Ethnicity, Race, and Health in Multicultural Societies: Foundations for Better Epidemiology, Public Health, and Health Care

“Race has played a major role in the way societies work and intereact and the cocept has been abused in the past to justify inequalities.” -Raj S. Bhopal (Page 10)

Author: Raj S. Bhopal

This reading is an introduction to a text that focuses on improving health using race and ethnicity in multidisciplinary epidemiological settings. I found it relevant to this course because it directly addresses a key element of the discussion of HIV/AIDS among black women: race. But the author approaches race and also ethnicity from the perspective of an epidemiologist and discusses how taking into account race and ethnicity in research may help or hinder advances in medical research and policy.

This introduction is especially useful because it discusses the concepts of race and ethnicity theoretically, socially and scientifically. It also addresses how human understandings of the two terms have evolved over time. On a more practical level, Bhopal discusses how race and ethinicity may be used as variables in research. This made me wonder how gender and race could be used as variables in HIV/AIDS research.

But at the end of the day, the reasons why HIV/AIDS seems to be affecting black women disportionately to other women and groups are more social than biological. Bhopal’s work speaks to this idea simply because he discusses the power of race and ethnicity in forming prejudices and biases. He also addresses the history of using race based theories to explain the inferiority of some races compared to others and while he sees the benefits of using both race and ethnicity in research he does so with caution all while acknowledging the negative that may come out of it. He writes, “since interest in, and the influence of, research on ethnicity and race is increasing it is important that the conceptual basis of the work is sound,” (9). He seems to be saying that people are going to use the two concepts as variables whether we like it or not, so the next essential step is to clearly define and understand the terms. For that reason Bhopal spends a lot of time explaining and discussing the differences between the two terms.

He goes on to talk about their influence. He writes, “Directly or indirectly, race and ethnicity have a major impact on populations’ health patterns,” (7). The indirect impacts (social results of being from a particular racial group) are what I am most interested in in my research and how ackowldeing them in AIDS related research may help in addressing the spread of HIV among black women. If this type of research would be beneficial or capable of… helping black women deal with the challenge of HIV/AIDS.

Bhopal acknowledges that race is social rather than biological construction but still asserts that is a useful tool for analysis. He devotes an entire section in the reading to discussing the social harm that has been and can be caused by the two concepts. He also makes a good case for the idea of environment as a causal factor in disease, specifically the social conditions of a given group.

I don’t disagree with Bohopal’s assertions, in fact I agree with a lot what he has to say about race and ethinicty. Mainly because he is relying on the facts of social and scientific history in his discussion of race and ethnicity and how the terms have been used and may be used in the future. This is by far the most practical reading I have yet to study because it addresses how these concepts and their use may impact research and then eventually policy.

The policy part is also what I’m interested in. Specifically Bhopal outlines how research using ethnicity or race as variables may influence the development of health services and individual clinical care. Research that looked at treating HIV/AIDS or caring for patients with the virus with a focus on race, so black people, or ethnicity, so a specific cultural group like carribeans, would be beneficial in developing policy and standards of care that could be more considerate of the culutural backdrop of a patient’s experiences and their specific needs.

A large majority of clinical care is focused on the general population, perhaps to the detriment of patients in minority groups. A more targeted approach to care could make a huge difference and research that encourages finding that out I think at least is important.

This is a reading from which real and positive results could be developed from. It is important work for that reason.

"Black Sexual Politics and the Challenge of HIV/AIDS"

"Understanding how ideas about Black masculinity and Black femininity affect interpersonal relationships is intrinsically important, and it is necessary for addressing HIV/AIDS." -Patricia Hill Collins (Page 290)

Author: Patricia Hill Collins

In this section all of Collins’ ideas converge on the very practical results and reality of the current state of black sexual politics: HIV/AIDS. The issue of AIDS among black people in America and around the world is a important example of why black sexual politics matter.

Before beginning the text I was most interested in reading this chapter and the conclusion because it has the most relevance for the topic at hand, HIV/AIDS among black people. The entry point of black sexual politics is also important because it includes black men in the discussion. I’ve been having trouble doing that in my research. Despite Collins’ thorough investigation of black sexual politics and the new racism, I found this section something of a disappointment.

Collins spends most of the first part of the chapter discussing the idea of honest bodies and the dishonest body politics of black sexuality. While an interesting discussion of the metal, spiritual and physical aspects of sexuality, I did question what it had to do with HIV/AIDS. It seems to come out of nowhere.

That being said, when she does eventually get to a discussion of HIV/AIDS and how black sexual politics play a role in the spread of the disease, Collins does a good job of tying her theories into the practical realities of the disease. She shows how the social conditions of blacks exacerbated by black sexual politics and male and female gender identities allow for the continuing spread of HIV. She states this explicitly when she writes, “The issues raised by the HIV/AIDS epidemic suggest the need for a progressive Black sexual politics is far from an abstract, academic concern,” (296).

And it really is not just about abstraction, despite the detailed discussion of “honest bodies.” While reading this section and the conclusion I noticed a strange dichotomy present itself in the tension between Collins’ practical authority versus her theoretical authority as an academic when it comes to a discussion of HIV. She writes with the same assertiveness I took issue with in previous chapters about AIDS but in some ways lacks the practical qualifications (e.g. medical expertise) to do so. This points to the same tensions that exist in addressing the issue of HIV/AIDS, that being the practical need to find a cure compared to the theories and concepts that attempt to account for its spread between people within a given group or society. Collins does not ever discuss that tension and I assume this is because her text focuses more on theory and politics, moreso than the medical dimension of HIV and AIDS.

