Volume 1, Number 6 (June 4, 2024)

There will come a time when, like the proud Bahamian I am, I will complain incessantly about the heat. That time is not now. Summer has come early to Philadelphia, and I am elated.

I’m writing this Musings and Marginalia in early May because I will be heading to Tanzania at the end of May to see the Great Migration, the annual passage of roughly two million wildebeests across The Serengeti.

Photo credit: Jorge Tung, Unsplash

My partner and I love international travel, and every few years prioritize “bucket list” trips. Mine, 10 years ago was to tour the temples at Angkor Wat in Siem Reap, Cambodia. That trip was intellectually, culturally, and spiritually transfixing. And supremely hot! We love hot weather but Cambodia’s heat was impressive! Anyway, seeing hordes of wildebeests cross The Serengeti is his.

Packing for this trip (also happening in early May to ward off stress) has been… trippy. I am the beneficiary of many talents and blessings. Alas, packing lightly is not one of them. I’m the type of person who will take four different types of black shoes (one dress, two pairs of sandals, and a pair of flats) for a 4-day trip, because you just never know.

Traveling internationally while Black is its own intersectional adventure. Having Tanzanians stare at us because we’re Black is not one of the worries that I’m packing for this trip, however. Reminiscent of our March 2024 Intersectionality Research Salon guest, Jasmine Abram’s 2016 article reflecting on intersectional positions while conducting qualitative research in South Africa, we are likely to be clocked first as Americans, likely rich Americans.

We loved our time in Cambodia, but my word was that trip racially taxing. Presumably, Siem Reap doesn’t get many Black tourists; the gawking stares of some locals in the “Night Market” suggested this.  It got exhausting fast. One night we opted to dine at the hotel rather than venture out because we were just so tired of the stares. The stares didn’t evoke racism, just curiosity about our difference (which admittedly can be indistinguishable from racism). Generally, most of the Cambodians that we met were warm and welcoming. An exception to this was a market several miles beyond Siem Reap. There, we observed a handful of vendors gesturing at us while laughing. After passing multiple stalls featuring vat-sized jars of skin-whitening creams, we joked that they were probably incredulous that we weren’t taking advantage of the bulk skin-lightening wares.

Traveling internationally (or nationally) provides yet another example of intersectionality’s utility for highlighting the fallacy of one-size-fits-all assumptions; it’s as true for health equity as for travel. In late April, The Washington Post featured an interesting article about the travel mogul, Rick Steves. Steves is especially passionate about European travel and has long been a leader in the European travel space. Steves seems like a great guy, but his travel recommendations have typically excluded the information about Europe that my partner and I always consider when we travel to Europe: What’s the anti-Black racism and/or colorism climate? Will we be comfortable? Will we be safe?

Being Black tourists in predominantly White countries means being always being conscious about anti-Black racism; this holds true for living in the U.S. too, obviously. So back to Europe. I fell wildly in love with Prague’s charm and architecture when we visited there in 2017; the only thing my partner remembers of Prague are many of the natives’ hostile and menacing stares. He has vowed never to return.

Yours in all things intersectionality and health equity and international travel.

Kwaheri (goodbye in Swahili),

Lisa Bowleg, PhD, MA
Founder & President
Intersectionality Training Institute

P.S.  We’re breaking from Intersectionalia for our annual Intersectionality Summer Intensive (ISI) in July, and then post-ISI recovery in August. Intersectionalia will return in September. Wishing you all a safe and enjoyable summer!

They’re Coming for Intersectionality: What You Need to Know and How to Resist

I’ve been talking a lot about diversity, equity and inclusion (DEI) bans and their implications for intersectionality work lately. Two weeks ago, I met with colleagues from a North Carolina university who were developing an intersectionality-focused grant proposal that they were uncertain they would be able to submit to the National Institutes of Health (NIH) given the UNC Board of Governors’ repeal of DEI policies and goals at all public colleges in NC. Last week, I spoke with another colleague at a public university in Louisiana with an NIH-funded  intersectionality grant who informed me that state legislators are seeking to eliminate DEI programs in her state.  And this week, I spoke with a prospective new colleague in Houston who asked, “And I’m sure you heard what’s happening with DEI in Texas.”   It’s bad, y’all. It’s going to get worse.

