Black Women and Health Disparities

Amy August and De Andre’ T. Beadle on April 18, 2019
Photo of a Black mother cuddling her newborn baby
Photo by Bonnie U. Gruenberg, Wikimedia CC

“When the medical profession systematically denies the existence of black women’s pain, underdiagnoses our pain, refuses to alleviate or treat our pain, healthcare marks us as incompetent bureaucratic subjects. Then it serves us accordingly.”

So writes sociologist Tressie McMillan Cottom, reflecting on her experiences of medical neglect during pregnancy that ultimately led to the loss of her child. Thick, Cottom’s recently published collection of essays, brings to life intimate portraits and sociological analyses of black women’s issues. It has been widely acclaimed by the Chicago Tribune, The New York Times, NPR, The Daily Show, and has set Black Twitter and Academic Twitter abuzz. With Black women’s health in the spotlight, it’s helpful to reflect on what sociologists already know about medicine and wellness at the intersections of race and gender.

In the United States, racial disparities in health are severe. Black mortality is higher than white mortality, and nationally, there has been no sustained decrease in black-white inequalities in mortality or life expectancy at birth since 1945.
Racism is itself a public health concern. Those who experience racism are more likely to suffer from chronic conditions and disability and to rate their physical health as poor. Racism is linked to poorer mental health as well, with conditions like depression and anxiety more common among those experiencing discrimination. This is particularly problematic for members of racial-ethnic minority groups who have mental health problems as they are likely to suffer discrimination effects on the basis of both characteristics. As discrimination may lead to poverty and social isolation, it can negatively impact help seeking, service use and treatment outcomes. Yet these adverse consequences are thoroughly preventable. In order to identify, anticipate, prevent, manage, and remedy such adverse outcomes, it is important for health service providers to understand racism as an ethical issue. By framing racism as the cause of preventable harmful consequences, many hope to reframe racism as an ethical issue for health service providers to address.
Black Americans tend to experience poorer health outcomes than whites when factors such as age and socioeconomic status are taken into account, but the race gap is even wider among women. For example, according to the Centers for Disease Control, black women are more than three times as likely to die while pregnant or within a year of pregnancy due to causes related to pregnancy or its management. The shockingly high maternal mortality rate for black women is the primary reason that the overall U.S. rate has risen by 250% in the past quarter century.  
Race, class, and gender are interlocking systems of oppression that help explain maternal health inequalities. While other groups may experience some of these dimensions of oppression — for instance white women are penalized by their gender, but privileged because of their race — black women experience oppression on all three of these dimensions.

No Taxation Without Sociological Imagination

Mark Lee on April 15, 2019
Photo of a 1040 tax form with a pencil.
Photo by PT Money, Flickr CC

Ben Franklin famously quipped that nothing in life is certain except death and taxes. However, sociologists would add that the burden of taxation (and mortality, for that matter) is not evenly distributed across members of society. This tax season we examine the research on who pays how much to Uncle Sam.

Taxation is such a divisive political issue because it is partially driven by ideology, not just fiscal needs. The sociological perspective on taxation highlights non-economic causes and consequences of tax policy. Taxation is more than just the state’s way of generating revenue. It is also a powerful tool for social control. For example, policies have been written to both encourage and discourage wives’ labor force participation depending on the needs and values of the state in different countries and periods. By restricting the political activity of  non-profit organizations, tax laws can also repress some social causes, while encouraging others.
Another function of the tax system is resource redistribution. Progressive tax policies can directly impact after-tax income distribution by taking more money from high-income earners than low-income earners. They can also indirectly affect pre-tax income inequality if taxes pay for programs that increase the earning-potential of less-advantaged people. However, in recent decades, declining tax rates on the rich have put more money in the pockets of the top 1%. Meanwhile, cities are finding creative ways of extracting tax revenue from people who struggle to pay. When residents cannot pay, for example, predatory investors buy their tax debt from the city. Investors can take the house if property owners cannot pay them back at a high interest rate. These policies force poor, non-white urban residents to shoulder an uneven tax burden, and have worsened class and racial inequalities in the United States.
Social factors shape individuals’ willingness to pay taxes. An international survey showed that people are less likely to evade taxes if they believe the government is competent and if tax revenue primarily funds popular programs. This helps explains why some countries are better able to collect taxes than others. In the United States, changing demographics predict changing attitudes about taxation. In a survey experiment, white Americans were less likely to support a tax increase if they were told that an influx of Latinx (compared to white) migrants entered their community. This was driven by declines in feelings of social solidarity. These studies show that whether people pay taxes is influenced by whether they consider public spending to be legitimate.

