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Dijkstra I, Horstman K. 'Known to be unhealthy': Exploring how social epidemiological research constructs the category of low socioeconomic status. Soc Sci Med 2021; 285:114263. [PMID: 34411967 DOI: 10.1016/j.socscimed.2021.114263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/06/2021] [Accepted: 07/22/2021] [Indexed: 01/07/2023]
Abstract
We examine how the category of low socioeconomic status (LSES) was constructed in European social epidemiological research and policy advice from 1977 to 2019. We analysed 22 empirical social epidemiological research publications on LSES and health, as well as six scientific advisory reports that offered government officials an overview of scientific evidence on health inequalities. We show the construction and reification of LSES as a problematic group in dominant thought, which consists of the following components: 1) the proliferation of SES concepts, indicators and groups labelled LSES; 2) generalisation through which LSES is constructed as a single population; 3) problematisation through which LSES is constructed as an inherently unhealthy population; and 4) individualisation by which a LSES personality is presented as an explanation of health differences. We also show how this knowledge is extrapolated into the policy domain in the form of scientific advisory reports. These findings provide evidence of the construction of LSES as an inherently unhealthy population through hyperproliferation and references to the objectivity of scientific research. With respect to the LSES category, the dynamics of research and policy resemble those regarding categories of ethnicity and gender. We conclude that if the construction of LSES remains unquestioned, social epidemiology might continue to (re)produce what it examines: LSES populations 'known to be unhealthy'.
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Affiliation(s)
- Ilse Dijkstra
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Klasien Horstman
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, PO Box 616, 6200, MD, Maastricht, the Netherlands.
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Zanting A, Meershoek A, Frambach JM, Krumeich A. The 'exotic other' in medical curricula: Rethinking cultural diversity in course manuals. MEDICAL TEACHER 2020; 42:791-798. [PMID: 32160094 DOI: 10.1080/0142159x.2020.1736534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: Implementation of cultural diversity training in medical education faces challenges, including ambiguity about the interpretation of 'cultural diversity'. This is worrisome as research has demonstrated that the interpretation employed matters greatly to practices and people concerned. This study therefore explored the construction of cultural diversity in medical curricula.Methods: Using a constructivist approach we performed a content analysis of course materials of three purposefully selected undergraduate curricula in the Netherlands. Via open coding we looked for text references that identified differences labelled in terms of culture. Iteratively, we developed themes from the text fragments.Results: We identified four mechanisms, showing together that culture is unconsciously constructed as something or someone exotic, deviant from the standard Dutch or Western patient or disease, and therefore problematic.Conclusions: We complemented earlier identified mechanisms of othering and stereotyping by showing how these mechanisms are embedded in educational materials themselves and reinforce each other. We argue that the embedded notion of 'problematic stranger' can lead to a lack of tools for taking appropriate medical action and to insecurity among doctors. This study suggests that integrating more attention to biological and contextual differences in the entire medical curriculum and leaving out static references such as ethnicity and nationality, can enhance quality of medical training and care.
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Affiliation(s)
- Albertine Zanting
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, School Caphri, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Agnes Meershoek
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, School Caphri, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Janneke M Frambach
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Anja Krumeich
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, School Caphri, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Verstraeten SPA, van den Brink CL, Mackenbach JP, van Oers HAM. The health of Antillean migrants in the Netherlands: a comparison with the health of non-migrants in both the countries of origin and destination. Int Health 2019; 10:258-267. [PMID: 29635370 DOI: 10.1093/inthealth/ihy026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/08/2018] [Indexed: 11/13/2022] Open
Abstract
Background This article examines risk factor and health differences between Antillean migrants in the Netherlands and Antillean and Dutch non-migrants, and relates these findings to four commonly used explanations for migrant health disparities. Methods Nationally representative data from the 2012 Dutch Public Health Monitor and the 2013 National Health Survey Curaçao was used. The weighted rates were calculated and significance assessed using the χ2 test. Logistic regression analyses were used to compare health behaviours and outcomes between Antillean migrants and the non-migrant populations. Results Overall, Antillean migrants had poorer physical and mental health than Antillean and Dutch non-migrants. For overweight/obesity and tobacco and alcohol use, Antillean migrants had rates in-between those of the Antillean and Dutch non-migrants. The poor health of Antillean migrants persisted in the second generation, who were born in the Netherlands. Conclusions Patterns of differences in physical and mental health among the study populations were suggestive of a 'stressful environment' effect. The poorer health of Antillean migrants may be partly determined by host-country-specific stressors, such as perceived discrimination, spatial concentration in multi-ethnic neighbourhoods and reduced social mobility.