It’s been almost four years since intersectionality luminary Kimberlé Crenshaw’s organization, The African American Policy Forum sounded the warning bell with the #TruthBeTold Campaign. The campaign described how former President Donald Trump’s federal Equity Gag Order that prohibited federal agencies, those who contract with the federal government, and those who receive federal grants from conducting any trainings that focused on structural racism or sexism. As one of his first official actions, President Biden repealed the gag order on January 20, 2021. Conservative state legislatures picked up where the Trump Administration left off. The Chronicle of Higher Education, which is tracking these anti-DEI initiatives, notes that 28 states and the U.S. Congress have introduced 85 anti-DEI bills since 2023; 14 have been approved, 14 have become law, and 49 have been tabled, failed to pass or vetoed.

Crenshaw is now leading the Freedom to Learn National Day of Action. In February 2023, Crenshaw’s work on intersectionality and critical race theory (like those who have written about topics such feminist theory, LGBTQ studies, reparations) was banned from the College Board’s Advanced Placement African American Studies course. The Freedom to Learn (F2L) project is a “collective that emphatically oppose[s] the attacks being waged on educational curricula in the United States and elsewhere against intersectionality, critical race theory, Black feminism, queer theory, and other frameworks that address structural inequality.” F2L’s Activation Guide is essential reading about Freedom Summer 2024 and actions you can take to resist assaults on democracy and the right to learn.   The F2L Activation Guide also highlights the proposed rollbacks to DEI, Civil Rights and Civil Liberties Protections outlined in Project 2025, Trump’s Presidential Transition Project. Among the proposed draconian rollbacks are:

• Deleting terms such as sexual orientation and gender identity, diversity, equity and inclusion, gender equity abortion, reproductive rights from every federal rule, agency, contract, grant and legislation that exists;
• Restricting sex discrimination to “biological binary meaning”;
• Making it illegal to consider DEI in hiring and/or promotion;
• Treating participation in Critical Race Theory (CRT) or DEI initiatives as grounds for termination;
• Ending all CRT trainings in the workplace;
• Criminalizing any teaching of discussion of race, racism, racial classifications and CRT in public schools and college campuses;
• Branding DEI and associated initiatives in the federal government as racist, illegal discrimination;
• Eliminating nondiscrimination mandates for federal contractors and subcontractors; and
• Dismantling and eliminating any committees, grants, leaderships positions and “anti-discrimination policy statements” in the federal government that promote the “leftist woke DEI agenda”

Get Up to Speed Here:

• What to know about state laws that limit or ban D.E.I. efforts at colleges. The New York Times, Betts, A. (2024, April 21 (Updated May 23)).
• The Chronicle of Higher Education’s DEI Legislation Tracker
• The Project 2025 (Donald Trump) Presidential Transition Project

“You are a Black woman. Breast cancer doesn’t happen in your community.  Come back in 10 years.”

An Interview with Bridgette Hempstead and Leah Marcotte, MD (ISI 2023)

If you’re able to join the next Intersectionality Research Salon on June 12th, you’re in for a very special salon. Our guests will be Bridgette Hempstead, the CEO and Founder of Cierra Sisters, a 28-year old nonprofit community-based breast cancer survivor and support organization for Black women, and Intersectionality Summer Intensive (ISI) 2023 cohort member, Dr. Leah Marcotte, MD, a board certified physician at the General Internal Medicine Clinic at the University of Washington Medical Center, Roosevelt, with 128 5-star (out of 5) star ratings!

When Leah emailed to tell me about her inspiring and partnership with Ms. Hempstead and Cierra Sisters, I was eager to interview them. In our March 2024 Zoom interview, we discussed a wide range of topics such as how and why Ms. Hempstead created Cierra sisters, Ms. Hempstead’s advocacy to eliminate racism and oncology (be sure to check out the video, Anti-Racism in Oncology, a partnership between Cierra Sisters and the Fred Hutch Cancer Center in Seattle), gendered racism and breast cancer, and the elements of a successful academic-community partnerships. Believe it or not, this  interview has been condensed and edited for length.