Filing your taxes is a good annual reminder that taxation does not just fund the government; it can reshape society.

Peace and Conflict in Northern Ireland

Mark Lee on April 11, 2019
Photo of a highway with a sign by the side of the road that says, welcome to northern ireland
Photo by Eric Jones, CC

Brexit negotiations have stalled on what to do about the Irish border. Some want to implement a hard border between Northern Ireland and the Republic of Ireland to control the flow of migrants into the United Kingdom. Others fear that a hard border will reignite violence that plagued the region in recent memory. Sociologists explain why peace is so fragile in this region by uncovering the structural, religious, and political roots of the conflict.

The conflict in Northern Ireland is religious, but that does not mean it is about doctrine. Religion does not just describe what individuals believe regarding the supernatural. It is a meaningful social identity that shapes how people experience and perceive the world. This is more true in Northern Ireland than in other parts of Europe. Protestants and Catholics not only worship in different churches, they also tend to live in different communities, send their children to different schools, and drink in different pubs. Through participating in these rituals, people in Northern Ireland construct strong identification with one or the other religious group, even if they do not personally believe in God at all.
Religion does not just signify group membership in Northern Ireland. It also signifies access to power and resources. Protestants there have been legally and socially privileged for centuries. This inequality set the stage for inter-group conflict. Because they constructed their social identity in opposition to Catholics, Protestants tended to see Catholic social ascent as a sign of their own descent. When Catholics mobilized for civil rights in the 1960s, the British-backed Protestants responded harshly. Violent repression strengthened the sense of group identification among Catholics. This collective victimhood identity was used to mobilize some Catholics to join violent resistance groups. A wave of bloodshed lasted for 30 years.
Conflict in Northern Ireland is more muted today. Globalization and trade liberalization have reduced the significance of the Irish border. The Good Friday Agreement signed in 1998 charted a path forward for peaceful power sharing in the territory. However, sectarianism did not end with the stroke of a pen. In the years following the agreement, residential segregation in Northern Ireland has increased, and periodic violence still occurs. The government has done little to dismantle structural sources of inequality, such as integrating schools. Instead, lawmakers place the blame of lasting inequality on bad individual actors. As a result, the Good Friday Agreement has not ushered in the era of religious and political cooperation that many hoped for.

The situation in Northern Ireland has parallels to social conflicts elsewhere, including racial inequality in the United States and South Africa. Social identities, such as religion and race, give meaning and texture to people’s lives. However, when one group’s success is defined by another group’s failure, harmful competition and conflict can tear at the fabric of society. Peace depends not only on individuals seeking and offering forgiveness, but on structural changes and daily rituals that construct an appreciation for differences in society.

Autism Across Cultures

Isabel Arriagada and Amy August on April 2, 2019
Photo of two hands holding a paper that says "I Like Being Autistic Because"
Photo by Walk InRed, Flickr CC

In 2007, the United Nations General Assembly designated April 2nd as World Autism Awareness Day. This community-wide event promotes the recognition and raises awareness about Autism Spectrum Disorder (ASD). The celebration brings individuals with autism and grassroots organizations together to connect and to promote appreciation for people with autism. Despite increasing awareness, the causes of ASD remain a puzzle. While scientific approaches consider it to be a developmental disorder associated with genetic or environmental factors, recent studies in social science illustrate how cultures themselves vary in their perception of both autism and other neurological differences.

The prevalence of autism has grown in past decades in North America.  Explanations of this trend point out to an increase in the prevalence of ASD, a broadening spectrum of autism diagnoses, and declining stigma that promotes recognition and acceptance of the condition. Sociologists have also suggested that this may be because parents, psychologists, and therapists have created alliances, using their expertise to develop a new system of institutions for approaching autism.
Regarding the causes of ASD per se, early scientific theories indicated that the condition was associated with genetic alterations, but social science studies have emphasized the role of environmental factors. Further, cultural factors across the world can also shape how people understand autism in the first place.
Both the description and diagnosis of the ASD depend on historical factors and vary across nations. In Korea, children with autism and their families experience profound stigma, especially the mother — who is considered to be responsible for her child’s condition. Since in Korea parents gain social respect based on the behavior of their children, having a child with autism constitutes a signal of defective parenting. On the other hand, in Nicaragua, there is an emergent culture around autism that encourages teachers and communities to create a supportive environment. However, both cultures still see autistic children as suffering with a disability. Both stances contrast with new ideas about neurodiversity that strive to create a new place for autism in larger socio-cultural contexts.
Somali immigrants call autism the “Western disease” because there is no word for autism in the Somali language and because many believe it does not exist in Somalia. Somali parents accuse the Western diet and medical environment in North America for the condition of their children. Their testimonies have not only opened possibilities to explore new scientific hypotheses regarding the environmental causes of autism, but also to reveal the power dynamics and struggles involved in validating different perspectives and narratives about the condition.  