Another interesting and important point that Collins brings up is the concept of the “black community.” It is a term that has already appeared a few times in my research and one that I have been cautioned to avoid because, to a certain extent, no single black community exists. It is extremely heterogenous and diverse. Different social classes, ethnicities and cultures of blacks have various ways of dealing with sexuality, community and issues like HIV/AIDS.

Collins suggests that one way of moving towards a progressive black sexual politics may be in “…developing inclusionary definitions of Black community,” (296). She goes on to discuss two ways of understanding the term and acknowledges that it would be hard for black people to conceive of themselves as a single a community and why it may not be beneficial. She notes specifically that having one notion of blackness within a single community will privilege some forms of blackness and disadvantage others (e.g. the mammy over the bad black mother in current conceptions of black women).

Before reading Collins' ideas about community, I found myself defending the idea of the black community and my choice to use the term in my work. Mainly because having black skin connotes certain social experiences that no matter your background is often universal. At least in my opinion. But I recognize that doing so doesn’t take into account personal experiences with race that individual black people have. There is some validity to my defence and more thought needs to be put into reconciling the two views, but even Collins agrees that some concept of community among black people is valuable and to some extent necessary. I think as I continue my research I will be able to come to a better way of understanding and using the term.

Collins has given me a lot to consider and to keep in mind as this project develops. Black sexual politics matter and will continue to matter among black people especially when it comes to issues like HIV/AIDS and its affect on black women.

"Rethinking Black Gender Ideology"

"Domestic violence, the decline of marriage, the spread of HIV/AIDS, substance abuse, adolescent pregnancy, and similar social issues all refelect, in large part, the damage done by prevailing Black sexual politics." -Patricia Hill Collins (Page 199)

Author: Patrcia Hill Collins

This section addresses black gender ideology, both male and female. This wasn’t a section I had intended to read in its entirety, but the issues and ideas that Collins brings up are quite relevant to the overall discussion of black women and HIV/AIDS. Specifically the section highlights the tensions that exist between black women and black men in terms of gender and the larger societal conflicts between and among these groups. How black men and women relate to each other and to society as a whole is an important element of the discussion of HIV/AIDS among black women. This is partly due to the fact that large portions of black women are contracting HIV through heterosexual sex with black partners.

The section also refers to important social and historical roots of what may be factors which put black women more at risk for contracting HIV/AIDS, specifically their marginalized social and economic positions within society. Collins presents ideas surrounding images of black gender through a class lens examining both male and female working class and middle class blacks.

She presents two images each of gender ideologies related to black women and men. According to Collins, black women are depicted in two ways within contemporary North American society. The working class black female is perceived as being a “bitch” and a Bad (Black) Mother, while images of the middle class black woman stem from ideas of modern mammies, black ladies and educated bitches. Working class black men in contrast are defined by images of the athlete and the criminal while their middle class counterparts are relegated to the role of sissies and sidekicks in wider societal depictions.

Collins asserts that these images are widely produced and reproduced through the media and popular culture. She uses examples like Destiny’s Child songs and Danny Glover film roles as evidence. I can’t dispute the fact that some of the images that Collins refers to are quite prevalent in the media (which can include news, television, movies and other outlets of popular culture), but I found myself wondering how true they really are. The images Collins points out are stereotypes. It would be easy to dismiss them as such, but Collins also shows how these stereotypes have real affects on the lives and situations of black men and women and their ability to advance as a group and individually within American society.

I found Collin’s discussion of hegemonic gender ideology and its impact on black gender ideology and relation to black sexual politics especially interesting. The historical views of black men and women tie in to current perceptions of black women and those perceptions exist, according to Collins, in opposition to contemporary hegemonic gender ideologies (i.e. the dominant white male and submissive white female). The main result of this and Collins’ discussion in this section is the continued disadvantaged position of African Americans in American society. Collins also continues to make a case for structural causes of African Americna disadvantage in America without explicitly saying so.

While I found Collins’ discussion in this section intriguing and worth considering, I was somewhat sceptical of a few of her assertions, simply because they were so adamant. Collins’ phrasing doesn’t allow for other interpretations of black gender ideology and black sexual politics. I do not disagree with what she writes, but I did find myself adding caveats to it, saying something doesn’t make it true and Collins’ approach ignores that fact to a certain extent. For example in the section on black female gender ideology Collins concludes at one point that “Aggressive African American women create problems in the imperfectly desegregated post-civil rights era, because they are less likely to accept the terms of their subordination,” (138). This is an interesting point, and perhaps true but the way it is written makes it sound as if it were the gospel—the only truth. In it Collins speaks for an entire group of people and how they are viewed by society. I just think that a caveat of some sort, that this is her interpretation based on her theories, is necessary and is not provided at multiple points in the text.

She speaks with an authority I don’t think is hers in entirety. It just makes me weary in terms of her speaking for all or making assertions about all on both sides of this—black males and females as well as speaking for wider society. This point also makes me wonder who exactly the text is written for; that is, who is Collins’ intended audience, African Americans or people outside of that group? As a black person reading this I can easily agree or disagree with Collins’ points based on my own experiences and those of other blacks close to me. But I would assume that someone who isn’t black reading this text is going to take away different things (not necessarily good or bad) from Collin’ work. Which is what makes me wonder who exactly her audience is—that’s more an issue of my own curiosity than something that needs to be addressed in the text though. I also recognize that her audience would include people from both groups.

With only a few concerns on my part, I think this is an especially valuable text and section in attempts to address African American gender theory. It is an important text in understanding the historical, current and evolving roles of black men and women and their relations to one another.