We’ll continue this conversation at the June 12th Intersectionality Research Salon.  We hope that you can join us to talk about Black women and breast cancer through the lens of intersectionality and gendered racism, and what we miss when we frame the issue of Black women and breast cancer only through the lens of racism.

How did you two meet?

Leah Marcotte (LM):  Back in 2020, I was switching over to research and my supervisors in the job that I was leaving at the health care system encouraged me to work on breast cancer screening equity. My colleague said, “You have to meet Bridgette if you do anything with breast cancer screening equity, you need to work with her.” We put the grant application together in two weeks and then got the grant.

Tell us about Cierra Sisters.  What’s the backstory?

Bridgette Hempstead (BH): Well, first, Cierra Sisters is an African word that means knowing. If you have the knowledge, you have the power to fight against the effects of breast cancer. And it is also the color of brown. I started this work because I was diagnosed with breast cancer on my 35th birthday. Prior to being diagnosed I went to see my doctor and get an exam, and she gave me a laundry list of reasons why I did not need a mammogram. And the last reason was: “You are a Black woman, and it doesn’t happen in your community, and come back in 10 years.”  So immediately I had to begin advocating for myself in her office, and I demanded a mammogram.

She gradually gave in, and after the diagnosis called me up on the phone and said, “Bridgette, I owe you an apology.” She said, I’ve been taught this in school and that’s why I was trying to not to give you a mammogram. So three days after my diagnosis I started Cierra Sisters. I didn’t know that was going to be the name. But I knew I needed to raise the alarm right away and educate Black women, and young women that doctors are going to push back and tell us we don’t need mammograms.

And then that’s when I found out, not only that breast cancer didn’t not happen to Black women, but that we were dying at an alarming rate with late-stage diagnosis because of this belief system that breast cancer didn’t happen to us as often as White women.  So I had to create programs and educational opportunities to spread the word into the community, and then came Cierra Sisters, the name. And we’ve been going for 28 years.

I was struck while watching the video (that we will watch and discuss as a collective at the June 12 Intersectionality Research Salon) that it focused exclusively on racism, when all of the women in the video described intersectional, specifically gendered racism. What are your thoughts about this?

 BH: Racism is a public health matter and of course we are just touching the tip of the iceberg when we talk about Black women and breast cancer.  We’ve heard so many stories about Black women going to oncologists and how we’ve been treated not only from the oncologists themselves, but their physician assistants, their nurses, the front desk, the people who are scheduling appointments. We just had an incident this past year where a Black woman had a scheduled appointment. It had snowed and they told her she couldn’t come in because of the snow, but then gave her appointment to a White woman. She was advocating for herself, and they deemed her an angry Black woman because she was standing up for herself. Then, the doctor’s office wrote her and told her not to come back, to go somewhere else. And there are other stories about Black women getting the wrong treatment for cancers they don’t have. Or doctors telling them there’s nothing else we can do for you; just prepare your family. In this case, there were treatment options available that this other doctor did not even want to explore because the patient was a Black woman.

LM: Since ISI 2023, I have noticed a lot of the oversimplification and single-axis attention. So what I found really valuable from ISI was to appreciate and focus on the heterogeneity of intersectional groups. When we talk about Black women, this is obviously very obvious, there is a huge diversity of experience and positionality. Appreciating this can direct research because just saying that what’s happening to Black women is just racism ignores the interplay of various interlocking power and oppression.

Bridgette and I in our discussion have paid attention to the intersection of aging community members. If you’re focusing only on racism, you’re ignoring not only gendered racism, but issues of class, the effects that having Medicaid insurance, or transportation barriers, or types of ableism.

BH: Oh my goodness! As a result of working with the LGBTQ community within Cierra Sisters, we’ve heard about our lesbian sisters being treated just absolutely horribly just getting a mammogram. We’re talking about how the technicians are treating them [poorly] even before a diagnosis. It’s just rotten.

Your video aims to educate about this important issue, but what are some of the other solutions to the problem of Black women’s experiences with gendered racism and breast cancer?