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Affiliation(s)
- Soraya P A Verstraeten
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.,Institute for Public Health (Volksgezondheid Instituut Curaçao), Ministry of Public Health, Environment and Nature, Willemstad, Curaçao
| | | | | | - Hans A M van Oers
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands
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The multiplicity and situationality of enacting ‘ethnicity’ in Dutch health research articles. BIOSOCIETIES 2017. [DOI: 10.1057/s41292-017-0077-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Schölmerich VLN, Erdem Ö, Borsboom G, Ghorashi H, Groenewegen P, Steegers EAP, Kawachi I, Denktaş S. The association of neighborhood social capital and ethnic (minority) density with pregnancy outcomes in the Netherlands. PLoS One 2014; 9:e95873. [PMID: 24806505 PMCID: PMC4012999 DOI: 10.1371/journal.pone.0095873] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 04/01/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Perinatal morbidity rates are relatively high in the Netherlands, and significant inequalities in perinatal morbidity and mortality can be found across neighborhoods. In socioeconomically deprived areas, 'Western' women are particularly at risk for adverse birth outcomes. Almost all studies to date have explained the disparities in terms of individual determinants of birth outcomes. This study examines the influence of neighborhood contextual characteristics on birth weight (adjusted for gestational age) and preterm birth. We focused on the influence of neighborhood social capital--measured as informal socializing and social connections between neighbors--as well as ethnic (minority) density. METHODS Data on birth weight and prematurity were obtained from the Perinatal Registration Netherlands 2000-2008 dataset, containing 97% of all pregnancies. Neighborhood-level measurements were obtained from three different sources, comprising both survey and registration data. We included 3.422 neighborhoods and 1.527.565 pregnancies for the birth weight analysis and 1.549.285 pregnancies for the premature birth analysis. Linear and logistic multilevel regression was performed to assess the associations of individual and neighborhood level variables with birth weight and preterm birth. RESULTS We found modest but significant neighborhood effects on birth weight and preterm births. The effect of ethnic (minority) density was stronger than that of neighborhood social capital. Moreover, ethnic (minority) density was associated with higher birth weight for infants of non-Western ethnic minority women compared to Western women (15 grams; 95% CI: 12,4/17,5) as well as reduced risk for prematurity (OR 0.97; CI 0,95/0,99). CONCLUSIONS Our results indicate that neighborhood contexts are associated with birth weight and preterm birth in the Netherlands. Moreover, ethnic (minority) density seems to be a protective factor for non-Western ethnic minority women, but not for Western women. This helps explain the increased risk of Western women in deprived neighborhoods for adverse birth outcomes found in previous studies.
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Affiliation(s)
- Vera L. N. Schölmerich
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands
- VU University Amsterdam, Department of Organizational Sciences, Amsterdam, the Netherlands
- Harvard School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts, United States of America
| | - Özcan Erdem
- Municipality of Rotterdam, Research and Business Intelligence, Rotterdam, the Netherlands
- Erasmus University Medical Center, Department of Public Health, Rotterdam, the Netherlands
| | - Gerard Borsboom
- Erasmus University Medical Center, Department of Public Health, Rotterdam, the Netherlands
| | - Halleh Ghorashi
- VU University Amsterdam, Department of Sociology, Amsterdam, the Netherlands
| | - Peter Groenewegen
- VU University Amsterdam, Department of Organizational Sciences, Amsterdam, the Netherlands
| | - Eric A. P. Steegers
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands
| | - Ichiro Kawachi
- Harvard School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts, United States of America
| | - Semiha Denktaş
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands
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Moubarac JC. Persisting problems related to race and ethnicity in public health and epidemiology research. Rev Saude Publica 2014; 47:104-15. [PMID: 23703136 DOI: 10.1590/s0034-89102013000100014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 09/18/2012] [Indexed: 11/22/2022] Open
Abstract
A recent and comprehensive review of the use of race and ethnicity in research that address health disparities in epidemiology and public health is provided. First it is described the theoretical basis upon which race and ethnicity differ drawing from previous work in anthropology, social science and public health. Second, it is presented a review of 280 articles published in high impacts factor journals in regards to public health and epidemiology from 2009-2011. An analytical grid enabled the examination of conceptual, theoretical and methodological questions related to the use of both concepts. The majority of articles reviewed were grounded in a theoretical framework and provided interpretations from various models. However, key problems identified include a) a failure from researchers to differentiate between the concepts of race and ethnicity; b) an inappropriate use of racial categories to ascribe ethnicity; c) a lack of transparency in the methods used to assess both concepts; and d) failure to address limits associated with the construction of racial or ethnic taxonomies and their use. In conclusion, future studies examining health disparities should clearly establish the distinction between race and ethnicity, develop theoretically driven research and address specific questions about the relationships between race, ethnicity and health. One argue that one way to think about ethnicity, race and health is to dichotomize research into two sets of questions about the relationship between human diversity and health.
