Integration, Clarification, Substantiation: Sex, Gender, Ethnicity and Migration as Social Determinants of Women's Health
Vissandjee, Bilkis, Hyman, Ilene, Spitzer, Denise L., Apale, Alisha, Kamrun, Nahar, Journal of International Women's Studies
The aim of this paper was to examine, via a scoping review, how the literature focusing on immigrant women's health, based on selected criteria, has been able to capture not only sex and gender differences but also the other socially grounded determinants of health.
Using selected health databases as well as a diversity of keywords, a final sample of 59 was obtained after a number of steps to increase validity and credibility of the process were taken. Since "women" was one of the main keywords, all of the studies included women either by themselves (n=20/59) or along with men (n=39/59). In 34 (57.6%) of the papers reviewed, gender was defined above and beyond 'sex' (i.e. some discussion was provided regarding the social context of the study population prior to the presentation of the goal of the study). Ethnicity was merely mentioned without being expanded upon and at times being substituted with race in 26 (44%) of the papers reviewed. Migration was defined in 22 (37.2%) of the papers and was predominantly operationalized by length of stay in the country. While the concepts at hand represent important units of analysis within women's health research, most studies neglected to either capture gender specificities beyond sex as a biological variable, or to define migration experiences beyond ethnic identity.
Anchored within women's health scholarship seeking for conceptual clarity and accuracy, this paper pleads for an improved consideration of the multiple and interactive social and biological determinants of health, as well as structural conditions at the basis of structural inequities; If the production of socially grounded women's health research depends upon accurate, fully integrated and applied conceptualizations of relevant dimensions, how can this be facilitated by policy-makers, health research funding bodies, the researchers themselves and ultimately by health care practitioners?
Keywords: Gender, Ethnicity, Migration
Many factors have been studied in terms of the influence they may have on health. These include economic, genetic and behavioural patterns, as well as physical and social environments and health systems (Adams, De Jesus, Trujillo & Cole, 1997; Agnew, 1996; Alexander, Patrick, Bovier, Gariazoo, Eytan & Loutan, 2003). Income, social support and housing, for example, have been shown to influence the physical and emotional well-being of individuals, neighbourhoods and communities (Allotey, 1998; Anand, 1999; Anand, Peter, & Sen, 2004; Blackford & Street, 2002; Boyd & Grieco, 2003). Such studies reveal a complex interrelationship between various factors that work together to determine health (Agnew, 1996; Allotey, 1998).
The concept of social determinants (6) draws attention to social and economic circumstances which strongly affect the health of women, men, families, groups and populations. Hillary Graham argues that this concept should play a pivotal role in the development of programs and policies (Graham, 2004). Raphael (2004) also insists on health promotion programs and policies that move beyond biomedical and behavioural risk factor approaches, anchored in the perspective that the social gradient in health runs fight across society. Such programs and policies should aim to decrease impairments in health while accounting for different levels of underlying social advantage.
A growing body of immigrant health research seeks to establish sex, gender, ethnicity and migration as social determinants of health (Aroian, 2001; Boyd & Grieco, 2003; Des Meules, Gold, Kazanjian, Manuel, Payne, Vissandjee, 2004; Dunn & Dyck, 2000; Dyck and McLaren, 2002; Hacking, 2005; Iglesias, 2003; Jolly, Reeves & Piper, 2003; Kazemipur, 2002; Krieger, 2004, 2005, 2006; Meadows, Thurston & Melton, 2001; Nazroo, 2003; Thurston & Vissandjee, 2005; Raphael, 2004; Vissandjee et al., 2001; Vissandjee et al. …