Part 1: “-Isms” and Intersectionality

“-isms” are the behavioral manifestation of bias, conscious or unconscious, that reinforce oppression and inequities in our culture.

The CDC definition of health disparities acknowledges the role of “-isms” as significant contributing factors of inequities. Some examples of pervasive toxic “-isms” include: racism, sexism, ageism, ableism, heterosexism (i.e., homophobia), classism, sizeism, and antisemitism. “-isms” are the behavioral manifestation of bias, conscious or unconscious, that reinforce oppression and inequities in our culture.

Not all “-isms” are oppressive. For example the uplifting ”-ism” of feminism is a term to convey activism for equity for all women. However when we talk about bias or “-isms” in this post we are talking about the conserved preference for “same” (people who have the same qualities as us) that disenfranchises and punishes “other” (people who have different qualities than us).

Why do we have healthcare disparities?

This is an excellent question with a simple answer: bias. Fundamentally institutionalized “-isms” are the entrenched implicit and explicit biases that shape the decisions that perpetually and disproportionately disenfranchise the people with less power.

Healthcare disparities have been built and reinforced by institutionalized “-isms” creating the barriers to health and access to healthcare. The U.S. Office of Disease Prevention and Health Promotion (DPHP) has defined barriers to health services as: high cost of care, inadequate or no insurance, lack of available services, and lack of culturally competent care. In addition to the barriers to accessing healthcare we all face innumerable barriers to health. Barriers that are also based in institutionalized “-isms” such as housing access, food security, air and water quality, pollution, and climate change [1]

Intersectionality:

The overlapping social infrastructures in place which reinforce “-isms” for patients are the inescapable parts of our entire social structure. Isms are intersectional - a term first coined by social justice scholar, Dr. Kimberlé WilliamsCrenshaw in 1989, to highlight the interconnected, compounding relationship of the Black American experience of oppression and the female American experience of oppression[2]. Intersectionality is defined as, “a theoretical framework for understanding how multiple social identities such as race, gender, sexual orientation, socio-economic status, and disability intersect at the micro level of individual experience to reflect interlocking systems of privilege and oppression (i.e., racism, sexism, heterosexism, classism) at the macro social-structural level.” However, not all “isms” are the same.

For example, Black and Hispanic patients have higher rates of type two diabetes [3], hypertension [4], obesity [5], low and socio-economic status [6] (all of which are risk factors for severe COVID-19 infections [7,8]). Black and Hispanic patients experience higher rates of type two diabetes, hypertension, and obesity because of the cyclic and additive institutionalized “-isms” that they faced in their daily lives. Black and Hispanic patients face racist policies with regards to housing [9], job acquisition [10], and our legal system [11]. These racist policies trap them in low socioeconomic conditions. Patients with low socioeconomic status live with higher stress, higher exposure to environmental toxins, and in food deserts/swamps (no access to fresh foods/high-density of fast food). These environments are risk factors for obesity, type two diabetes, and hypertension. Although there are genetic differences amongst people that increase their risk for type two diabetes and hypertension, arguably the greatest risk factor for both is lower socioeconomic status [13]. The prejudice in our society added to the additional prejudice in our healthcare system is an example of the intersectionality of compounding “-isms” fostering healthcare disparities [14].