Contemporary educational programs in the United States are now more aware of the importance of highlighting the strengths rather than the deficits of students with autism. They also recognize that accommodation and acceptance of autism is as important as finding its genetic and neurological causes.

“That’s Not Funny!” Social Context and Humor

Allison Nobles on April 1, 2019
Three women laughing side by side
Photo by Marc Kjerland, Flickr CC
It may be April Fools Day, but the sociology of humor is no joke! Social science research demonstrates that humor reflects societal conditions and can be important for social cohesion. For example, “inside jokes” — shared references between members of a group — promote social cohesion and ensure the group continues to exist by reminding members of the group’s shared history and their social ties to each other.
Women tend to use cohesion-building humor — treating the audience as a cohesive unit — and women rarely make jokes when men are present. Men, on the other hand, tend to use differentiating humor — calling out specific members of their audience and building hierarchies. In other words, using differentiating humor challenges the sense that “we’re all in this together” and instead point out distinctions between group members. Thus, humor can be viewed as a wedge or glue depending on who is using it.
Humor can also reveal cultural tensions in particular times and places. For instance, in Malawi “AIDS humor” reflects the huge shadow cast by the disease over everyday life. For instance, many jokes play on the multiple meanings of “to give” — relationships are often a place of expected exchange, but have also become a key location for the spread of HIV. One cartoon includes the picture of a man kneeling beside a woman saying, “well, you asked me for a romantic present — I’ve just given you AIDs, girl.” While many outsiders would not view these jokes as funny, AIDS is sometimes funny to those in Malawi because it touches the lives of those reading and listening to the jokes.

The next time you tell a joke, consider how you’re responding to a particular social context or situation and whether your humor is pointing out distinctions or bringing people together.

Reconstructing Identity after a Brain Injury

Allison Nobles on March 28, 2019
Woman with hand on forehead and eyes closed
Photo by jill, jellidonut… whatever, Flickr CC

We’re hearing more and more about the dangers of brain injuries, especially in sports. While the physical nature of these injuries often take the forefront, brain injury survivors must also deal with the emotional and social repercussions of their injuries. To mark Brain Injury Awareness month, we delve into social science research on how recovery from a brain injury involves changes to identity, social relationships, and everyday routines.

Post-injury, brain injury survivors must learn to adapt to the changes their injury caused — this could mean relearning how to walk or eat, learning to rely on others for help, and taking more breaks during the day. With these changes to daily life, many survivors believe their identities change too — and they must construct or reconstruct a new version of themselves. And while they retain aspects of their old selves, many survivors view their new identities as separate pieces. For example, brain injury survivors may distinguish between their new “brain injured self,” an “old self,” and a self that does “meaningful” activities, like parenting, helping others, paid work, art, or gardening. The process of healing and therefore the process of constructing a new self is not linear — like riding a rollercoaster, survivors get better for a while and then backtrack, then getter better, and so on. Consequently, a large part of accepting a new self also involves accepting an unpredictable future.

Constructing Merit in College Admissions

Jean Marie Maier on March 26, 2019
Image of a sign that reads, "honk for your kid's future"
Photo by Kyla Duhamel, Flickr CC

The FBI recently announced charges in a wide-spread college admission scandal involving fake test scores and fabricated athletic resumes. In the wake of the scandal, sociologists are weighing in and reminding us that college admissions is as much about legitimating privilege as improving life prospects. Sociologists have long been skeptical of the term meritocracy, which was in fact first coined as satire by Michael Young. The research below shows how constructed measures of merit in college admissions play a key part in reproducing inequality.