 BH:  Doctor’s offices need to have non-discrimination policies in place. They need to empower your patients. So that when they see and they feel [discrimination], there’s a safe place for them to share their experiences and give feedback. Transparency has to happen. Policies have to be in place, and consequences need to happen. If you no longer want to do the job you were hired to do and this is how you’re treating our people then you should not be working here. That’s right. Find somewhere else to work. That’s it.  And colleagues [who hear discriminatory treatment] need to call their colleagues out, and not receive negative repercussions for doing so just because the person they’re calling out has a higher salary.

Many researchers rightly have bad reputations about their work with community partners. You two have clearly had a successful partnership.  What are some of the elements of a successful academic-community partnership?

BH: Researchers who come back to the community share information with them, and compensate the community for their valuable input to the research. Including the community as authors on research papers, and not just using them as a number.

What are some of the worst things you’ve had happen in academic-community partnerships?

BH: Oh researchers come in and steal the ideas, and then go away and claim the idea for themselves. They may change the name of the project to protect themselves.

Leah, what are some of the lessons you’ve learned about creating more equitable community partnerships?

LM: I’ve received a huge amount of mentorship and advice from Bridgette. And a lot of it is asking and understanding [the need to be equitable and respectful]. I mean, one of the things that we started out with asking is: “What is Cierra Sisters’ consulting rate?”, rather than just saying this is the amount of money you’re getting. What we do is start with the budget as we first work out what is Cierra’ Sisters’ time?  What is the participant’s time?  I always defer to budget: What is a rate that you think we should be doing? What do you think the reasonable compensation rate or appropriate compensation rate is for doing focus groups or doing any kind of different sections of the project?

Leah, as a member of the ISI 2023 cohort, what would you say is the one thing you learned that informs the work you’re doing as a physician, or in collaboration with Bridgette?

LM: There is way more than one thing. I wrote a NIH K08 application and included intersectionality as our guiding social framework. Bridgette is advisor on that award. It’s really has had a very big impact on my thinking about research, particularly community-engaged research.  And I don’t use the D-word [disparities] anymore. I only use inequities.

The other thing is on intra-group analysis instead of comparing groups (as with inter-group analysis). This is important because when you’re comparing, you tend to do more deficits type screening, and then you also treat groups as homogenous, which is really detrimental.

BH: The issue of heterogeneity and not assuming categories is very complex because the community is definitely self-identifying.  I think one of the best ways to recruit is to say we’re going to include all of the different names that communities use to identify and define themselves so that you have a recruitment strategy where the community can look and see that, “Oh, I’m in there.”

Leah, what’s the thing you continue to find most challenging about applying intersectionality to your work?

LM: Both language and inclusion. If you’re using multiple intersections, it’s appreciating that those positions are social constructs.  One example of this is when we’re doing our research among Black women and not wanting to exclude people who are Black and eligible for breast cancer screening who don’t necessarily identify as women. And then at the same time it’s about honoring and respecting the experience of Black women in the health care system and the impacts of gendered racism, while also not ignoring the experiences of those who do not identify as women. I’m trying to think about how to do this in a respectful and responsible way.

In a world that’s ever grim and challenging, what things are both bringing you joy these days?

BH: Oh, what brings me great joy is my family, my daughters, their family and my grandchildren. I’m having one on the way that will make me a grandmother of five. Also, the work I’m doing.  It’s really promoting advocacy and it is saving lives.

LM: We have this really lovely summer weather here in in Seattle in March. I just biked to a lunch meeting with one of my research mentors which was lovely. And professionally, Bridgette just hosted World Cancer Day and attending the Cierra Sisters’ community events have been such a joy and such a privilege. It’s really remarkable to see how many people Bridgette brings together at these events. They’re spectacular!  There’s poetry, there’s singing, there’s music and there’s education.

Would you like to be featured in The C³?  We’d love to hear from you.  Please email us at info@intersectionalitytraining.com, subject line: C3 and let us know what you’ve been up to intersectionality-wise, and we’ll be in touch. 
We thank you in advance for your support.

