where you are standing as a person who would like to do something about the sickness in question or there is the implicit assumption that you are on the banks of the stream (Bhatia, 2003). But, are you on the banks, or are you really in the water or in a boat? We need to think about where we are, what our role is, and the processes shape our role.
What are some strategies for integrating reflexivity in your work?
There are many methods for self-reflection, such as keeping a journal or diary, analytic memos, observation, etc. However, it is not sufficient to merely ponder the meaning of life and our place in it. Kondrat (1999, as cited in Heron) offers three specific types of questions one must ask themselves in the process of reflection; questions about the world, questions about your world, and critical analysis of the similarities and differences between those two worlds. Heron (2014) builds on this work, stating that we must also consider how our positions of power play out in our interactions, that we sometimes resist our place in the world which will impact our choices and behaviours, and that it is critical to consider why we are doing the work that we do.
Do you practice being reflexive? How do you bring reflexivity to your work? Do you do this, but call it something else?
2. Communicating Inequity
One of the most formidable barriers to being an agent of change is the enormity of it all. It’s overwhelming and sometimes I feel like nothing will ever change. One of the reasons I feel this way is the difficulty I have communicating my ideas around inequity. Sometimes it is just easier to sit back and not say anything, and I worry this is what will happen to me when I enter the world of public health after my degree is finished.
Why is it so hard to talk about social inequity?
First, the circumstances surrounding inequities is often a moralistic question for people: Do you believe that people who encounter hardship just need to pull up their bootstraps and get to work, or do you believe that the way we have structured our society plays a part? This now leads to complex discussion about free will. I believe there is a space for free will or agency to play a part here, but it is not the only factor.
This also leads us to the question, nature or nurture? I think what ultimately makes these types of discussion so hard is the fact that people want to believe that they have control over their lives. While I certainly believe that personal agency plays a role, it is not the main contributing factor. We all live within a context and it is this context that determines what information we are exposed to, the types of experience we will have, and ultimately affecting our attitudes which in turn impact our behaviours and decisions.
Do you think you are in control of your choices and behaviours 100% of the time? Is it really a “choice” if your options are limited or your coping capacity is not 100%?
Second, some people don’t want things to change. Even though most of what I have read suggests that it is our global capitalist society that produces and entrenches social inequities. There are also compelling arguments that capitalism is making us sick and is also unsustainable. If we really want to see change, the status quo must change. Those who have more should have less. We need to see more equitable distribution of wealth and the elimination of profits. Yet, as Mark Fisher argues, most people who have an easier time imaging the end of the world, than a world without capitalism. How can we change the world if we can’t imagine what it should look like?
Can you imagine a world without capitalism? What is it like? It’s Star Trek for me…
Third, the processes that create social inequity are complex, so is talking about them. In the past, I have found that I am not communicating my ideas very well, which leads to misunderstandings and anger. It is especially difficult discussing gender inequity with males. How do you talk about gender inquiry without making men feel that you are blaming them personally, but still pointing out that they might be participating and benefiting from the process that produce gender inequity like patriarchal structures?
Why do we need strategies to effectively communicate ideas about social inequities?
It is important to have strategies to communicate social inequities because these are complex ideas that challenge some very entrenched aspects of contemporary society. But, there are practical reasons too:
Keeping the peace. I have had many arguments with family members and friends, people on message boards, and in social media about some of my ideas surrounding social inequities. It is not fun to have people call you names or to feel like your friends and family are always on the opposite side from you. I simply cannot ignore blatant examples of inequity anymore, so I need to be able to talk about it and address it when it comes up in conversation. It is stressful to feel like you are always the one calling something out, so t is important to learn ways to talk about inequity that won’t alienate the people in your life.
Building allies and support. As I said above, one of my fears is leaving school and not being able to bring what I have learned into the real world. I am far more likely to be successful in maintaining my inequity focus if I have allies and supporters I can turn to. If I can learn to talk about inequities in an effective way, I will increase the number of people in my life who will support my work and perhaps even challenge it themselves.
Getting your message across. What is the point of learning everything I have, if no one will listen? I have had several encounters with people online and in real life, where heated debates about subjects such as innate gender roles come up. I used to get very frustrated and end up walking away from such discussion feeling disgusted, useless, and angry. Lately, I have found that if I can talk about inequity effectively that people will listen and not write you off as a communist who wants us all to live under a bridge.
