Thread by @aasewell

Thank you @mclemoremr @RheaBoydMD @EdwinLindo @Lachelle_Dawn, there has a been a growing amount of research that uses the term "health inequities" without either knowing what it means or intentionally engaging it on its premise. 1/n

https://twitter.com/Health_Affairs/status/1278713810426232834

Equity is about need not mere difference. We could get "equality" for decades and never close the health and wealth gaps ethnoracially marginalized people face. Bravemen's ARPH 2006 piece laid this out really clearly. 2/n doi.org/10.1146/annure…

I think another term that falls into the geneticist trap is culture, particularly in the behavioral/social sciences. The approach we need to take is one of "cultural systems" (@CourtneyCogburn). The approach we take, however, blames the victim.
3/n

doi.org/10.1111/1468-0…

I think Maggie Hinks also draws out the systemic structure of cultural racism as a determinant of health. In sociology, we denote cultural racism as "racial ideologies". Ironically, the cr term takes a more insidiously racism tone in my discipline. 4/n ncbi.nlm.nih.gov/pmc/articles/P…

One really cool measurement of systemic racial ideologies is David Chae's work on internet-based racism, which provides an areal view of racial bias. 5/n journals.plos.org/plosone/articl…

Racial healthvare disparities concepts fall into this trap when they eliminate "cultural preferences" as a basis for health disparities. The NAS Unequal Treatment report on healthcare disparities set these guidelines, & I don't think health services research has recovered. 6/n

Healthcare(*typo). It has stifled my own work bc you cannot NOT cited this report if u r doing HSR (8k cites today btw). There are tons of gems there, but the initial chapter that lays out a definition for hc that sets an individualistic tone. Behaviors become choices. 7/n

Not a function of choices. The reality is systemic notions of culture have a foothold in soc, but they are one camp. There is a fierce debate though, especially in research on poverty, educational achievement, and social strat. Here is an example: jstor.org/stable/2673253 8/n

I speak 2 this tension in my own work on physician trust. I draw out an extended argument against this logic in the setup of a paper on ethnoracial disparities in medical reliance. Thanks to @Els_SocialScien 4 giving me the space 2 elaborate on this. 9/n

doi.org/10.1016/j.ssre…

Implications of the cultural ideology in sociological research has had devastating effects on decades of social welfare policy, as evidenced in the Moynihan report -- arguments that are being eloquently debunked by the award-winning @christinajcross. 10/n

doi.org/10.1111/jomf.1…

It is a relief that health disparities research like you all are taking a direct approach to this nonsense. These r myths, as Dean LaVeist (a sociologist btw) indicates, parading as facts (remember Fauci's fumble when asked 2 speak on race & #covid19) utimes.pitt.edu/news/myths-per… 11/n

The troubling concern for me is where genetic research has actually gone at NIH. Joan Fujimura has applied a corrective 2 the lens, but it remains 2 b seen how much of this critique will shift the minds of geneticists & genetic research on race. 12/n

doi.org/10.1177/030631…

I lool at the research being funded by NIMH (which was taken over by neurosci) and the $495M budget of NHGRI, & I am reminded of @DorothyERoberts key lesson in #FatalInvention: Scientists r being paid 2 erase racism as the IV of health inequities. Maybe, I am just pessimistic?!?

NIMHD seems pretty large at $335M, but numbers don't lie: $495M is 147% of $335M. So, if I believed im statistics and attribute importance to $$$, then genomics research is 47% more important than health disparities research. That's a clear message from THE government and @NIH.

There are literally decades of research on discrimination & racism as the the true X of health inequities. See this pitch perfect review by @tenelewis2 and @CourtneyCogburn. This is an issue of politics, & publishing is its finest platform.

ncbi.nlm.nih.gov/entrez/eutils/…

And, not to leave anybody on the table, @NIMHD has only recently put out an explicit call for research assess structural racism as an intervening mechanism.

And, it was a call for papers on the topic.

And, it was Sept 2019.

Where is da $$$?

n/n

content.govdelivery.com/accounts/USNIH…