• The title of a new KFF health brief, deftly captures the stark intersectional reality: The South Can Be a Dangerous Place to be Black and Pregnant. The report documents that Black women in South Carolina were four times as likely as their White counterparts to die of a pregnancy-related complication in 2020, and cited discrimination as the primary factor.
• Perspicacious readers of Intersectionalia’s “In The Know About Intersectionality” section (March 2024, Issue 3) issue will recall that we listed Harriet Jacob’s 1861 book, Incidents in the life of a slave girl: An autobiographical account of an escaped slave and abolitionist, as an example of what Dr. Ange-Marie Hancock in her book, Intersectionality: An Intellectual History, calls “intersectionality-related thought.” Now comes news of her brother, John S. Jacobs, who was mostly unknown compared with his sister. Mr. Jacob’s narrative, titled, THE UNITED STATES GOVERNED BY SIX HUNDRED THOUSAND DESPOTS, was published this month for the first time in 169 years! According to The New York Times’ May 24, 2024 article about the book, what makes the rediscovery of this book so impactful is the fact that it was published outside of the network and censorious gaze of White abolitionists and thus delivers a rageful and scathing indictment of the U.S. and its revered Constitution. The article details how many of the narratives of formerly enslaved people often had their political arguments (e.g., the hypocrisy of lofty political rhetoric about liberty and freedom) to focus on conventional stories about suffering and escape. The discovery of this book is exciting because, resonant with a message that Jameta Barlow repeated at her April 2024 Intersectionality Research Salon, “our ancestors gave us the formula.”  At a time when conservative (and let’s call them what they are: racist) politicians are actively trying to erase the history of slavery and its ongoing legacy of structural racism from public classrooms, books, and the federal government (e.g., grants, workplace) Jacob’s book (currently listed as a best seller on Amazon), affirms what the mighty Sojourner Truth told us: “Truth is powerful and it prevails.”  Given the contemporary assaults on The Freedom to Learn, Jacob’s book profoundly reminds those of us committed to social justice and equity that the fight for freedom has never ended. We must continue to speak truth to power and to resist.
• Ella’s Song: Remember how in the inaugural version of Intersectionalia, we told you that you might find song lyrics here? Here, with another gorgeous version by Sweet Honey in the Rock, are the lyrics to Ella’s Song.  The lyrics and music are by the legendary Bernice Johnson Reagon, Ph.D., a founding member of Sweet Honey In the Rock.

Trainings, Webinars and Lecture Series

• Chandra Ford, PhD, a Professor at Emory University and a a leading scholar of the application of critical race theory to public health is teaching course a Advanced Critical Race Theory Concepts for Health Equity Research. This is the direct link for professionals to register and pay for the course: Register for Advanced Critical Race Theory Concepts For Health Equity Research.
• The Sex Ed Lecture Series (SEL) Team has a new certificate program on SOCIAL JUSTICE AND SEXUALITY EDUCATIONthat will run in July and which will be taught by Dr. Tanya M. Bass. The registration page is here. SEL has new lectures every Wednesday, a library of more than 150 recorded lectures, and annual subscriptions for under $15 per lecture.
• The National Institutes of Mental Health’s Office of Disparities Research and Workforce Diversity (ODWD) is hosting a free virtual workshop “Discrimination as a Social Determinant of Mental Health Disparities” on Thursday, June 6^th, 2024 from 10-5 pm EDT. The event is now sold out, but note that under Project 2025, such a workshop would be illegal.

Got something that you’d like to see featured in This, That & The Other? We’d like to know about it.  Please email us at info@intersectionalitytraining.com, subject line: TTTO.  Please let us know what you’ve heard about, read, or seen intersectionality-wise, attach a copy or link, and we may feature it in This, That & The Other.  And of course, we will give you credit for the find.  Thank you in advance.