Mitchell Stevens spent a year in the admissions department at a selective liberal arts school. His book describes “the aristocracy of merit” — especially how the review process rewards the activities and presentation styles most common for privileged students. And while admissions officers are mostly the ones judging merit, the book also highlights how staff from other departments, such as coaches or fundraising officers, can advocate for a student’s admission. Shamus Khan’s ethnographic work similarly notes how elite prep schools set up their students to be competitive in elite college admission through skills, activities, and awards. Prep school staff even occasionally call admissions offices of Ivy League schools for students.
Other work on college admissions highlights that the idea of “merit” has always been socially constructed because those with race and class privilege can set the rules. For instance, colleges instituted  “holistic admission” in the early twentieth century because contemporary elites worried that their children would be shut out of attending their alma mater because of high-achieving Jewish students. They rewrote admissions criteria to devalue standardized test scores in favor of a review process that gave students credit for the experiences, skills, and habits that students from the upper-class were more likely to have.
So, if upper-class kids already have advantages, why is there a college cheating scandal? Jessica Calarco points out in NPR that the students affected by this scandal would likely do well no matter what school they attended, but parents are anxious about rising inequality, a bifurcating labor market, and afraid that children will have a harder time than their parents did. From teaching children how to advocate for themselves in school to paying thousands of dollars for out-of-school activities, middle and upper-class parents do whatever they can to help their children get ahead. American higher education is a decentralized marketplace that runs on prestige, which makes credentials from a big-name school potentially even more important in today’s changing labor market — both for students looking for social mobility and those looking to legitimate their privilege.

As Anthony Jack told CNN, the admission scandal flips the usual script — usually when we are discussing merit in college admissions it is around insinuations that minority students don’t deserve to get in. For more on race-based affirmative action, check out other TSP work below!

Affirmative Action, College Admissions, and the Debunked “Mismatch” Hypothesis

The Supreme Court’s Impacts on Race and Admissions in America

Merit and the Admissions Debates at Harvard University and Stuyvesant High School

The Luck of the Irish

Neeraj Rajasekar on March 17, 2019
Photo of the Irish Immigrant Memorial in Pennsylvania by Kevin Burkett, Flickr CC

Happy St. Patrick’s Day! As you top one off down at the pub, here’s a round on the house about how the Irish became white in the United States.    

Irish presence in America greatly expanded following increased emigration in the mid-to-late 19th century. The journey from Ireland was arduous and dangerous, but their welcome on arrival was worse. Various political and social organizations espoused prejudiced, bigoted views towards Irish immigrants their families; frequent metaphors included comparing the Irish to animals or vermin. Scholars have described how Irish groups in America resisted hatred and discrimination and took steps to combat discrimination both in the job market and everyday culture. As the sources below describe, the Irish actively overcame and struggled against oppression, and civil society organizations and community engagement helped the Irish to eventually be seen as part of the racial category “White” in America.
This story of becoming white applies not only to the Irish, but also to Italians, Poles, and virtually any other European group once framed as outsiders by America’s paradigm of “whiteness” in the 18th and 19th centuries. Over time, these groups’ cultural identities didn’t disappear; instead they became symbolic and strategic expressions of identity that no longer bore these oppressive stigmas.
Following work by civil organizations and resulting changes in dominant cultural practices, the racial paradigm has expanded to incorporate some groups into the label of white, but not all. Non-European groups’ stories contrasted greatly with that of the Irish, spawning inequalities that still exist today.

As you finish your drink, ponder how several immigrant groups have been historically labeled as racially black, Hispanic, or Asian, instead of white. How would life be different for Irish-Americans if that had been their story?

When Boys are Victims of Sexual Assault

Amber Joy Powell on March 15, 2019

Photo of a sign that reads, “rape hurts all of us.” Photo by FGTE, Flickr CC

Last week, HBO released the documentary, Leaving Neverland, which chronicles two young men’s accounts of sexual abuse by pop superstar Michael Jackson in the late 1980s and early 90s. The documentary provides harrowing details of abuse and grooming, although Jackson maintained his innocence throughout his life. Yet, beyond Jackson’s guilt or innocence, HBO’s airing of Leaving Neverland forces us to engage in larger discussions about an often-neglected group of sexual assault survivors — adolescent boys. Sociological research is examining how masculinity and heterosexuality shape boys’ experiences of sexual victimization.

