Racism and Health

In 2001, Richard Delgado and Jean Stefancic published their definitive Critical Race Theory, a compact introduction to the field that explained, in straightforward language, the origins, principal themes, leading voices, and new directions of this important movement in legal thought. Since then, critical race theory has gone on to influence numerous other fields of scholarship, and the Delgado and Stefancic primer has remained an indispensible guide for students and teachers.

Racial scholars argue that racism produces rates of morbidity, mortality, and overall well-being that vary depending on socially assigned race. Eliminating racism is therefore central to achieving health equity, but this requires new paradigms that are responsive to structural racism's contemporary influence on health, health inequities, and research.

Critical Race Theory is an emerging transdisciplinary, race-equity methodology that originated in legal studies and is grounded in social justice. Critical Race Theory's tools for conducting research and practice are intended to elucidate contemporary racial phenomena, expand the vocabulary with which to discuss complex racial concepts, and challenge racial hierarchies.

Kimberlé Crenshaw's seminal paper explains the concept of Intersectionality, the study of overlapping or intersecting social identities and related systems of oppression, domination or discrimination. The theory suggests that various biological, social and cultural categories of identity (such as gender, race, class, ability etc.) interact on multiple and often simultaneous levels. The framework can be used to understand how systemic injustice or social inequity occur on a multidimensional basis.

The "outsider-within" position (Collins 1986) that is currently the norm for scholars of color in social work presents both opportunities and barriers to being fully realized, first, as academics, and then, as activists. Because social work scholarship has been dominated by white men and women, the presence of women of color in academia is itself a rupture of usual practice. For women of color, the energy required to pursue and secure academic opportunities requires vigorous commitment to political goals of representation and challenge to the status quo. This article draws on my early experience as a scholar to develop some hypotheses about the meta-experience of academic women of color who attempt activism.

Although Black gay and bisexual men have written eloquently about the intersections of race, gender, and sexual identity in anthologies such as Brother to Brother and In the Life, empirical studies of intersectionality with men, and Black gay and bisexual men in particular are rare. This qualitative study examined descriptions and experiences of intersectionality in individual interviews with 12 U.S. Black self-identified gay (n = 9) and bisexual (n =3) men in Washington, DC. Participants ranged in age from 21 and 44 (M = 36.33) and were predominantly highly educated and middle income. Research questions were: (1) How do participants describe and experience intersections of race, gender, and sexual identity?; (2) How do social processes shape their social identities?; (3) What are their challenges due to intersections of race, gender, and sexual identity?; and (4) What are the perceived benefits of these intersections? Analyses highlighted four key themes: (1) explicit and implicit descriptions of intersectionality; (2) the primacy of identities as Black and/or Black men first; (3) challenges such as negative stereotypes, racial microaggressions in mainstream and White LGB communities, heterosexism in Black communities, and gender role pressures to act "masculine"; and (4) perceived benefits such as psychological growth, liberation from traditional gender role or heteronormative expectations, and the freedom that being outsiders or "never being comfortable" confers in terms of exploring new opportunities and experiences. These findings imply that intersectionality can be expanded to incorporate the strengths/assets of intersectional identities in addition to oppression based on interlocking social identities.

The notion that social identities and social inequality based on ethnicity, sexual orientation, and sex/gender are intersectional rather than additive poses a variety of thorny methodological challenges. Using research with Black lesbians as a foundation, I examine how these challenges shape measurement, analysis, and interpretation. I argue that a key dilemma for intersectionality researchers is that the additive (e.g., Black + Lesbian + Woman) versus intersectional (e.g., Black Lesbian Woman) assumption inherent in measurement and qualitative and quantitative data analyses contradicts the central tenet of intersectionality: social identities and inequality are interdependent for groups such as Black lesbians, not mutually exclusive. In light of this, interpretation becomes one of the most substantial tools in the intersectionality researcher’s methodological toolbox.

Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, socioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism). Public health’s commitment to social justice makes it a natural fit with intersectionality’s focus on multiple historically oppressed populations. Yet despite a plethora of research focused on these populations, public health studies that reflect intersectionality in their theoretical frameworks, designs, analyses, or interpretations are rare. Accordingly, I describe the history and central tenets of intersectionality, address some theoretical and methodological challenges, and highlight the benefits of intersectionality for public health theory, research, and policy.