• The salon started with Professor Bastos sharing that his focus on edentulism, the complete loss of all natural teeth, stemmed from his training as a dentist. Asked how a dentist finds himself doing research on intersectionality and structural health inequities such as edentulism, Bastos explained that an undergraduate epidemiological course piqued his interest in epidemiology (the focus of his Master’s and doctoral degree). His trajectory from dentistry to epidemiology was also personal, informed by witnessing his two Black adopted cousins’ many experiences with discrimination.
• In response to the question about what he was grappling with intersectionality-related these days, Bastos outlined four major challenges: (1) based on his 15-year experience of developing a self-report measure of experiences with discrimination in Brazil, how to develop items that reflect the experiences of unique social groups; (2) how to ensure that respondents interpret the items similarly and that researchers are assessing the same construct to the same extent across respondents who belong to different groups; (3) how to take history and place into account when assessing the health impacts of structural oppression; and (4) how to translate study results into public policies and other initiatives that promote social justice and increase health equity.
• Asked about the tension in his work; that he critiques discrimination measures such as the widely used Everyday Discrimination Scale (Williams & Mohammed, 2009) and the Intersectional Discrimination Index (InDI; Scheim & Bauer, 2019) on one hand, and then on the other uses them in his own work, Bastos first agreed that this tension existed, but then explained his goal of further developing them to try and overcome the limitations of the specific assumptions on which they were first developed. For example, Bastos along with his co-author Cathy Harnois (Harnois & Bastos, 2019) disagrees with the InDI authors’ claim that the InDI can be used to assess intersectional discrimination of all marginalized groups.
• Relevant references include:
  • Harnois, C. E., & Bastos, J. L. (2019). The promise and pitfalls of intersectional scale development. Social Science & Medicine, 223, 73-76. https://doi.org/10.1016/j.socscimed.2019.01.039
  • Scheim, A., & Bauer, G. R. (2019). The Intersectionality Discrimination Index: Development and validation of measures of self-reported enacted and anticipated discrimination for intercategorical analysis. Social Science and Medicine, 226, 225-235. https://doi.org/10.1016/j.socscimed.2018.12.016
  • Williams, D. R., & Mohammed, S. A. (20090). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32, 20-47. https://doi.org/10.1007/s10865-008-9185-0
• Bastos described two different approaches to developing discrimination measures: (1) develop specific scales for specific groups (e.g., Black middle-aged women in the U.S.) and (2) develop sets of items that reflect experiences with discrimination shared across marginalized groups. Noting that both approaches had procs and cons, he said that he favored the latter (i.e., intercategorical), even if it meant that specificities could be loss and some error could be introduced into the measure. The reason for this, he noted, is that comparability is an important issue in quantitative analysis.  Astute intersectionality researcher that he is, Bastos realized that this view conflicted with intersectionality’s attentiveness to contextual specificity.  “How can you value specificity on one hand, and try to come up with universal measurements on the other hand?” he asked.
• Bastos acknowledged another problem with measuring discrimination: if we continue studying the effects of discrimination on health and health inequities, we run the risk of naturalizing these relationships and seeing them as intractable. Bastos offered an important solution to this problem: explain the origins of discrimination and the effects of discrimination on health outcomes and health inequities in ways that make historical context and place salient.
• Asked what type of concrete advice he’d give quantitative intersectionality researchers, Bastos emphasized two critical steps. First, the importance of basing their research on a sound theoretical framework, one that describes and analyzes the social processes at play and that are important to the outcome in question. This theoretical articulation would typically happen the introduction of an article or the specific aims. Then, the researcher would develop the study and conduct the analysis. The second vital step in this process is for intersectionality researchers to interpret their findings in terms of the theoretical framework that informed the study, something that he said rarely happened in epidemiologic studies. 
