The term “ism” is a suffix that forms nouns of action ( 153). The first point is that isms are not things. Health equity research: illustrations of measures of isms, and anti-isms, for racism, sexism, heterosexism, and gender binarism, by level a ON ISMS AND HEALTH EQUITY: CONCEPTS AND KEY CONSIDERATIONS All Isms Combine Belief and Action, but Not All Involve Injustice As shown in the examples below, the availability of apt measures-and, more often, their absence-means that there is a grave need for better work worldwide to improve the conceptual and methodological rigor, as well as the scope and inclusiveness, of these much-needed metrics. My sources include both literature I have engaged with during the past 35 years as a US social epidemiologist ( 90– 99, 109) and new material I have reviewed for this article (see search terms in Supplemental Table 2). Drawing on the ecosocial theory of disease distribution ( 91, 93, 97), I synthesize key features of these isms ( Table 1) and provide a measurement schema ( Table 2), which together inform my discussion of concrete examples of such research from the Global North and the Global South ( Table 3). Only a small fraction of this work has addressed environmental racism ( 43, 182) even less has focused on global climate change ( 57, 162) ( Supplemental Table 1).Īccordingly, in this review I focus first on first principles for thinking through what measuring isms entails-whether for the isms I was invited to address or those beyond the scope of this review-and why this can vary, not only across different types of injustice and in different societal contexts, but also over time, depending on advances and setbacks in collective efforts to build equitable societies. Only in the past 10 years has a body of research emerged regarding the health impact of what variously is referred to as structural or institutional discrimination ( 8, 58, 77, 99, 196), albeit using a confusing welter of heterogeneous social metrics. However, prior to the 1990s, only scant research measured the impact of discrimination and health, and research conducted since then, largely in the Global North, has chiefly used individual-level measures of self-reported experiences of discrimination ( 91, 99, 157, 196) ( Supplemental Table 1). These may appear to be obvious statements. It also requires challenging biological essentialism and situating human power relations in the larger context of life on Earth ( 57, 61, 65, 97, 117). Accounting for the avoidable and inequitable suffering these “isms” cause requires measures of exposure that are attuned to ( a) the explicit and tacit rules that codefine the social groups at issue and the polarities of superior/inferior and normal/deviant they encompass and ( b) clarifying not only who is harmed but who gains, socially and materially, from these divisions ( 13, 99). Each of these seemingly abstract terms encompasses very real and intimately harmful and distinct societal systems of self-serving domination and privilege ( 13, 67, 74) that are created by people and structure health inequities ( 99)-that is, unjust, unnecessary, and preventable differences in health status between social groups ( 26, 194).
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Age of conquest iv template drivers#
Recommendations include ( a) expanding the use of structural measures to extend beyond the current primary emphasis on psychosocial individual-level measures ( b) analyzing exposure in relation to both life course and historical generation ( c) developing measures of anti-isms and ( d) developing terrestrially grounded measures that can reveal links between the structural drivers of unjust isms and their toll on environmental degradation, climate change, and health inequities.
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Metrics discussed include ( a) structural, including explicit rules and laws, nonexplicit rules and laws, and area-based or institutional nonrule measures and ( b) individual-level (exposures and internalized) measures, including explicit self-report, implicit, and experimental. Guided by the ecosocial theory of disease distribution, I synthesize key features of the specified “isms” and provide a measurement schema, informed by research from both the Global North and the Global South. Together, they comprise intimately harmful, distinct, and entangled societal systems of self-serving domination and privilege that structure the embodiment of health inequities.