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Affiliation(s)
- Jean-Claude Moubarac
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.
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Marsicano E, Lydié N, Bajos N. 'Migrants from over there' or 'racial minority here'? Sexual networks and prevention practices among sub-Saharan African migrants in France. CULTURE, HEALTH & SEXUALITY 2013; 15:819-835. [PMID: 23659520 DOI: 10.1080/13691058.2013.785024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Migrants from sub-Saharan Africa bear a disproportionate burden of HIV infection in Europe, with an increasing proportion of them acquiring HIV after migration. This transformation in the epidemic pattern has raised concerns about the sexual mixing and preventive behaviours of migrants. This paper aims at exploring how racial boundaries shape sexual networks and structure prevention practices among migrants from sub-Saharan Africa. Analyses are based on a French survey carried out among 1874 individuals born in sub-Saharan Africa, aged 18-49 and living in Paris and its surroundings. Our results provide evidence of the existence of African sexual networks, over and beyond those of national origin. The intra-African segregation of these sexual networks leads to sexual contacts between migrants from low- and high-HIV prevalence countries, which probably contribute to the development of the epidemic amongst these migrants. Moreover, racially-based perceptions of HIV-related risk seem to produce a specific attitude toward prevention practices as shown by higher rates of condom use among migrant women from sub-Saharan Africa with a partner born outside sub-Saharan Africa. As a consequence, community-based approaches to HIV prevention should take into account the identification of migrants from sub-Saharan Africa as a racial minority and not only focus on national borders.
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Krumeich A, Meershoek A. Health in global context; beyond the social determinants of health? Glob Health Action 2013; 7:23506. [PMID: 24560252 PMCID: PMC6442658 DOI: 10.3402/gha.v7.23506] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/17/2013] [Accepted: 11/20/2013] [Indexed: 11/16/2022] Open
Abstract
The rise of the social determinants of health (SDH) discourse on the basis of statistical evidence that correlates ill health to SDH and pictures causal pathways in comprehensive theoretical frameworks led to widespread awareness that health and health disparities are the outcome of complex pathways of interconnecting SDH. In this paper we explore whether and how SDH frameworks can be translated to effectively inform particular national health policies. To this end we identified major challenges for this translation followed by reflections on ways to overcome them. Most important challenges affecting adequate translation of these frameworks into concrete policy and intervention are 1) overcoming the inclination to conceptualize SDH as mere barriers to health behavior to be modified by lifestyle interventions by addressing them as structural factors instead; 2) obtaining sufficient in-depth insight in and evidence for the exact nature of the relationship between SDs and health; 3) to adequately translate the general determinants and pathways into explanations for ill health and limited access to health care in local settings; 4) to develop and implement policies and other interventions that are adjusted to those local circumstances. We conclude that to transform generic SDH models into useful policy tools and to prevent them to transform in SDH themselves, in depth understanding of the unique interplay between local, national and global SDH in a local setting, gathered by ethnographic research, is needed to be able to address structural SD in the local setting and decrease health inequity.
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Affiliation(s)
- Anja Krumeich
- Department of Health Ethics and Society, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands;
| | - Agnes Meershoek
- Department of Health Ethics and Society, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Bradby H. Race, ethnicity and health: the costs and benefits of conceptualising racism and ethnicity. Soc Sci Med 2012; 75:955-8. [PMID: 22521333 DOI: 10.1016/j.socscimed.2012.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Hannah Bradby
- University of Essex, Health and Human Sciences, Wivenhoe Park, Colchester, United Kingdom.
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