• Myla asked about where attention to historical context and place could show up in a quantitative study where, for example, there was only demographic data and no social process (e.g., intersectional stigma, discrimination) measures. Bastos recommended that researchers should orient readers to why they are talking about demographics, and explain that the demographic variables were the closest proxy to the social processes of interests. Bastos also advised that researchers avoid treating individual characteristics (e.g., “race” gender, sexual orientation, socioeconomic status) as fixed individual attributes. Instead, the astute intersectionality researcher recognizes that these variables are instead indicative of major social processes linked to power. Researchers could, and should, note that they are socially constructed and historically and geographically based.
• As he and his colleagues have done in their structural intersectionality and edentulism work (Bastos et al., 2022; 2023), Bastos credited Patricia Homan’s excellent work on structural intersectionality (Dr. Homan will be the distinguished guest and keynote speaker at Intersectionality Summer Intensive 2024) as the inspiration for his work.
• Relevant references include:
  • Bastos, J. L., Constante, H. M., Schuch, H. S., Haag, D. G., & Jamieson, L. M. (2022). How do state-level racism, sexism, and income inequality shape edentulism-related racial inequities in contemporary United States? A structural intersectionality approach to population oral health. Journal of Public Health Dentistry, 82(S1), 16-27. https://doi.org/10.1111/jphd.12507
  • Bastos, J. L., Constante, H. M., Schuch, H. S., Haag, D. G., & Jamieson, L. M. (2023). The mouth as a site of compound injustices: A structural intersectionality approach to the oral health of working-age US adults. American Journal of Epidemiology, 192(4), 560-572. https://doi.org/10.1093/aje/kwac205
  • Hardeman, R. R., Homan, P. A., Chantarat, T., Davis, B. A., & Brown, T. H. (2022). Improving the measurement of structural racism to achieve antiracist health policy. Health Affairs, 41(2), 179-186. https://doi.org/10.1377/hlthaff.2021.01489 o Homan, P. (2019). Structural sexism and health in the United States: A new perspective on health inequality and the gender system. American Sociological Review, 84(3), 486-516. https://doi.org/10.1177/0003122419848723
  • Homan, P. (2021). Sexism and health: Advancing knowledge through structural and intersectional approaches. American Journal of Public Health, 111(10), 1725-1727. https://doi.org/10.2105/AJPH.2021.306480 o Homan, P., Brown, T. H., & King, B. (2021). Structural intersectionality as a new direction for health disparities research. Journal of Health and Social Behavior, 62(3), 350-370. https://doi.org/10.1177/00221465211032947
• Bastos discussed how he and his colleagues incorporated Nancy Krieger’s ecosocial theory — in essence, a theoretical framework that describes how people come to literally embody the effects of discrimination, and the biopsychosocial processes that facilitate such embodiment — into his work.  He noted that intersectionality and ecosocial theory were complementary in the sense that they referred to similar processes, albeit in different ways.  For example, he noted that whereas intersectionality emphasizes co-constitutionality and interdependency between systems of oppression; ecosocial emphasizes the embodiment of these social processes.
• Relevant references include:
  • Krieger, N. (2012). Methods for the scientific study of discrimination and health: An ecosocial approach. American Journal of Public Health, 102(5), 936-944. https://doi.org/10.2105/AJPH.2011.300544
  • Krieger, N. (2019). Measures of racism, sexism, heterosexism, and gender binarism for health equity research: From structural injustice to embodied harm—an Ecosocial Analysis. Annual Review of Public Health, 41, 37-62. https://doi.org/10.1146/annurev-publhealth-040119-094017
  • Krieger, N. (2021). Ecosocial theory, embodied truths, and the people’s health. Oxford.
• In response to a question about the most important thing he learned about structural intersectionality by using a nationally representative dataset such as the Behavioral Risk Factor Surveillance System, Bastos noted that his main takeaway that we have to increase democracy in inclusive and comprehensive ways to observe better population patterns of health to mitigate health inequities.
• Asked whether appeals to cost effectiveness might be persuasive in getting U.S. politicians and policymakers to reduce health inequities, Bastos recommended the Elias and Paradies (2016) study as one that should be replicated. Ana Maria acknowledged that although an economic argument might appeal to policymakers, a primarily economic argument manages to sidestep the fact that it is economic inequality expressed as racism that is actually causing the health inequities and the increased cost of health outcomes. She also noted the risk of some people reading an economic impact argument as, “See Black people are super expensive too.”
• Ana Maria cautioned us to remember that if when we use “race” as a proxy for racism that we talk directly about racism, and not “race.”
• Relevant references include:
  • Braveman, P., & Parker Dominguez, T. (2021). Abandon “race.” Focus on racism. Frontiers in Public Health, 1318. https://www.frontiersin.org/articles/10.3389/fpubh.2021.689462/full o Elias, A. & Paradies, Y. (2016). Estimating the mental health costs of racial discrimination. BMC Public Health 16, 1205. https://doi.org/10.1186/s12889-016-3868-1