Threat to masculinity often shapes how male youth interpret experiences of sexual coercion. Many boys view sexual victimization by another man as individual weakness and vulnerability. Forensic interviews with adolescent male survivors reveal how boys attempted to fight off their male perpetrators and/or avoid physical stimulation to show their unwillingness. Boys can be hesitant to disclose abuse by older men because they do not want others to think they are gay. Sexual abuse by women is often viewed as less harmful (e.g. saying it was “weird but fine” and “she wanted it”), suggesting that despite women’s use of sexual coercion and manipulation, these interactions posed less of a threat to boys’ masculinity.
Parents of boys who were sexually assaulted by other men also reinforce cultural messages that link same-sex sexual victimization to homosexuality. Many parents believed the trauma of sexual assault by another man would turn their son gay. In his interviews with 62 parents of Black and Puerto Rican male victims, Shawn McGuffey found that parents engage in “gender recovery work” after the abuse to reaffirm heteronormative gender roles. As such, they encouraged their sons to participate in heterosexual relationships, objectify women, and engage in sports. Fathers in particular expected that immersing their sons in traditionally masculine activities would strengthen their heterosexual identities after the trauma of same-sex assault.
Criminal justice institutions further reinforce gendered rape myths regarding male sexual assault victims. Court observations reveal how attorneys dismantle boys’ credibility by pointing to the lack of emotional trauma on the witness stand and physical evidence on their bodies. In the case of one 12-year-old boy, defense attorneys dismissed the victim’s claims of assault by two older men because the boy did not show enough emotion and failed to display the penetrative injury expected from a same-sex sexual assault. One defense attorney suggested a young Latino victim fabricated the use of sexual force by his sister’s boyfriend because he was ashamed to admit that he “consented” to homosexual sex.

As we continue to grapple with the implications of #MeToo for boys, sociology allows us to challenge how masculinity and heteronormativity silence young male sexual assault survivors. Dismantling these systems of power brings us one step closer to effective prevention and response to boys’ sexual victimization.

The Pervasive Problem of Intimate Partner Violence

Mark Lee on March 11, 2019

Photo of marchers holding a sign that reads, “choose respect.” Photo by Office of Governor Sean Parnell, Flickr CC

Audiences are re-living one of America’s most infamous cases of intimate partner violence (IPV) with Jordan Peele’s recent documentary about Lorena Bobbitt, who retaliated against her husband John after years of alleged abuse. While the Bobbitt case is unique, the issue is common. The Centers for Disease Control and Prevention estimate that 1 in 4 women and 1 in 7 men in the United States have experienced severe physical violence by an intimate partner. Tabloid exposés of such cases highlight personal details of the individuals involved. By contrast, sociological perspectives on IPV uncover the structural conditions that make it such a pervasive problem.

Sociologists began studying violence between spouses in the 1970s, particularly violence against women. Feminist scholars, drawing from interviews with victims in women’s shelters, focused on women’s experiences as targets or victims. They believed that IPV’s root causes were the patriarchal norms and laws that defined wives as their husbands’ property. Other survey researchers found that men were also likely to be targets of IPV — sometimes at rates as high as those for women.  They considered IPV a special case of violence in the home, but similar to child or elder abuse in its determinants: stress, social isolation, and intergenerational histories of family violence. Although the question of gender differences in IPV remains controversial, contemporary research does not necessarily see these perspectives as competing, but rather as describing two or more different types of IPV, such as “patriarchal terrorism” versus “common couple violence.”
Victims of IPV often suffer severe consequences. Violence damages physical and mental health, leading to injury, chronic pain, depression, sexually transmitted disease, and post traumatic stress disorder. Beyond these individual effects, the negative impact of abuse spills over into other areas. In some cities, landlords are penalized if the police are called to their property too often. Because of this, female renters who report domestic violence are considered a liability and often face eviction. Trouble at home also follows many women to work in the form of stalking and harassment. IPV victims miss work more frequently than their peers because of injury and distress, which results in lower productivity and higher job turnover.
Eradicating IPV across the world is a major focus of human rights organizations, but a big obstacle to changing behaviors remains: the continuing social acceptance of physical violence against wives in some areas. A recent international survey found that support for a husband hitting his wife varies widely across countries, but tends to be greatest in places where gender inequality is relatively high. Within a given country, the most marginalized people (rural, lowest wealth quintile, least education) are generally the most likely to support IPV. The good news is that these attitudes are changing. In nearly every country where data are available, support for IPV has declined since the 1990s. This trend parallels an increasing number of policies banning violence against women in recent decades.

This research shows how intimate partner violence affects both men and women, though women tend to experience more severe and persistent abuse in the United States and internationally. Undoing this social problem will require structural change in the way societies construct gender norms and how institutions respond to victims. In the meantime, some resources for abuse victims can be found here.