What are some strategies for communicating social inequity?
The strategies I use to create more effective means of communicating inequity are based on my own experiences and don’t come from any formal source. I wish I had more to put here. I feel this is the one area of my education that needs more work and I plan on building some kind of workshop or framework for communicating inequities for my final capstone project.
–Talk to your family and friends the same way you would someone you consider an ally. I was talking to my husband once about something to do with gender inequity and he was getting a bit upset with me. He felt that he was the problem and I was angry with him. I told him that I was speaking to him the same way I would one of my close girlfriends and that I consider him an ally, that my passion and anger were not directed at him. By having that conversation I realized that he didn’t see that I did not blame him personally for the way women are treated in our society and it was a turning point for how we talk about the subject.
–Don’t assume you are right and your ideas will never change. The most dangerous people out there are those who think they have it all figured out and will never change their minds. I change my mind everyday. Everyday I wake up a different person, with a different perspective.
–Challenge ideas, not people. Realize that when you challenge inequities, the people around you might feel like you are challenging them and they way they live their lives. To a certain degree this is true, but not directly. No one person is responsible for the ills we see in the world.
–Don’t challenge everything. I have a hard time with this one. Partly because I feel that I need to walk the talk, if I don’t challenge inequity when I see it then I feel like I am a hypocrite and just part of the problem. The other reason I have a hard time with this point is that I want to be a good example to my daughters and not actively participate in creating social inequities. This point will change as I develop more effective ways to talk about my work. I should be able to challenge everything and point out inequity when I see it, but it can be exhausting, alienating, and unsustainable.
–Say what you want to say (Be brave). You shouldn’t feel like you have to water down your ideas when discussing social inequities. Some research says that this is exactly what you should do, but I think creating “more palatable” messages about social inequities simply creates spaces for inequity to continue and decreases the urgency of the matter. Be brave, if you can, say what you want to say…
–Remember, most people are good people. Everyone lives within a context. Those who don’t see the importance of acknowledging social inequities are not bad people, they just buy into the status quo, where people who are subject to the processes of marginalization just need to work harder, get a job, or stop looking for a handout. This is the common narrative of our society. Most mainstream media frame social inequity this way and most programs to “help” are individually based, where nothing is done to actually address the root causes of the problems at hand.
–Keep your eye on the prize. The ultimate goal of talking about social inequity is to move the bar and make social inequities unacceptable to everyone. If we can learn to talk about social inequity in a way where people start to see the inequity themselves, then the battle is won. I think that the biggest barrier to combating social inequity is how invisible it is to most people. Many see inequity as normal and confuse it with inequality. Some people will just have more, right? We want people to think about why some populations are at a disadvantage.
For once you pull back the curtain, there is no going back.
I have tried to convey a framework that I will be able to use to guide my future work in social inequities. I don’t know where I will end up working once I am done my degree, but I do know that I don’t want to become someone who doesn’t consider who I am and how I fit into the work that I do. I also don’t want to be afraid to speak up and be ineffective when I do so.
Asian Communities for Reproductive Justice. (2008). The EMERJ reproductive justice lens toolkit: Identifying reproductive justice issues in your community. Accessed March 15, 2014 from http://racialequitytools.org/resourcefiles/ACRJ-RJ-Lens-Toolkit.pdf.
Bhatia, R (2003) Swimming Upstream in a Swift Current Public Health Institutions and Inequality. In Hofrichter, R (Ed) (2003) Health and Social Justice Politics, Ideology, and Inequity in the Distribution of Disease A Public Health Reader. San Francisco: Jossey Bass, pp. 557-578.
Heron, B (2005) Self-reflection in critical social work practice: subjectivity and the possibilities of resistance. Reflective Practice, Vol. 6(3), pp. 341-351.
Robert Wood Johnson Foundation. (2004). A new way to talk about the social determinants of health. Accessed March 15, 2014 from http://www.rwjf.org/content/dam/farm/reports/reports/2010/rwjf63023
Russo, N.F., Rubin, L., Becker-Blease, K., & Breitkopf, E. (2013). Gendered Violence and Reproductive Issues, in Sigal, J.A. & Denmark, F.L. (Eds) Violence Against Girls and Women: International Perspectives. Santa Barbara: Praeger, pp 39-63.