  • Yudell, M., Roberts, D., DeSalle, R., & Tishkoff, S. (2020). NIH must confront the use of race in science. Science, 369(6509), 1313-1314. https://doi.org/10.1126/science.abd4842
• Bastos also identified the capitalist system of production as a facilitator of intersectional health inequities that contrasts starkly with good population patters of health and equity.  I (LB) explained that such a focus would be in alignment with The Combahee River Collective Statement’s emphasis on class exploitation, an area that remains underexamined in most intersectional health equity research, at least that conducted in the U.S.  Charity countered that an economic argument of the cost ineffectiveness of racism would likely not be effective because capitalism, by its very nature requires inequities in order to function.
• Ana Maria’s asked a question about the extent to which intersectionality researchers should be looking for measurement invariance and consider differential item functioning or invariance in discrimination measures.  She provided the example of an item of being stopped for a minor traffic example, an item on the InDI that would look different for a White man compared with an undocumented Latino immigrant. Bastos responded that we need to consider invariance as a value to be pursued in quantitative assessments of discrimination in comparisons between estimates of discrimination among groups.  He said that the ideal scenario would be to have general measures of discrimination that could be used among multiple groups, but also have specific measures of discrimination tailored for specific groups.  This could, he considered, involve a combination of the simultaneous use of both general and specific measures.
• A relevant paper on this topic is:
  • Shariff-Marco, S., Breen, N., Landrine, H., Reeve, B. B., Krieger, N., Gee, G. C., Williams, D. R., Mays, V. M., Ponce, N. A., Alegría, M., Liu, B., Willis, G., & Johnson, T. P. (2011). Measuring everyday racial/ethnic discrimination in health surveys: How best to ask the questions, in one or two stages, across multiple racial/ethnic groups?
• Anna, a doctoral candidate who joined the salon from Brazil, was conducting her dissertation research with poor Black women. She said that she had noticed while interviewing her participants that all had edentulism, but like most of the people attending the salon, wasn’t even aware of the word until the announcement of Bastos’ salon. Reading Bastos’ work, she said, made her realize that all of her participants had an intersectional problem accessing oral health care.
• Picking up on an earlier question that Melanie had asked about how to get the dental community more involved in oral health, Anna pointed out that dentists, who were predominantly men, typically decided what would happen to their patients once they were in the chair: treat the condition or pull all the teeth. Thus, for Black and poor women in Brazil, the main choice was typically to pull all of their teeth, underscoring yet another structural component of edentulism. In line with intersectionality’s attention to power, Bastos affirmed, “So many times it’s not just about race, gender and class. It’s about racism, sexism, patriarchy and capitalism.”  He added that he had empirical evidence from Brazil using simulations of patients going to dentists and vast differences in dentists’ decisions about whether to retain or extract a tooth based on the patient’s racial group.
• Finally, Melanie asked to what extent does bidirectionality enter into intersectional measurement.  Using the example of going to the dentists, she noted that we often talk about the individual’s experience of the intersecting structures of oppression, but wondered how the dentist seeing the patient factored into intersectional measurement. Bastos explained that a lot of this work was nascent in intersectionality, but mentioned a study that he did roughly 15 years ago about racial classification in the context of a health study. Results showed that men approached by Black younger women were more likely to self-classify as White. The study showed, Bastos continued, that “race” in addition to reflecting racism, is also a space for negotiation in human interactions.
• Relevant articles include:
  • Bastos, J. L., Dumith, S. C., Santos, R. V., Barros, A. J., Del Duca, G. F., Gonçalves, H., & Nunes, A. P. (2009). Does the way I see you affect the way I see myself? Associations between interviewers’ and interviewees'” color/race” in southern Brazil. Cadernos de saude publica, 25, 2111-2124.
  • López, N., & Hogan, H. (2021). What’s your street race? The urgency of Critical Race Theory and intersectionality as lenses for revising the U.S. Office of Management and Budget Guidelines, Census and administrative data in Latinx communities and beyond. Genealogy, 5(3), 75. https://doi.org/10.3390/genealogy5030075 o López, N., Vargas, E., Juarez, M., Cacari-Stone, L., & Bettez, S. (2017). What’s your “street race”? Leveraging multidimensional measures of Race and intersectionality for examining physical and mental health status among Latinxs. Sociology of Race and Ethnicity, 4(1), 49-66. https://doi.org/10.1177/2332649217708798