Perspectives From the Social Sciences: Critically Engage Public Health

AJPH has long ranked first on my go-to list of journals. It is my reliable source for current, rigorous, and innovative public health research, policy, and commentary. Although I was familiar with and had even published in Perspectives From the Social Sciences (under the section’s previous name), I still had trepidations about what meaningful contribution I, as an editor, could make to an already strong and thriving section.

The core mission of this 12-year-old section—called Framing Health Matters when AJPH associate editors Deborah Holtzman and Kenneth McLeroy launched it in 2006 and Perspectives From the Social Sciences since 2016—is to advance the contributions of the social sciences to public health theory, research, and interventions. It accomplishes this mission through publication of recent high-quality, theoretically grounded, multidisciplinary and transdisciplinary research conducted via diverse methods, as well as synthesis and review articles. This mission is unaltered. That noted, readers will find some nuanced changes, most notably a greater emphasis on critical perspectives.

CRITICAL PERSPECTIVES

Critical perspectives interrogate, expose, and challenge assumptions about policies, institutions, and practices that obscure power relations that foster inequality and oppression and conceal how dominant groups construct knowledge, facts, and problems. Critical frameworks offer a useful antidote to epistemologies of ignorance—willful ignorance about inequalities such as White supremacy, sexism, heterosexism, and classism—that function to “maintain hierarchy and harm in the name of the common good or the social contract.”^1(p186) Examples of this abound in public health, but two will suffice.

The first example involves the common practice of highlighting sociodemographic variables such as race, ethnicity, gender, socioeconomic status, and sexual identity (to name a few) as explanatory, without regard to how social processes (e.g., stigma) and systemic factors (e.g., institutional discrimination) based on these variables influence inequitable health outcomes. This practice also has moorings in conventional biomedical and psychosocial theoretical frameworks that conceptualize health primarily as a property of individuals rather than in a social–structural context. The predominance of these conceptualizations explains the relative void of theory, research, and interventions (not to mention education and training) focusing on the multilevel and macro-level (and modifiable) policies and practices that contribute to health inequities.

The second example involves the noncritical embrace of the language of health disparities (versus health inequities) within US public health.² This practice obscures the fact that most of the health differences deemed disparities are not naturally occurring differences but, rather, ones rooted in historical and systemic inequality. As noted by the World Health Organization, health differences between privileged and marginalized groups, because they are unnecessary and avoidable by reasonable means, are unjust and inequitable rather than merely representing disparities.³

Critical perspectives are hardly new to AJPH. Critical theoretical frameworks such as levels of racism,⁴ critical race theory,⁵ intersectionality,⁶ and ecosocial theory⁷ have made noteworthy inroads into AJPH in recent years, prodding the field to acknowledge the significant impact of power and inequality on health. Countless health inequities—for example, that the maternal mortality rate among US Black women, regardless of their socioeconomic position, is more than double that among White women—underscore an urgent need for critical social science perspectives to inform public health theory, research, and efficacious and cost-effective interventions.

ENCOURAGED SUBMISSIONS

To this end, I encourage submissions to Perspectives From the Social Sciences that focus on the following priorities:

• Critically engaging with public health theory, research, and interventions: To date, much of the critical work published in AJPH has been theoretical. An important next step is the application of critical perspectives to empirical research. In addition, given the commonalities among many of these perspectives, there is a need for work that highlights their complementarity (e.g., between ecosocial theory and intersectionality) or opportunities to enhance conventional biomedical, psychosocial, and other social determinants of health theoretical frameworks (e.g., human rights, political economy). The field would also be strengthened by work that applies critical perspectives to issues such as emergency preparedness, disaster relief, and climate change.

• Emphasizing strengths and assets: Individual and group deficits are often the primary lens of social science theory, policy, and practice. There is an important need for work examining the undertheorized and understudied strengths and resources of individuals and communities (e.g., resilience, religion, spirituality, social capital, community- or neighborhood-level resources, social support, resistance, positive identities) to improve interventions and health.

• Advancing multilevel and structural interventions: Despite burgeoning advocacy for structural interventions, there is a substantial dearth of theoretical and empirical work on the development, implementation, and evaluation of multilevel (i.e., individual, community, neighborhood level) and structural interventions to guide the field and reduce health inequities at the population level.

• Promoting ethical and mutually beneficial community–researcher partnerships: A recurrent theme from community-based activists and practitioners is that stark discrepancies exist in the benefits that the research enterprise accords researchers versus communities. Community fatigue (disgust) with privileged researchers has considerable negative implications for the future of research, interventions, and practice. Needed is work that demonstrates and evaluates best practices for addressing these challenges, many of which are structural (e.g., funding agencies typically prioritize grants to academically credentialed and university-affiliated investigators), including but not limited to community input in defining research problems, equitable sharing of resources and information, and dissemination of results back to communities.

• Abandoning race as an explanatory independent variable and improving the conceptualization of socioeconomic variables (e.g., socioeconomic status, socioeconomic position, class): Similar to socioeconomic variables, race is frequently included in analyses (and often controlled for) despite evidence that it is conceptually meaningless relative to more consequential racial concepts (e.g., socialization, racial discrimination). Needed are more theory and research about how to better conceptualize, measure, and analyze socioeconomic variables at the individual, household, and neighborhood levels.

• Featuring diverse and underrepresented methodologies and methods: On the qualitative front, there is a need to transcend research that, although interesting, is primarily descriptive or qualitative (e.g., focus groups, interviews) in favor of studies that, through rigorous and well-detailed methodologies and analytical strategies, highlight mechanisms or demonstrate novel or in-depth insights into understudied phenomena, populations, or experiences. I also welcome submissions that include underrepresented (at least in the United States) qualitative methodologies, such as discourse analysis, ethnography, photovoice, and phenomenology, that critically engage with public health theory, research, and interventions. As for mixed methods research, I encourage submissions that reflect the fidelity of this distinct approach by integrating quantitative and qualitative methods at one or more stages of the research process. On the quantitative front, I invite submissions that innovate with analyses such as those involving intersectionality, particularly the effects of social processes on groups (between and within) at different intersections of power; intensive longitudinal data (e.g., ecological momentary assessments); and hierarchical models to address multilevel effects. I also invite submissions with a social media methodological focus, regardless of method.

MY VISION

My vision for this section is not only substantive but stylistic. As you may have gleaned, I bring a different voice to scientific writing. This is purposeful. Scientific writing should be clear, precise, and well documented (but not exceed AJPH’s article type word and references limits), but it does not have to be staid or boring. For starters, I encourage submissions that jettison the passive voice, a relic of the postpositivist scientific tradition that often functions to demonstrate objectivity by masking agency (e.g., “analyses were conducted”).

With an eye toward using critical perspectives to advance and enhance the important contributions of social sciences to improving public health, I await your submissions.