Diversity and Political Leaning: Considerations for Epidemiology

Abstract

The positive effects of increased diversity and inclusion in scientific research and practice are well documented. In this issue, DeVilbiss et al. (Am J Epidemiol. 2020;189(10):998–1010) present findings from a survey used to collect information to characterize diversity among epidemiologists and perceptions of inclusion in the epidemiologic profession. They capture identity across a range of personal characteristics, including race, gender, socioeconomic background, sexual orientation, religion, and political leaning. In this commentary, we assert that the inclusion of political leaning as an axis of identity alongside the others undermines the larger project of promoting diversity and inclusion in the profession and is symptomatic of the movement for “ideological diversity” in higher education. We identify why political leaning is not an appropriate metric of diversity and detail why prioritizing ideological diversity counterintuitively can work against equity building initiatives. As an alternative to ideological diversity, we propose that epidemiologists take up an existing framework for research and practice that centers the voices and perspectives of historically marginalized populations in epidemiologic work.

Abbreviations

PHCR

Public Health Critical Race Praxis

SER

Society for Epidemiologic Research

Editor’s note: The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the American Journal of Epidemiology.

Addressing the lack of diversity in the academic and applied health sciences is a crucial task for research and clinical institutions, as well as individual academics and public health practitioners. As DeVilbiss et al. aptly note in their article presenting findings from a survey on diversity and inclusion in the Society for Epidemiologic Research (SER) (1), evidence indicates that diversity in science is associated with numerous positive effects (2–4). Most importantly, a diverse constituency of scientists produces better science and is more effectively able to translate that science to develop solutions to complex social problems (5, 6). Despite consensus on both the utility of and moral imperative for diversity in science, the scientific community has not agreed upon a definition of diversity.

The definition operationalized by DeVilbiss et al. characterizes diversity as “the variety of attributes represented within a particular social group or structure on many axes including, but not limited to, race, socioeconomic status, class, gender, sexual orientation, country of origin, ability, culture, politics, religion, etc.” (1, 7). SER’s investment in diversity and inclusion is a laudable step toward building out diversity among epidemiologists, and we commend the organization for conducting the recent survey. Briefly, results from the survey identified that SER members overwhelmingly are White, heterosexual, and middle to upper-middle class, indicated through proxies of intergenerational affluence such as childhood housing stability, parents with graduate education, and lack of public assistance during childhood (1).

Although women compose a majority of SER’s membership, it is important to note that, despite this majority, women were less likely than men to feel welcomed in the organization (1). Likewise, it is crucial to view these results through an antiracist lens to remind us that women of color historically have been excluded from medicine and the health sciences (8) and note that women of color reported feeling the least welcomed in the organization, compared with men of color and White women and men (1). Despite composing a minority of membership, White men reported feeling the most welcomed (1). Indeed, there is much work to be done.

The survey findings are a foundation on which SER can build a professional organization and scientific community that reflects, engages, and honors the diverse constituencies we serve as epidemiologists. But this process requires care and critical engagement from the earliest possible stage. We agree with the definition of diversity used for the survey save 1 notable exception, the elevation of politics (i.e., political leaning) as a facet of diversity alongside the other aforementioned dimensions. Our intentions for this commentary are to briefly 1) argue why political leaning is not appropriately described as a dimension of diversity and 2) highlight an alternative diversity framework that centers the voices and perspectives of historically marginalized populations in epidemiologic research and practice.

POLITICAL LEANING DOES NOT EQUAL DIVERSITY

Results from the SER survey indicated that the majority of epidemiologists identify as politically liberal and that conservative epidemiologists feel less included in the profession (1). Does this not indicate a disparity of ideology, and, if so, should we strive for equal representation of politics in the discipline? We argue there is not and we should not. The instinct to promote political diversity is based on the misguided premise that increasing diversity merely means increasing the variety of identities, a method that is agnostic to the power and priority those identities historically have received. Instead, we suggest that increasing diversity should create an inclusive environment for those whose identities have been structurally excluded from and marginalized within epidemiology and society at large.

The inclusion of political leaning as part of this diversity and inclusion survey speaks to the widespread public and academic attention paid in recent years to “ideological diversity” (sometimes referred to as “intellectual diversity”), generally defined as a call for equal representation of both conservative and liberal political opinions in academia on the premise that the majority of university faculty identify as liberal (9). The phrase was coined by conservative commentator David Horowitz in his “Academic Bill of Rights,” which has achieved canonical status among conservative academics and politicians since its publication and, with the help of the conservative lobbying group the American Legislative Exchange Council, was reformatted into legislation to mandate conservative faculty representation in universities and introduced to a number of state legislatures during the past 15 years (9). (Notably, proponents of ideological diversity have not called for equal representation of leftist viewpoints alongside liberal and conservative perspectives.) Several prominent education and labor organizations have publicly opposed the “Academic Bill of Rights” and the ideological diversity framework, including the American Association of University Professors (10), American Federation of Teachers (11), American Library Association (12), and American Federation of Labor and Congress of Industrial Organizations (13).

As proof of concept, proponents of ideological diversity in academia often cite that most university faculty identify as liberal and use the classroom to promote liberal politics, despite empirical evidence demonstrating that faculty political leaning is unpersuasive to students and unlikely to change students’ political leaning (14). Public health and medicine largely have avoided or abstained from this ongoing academic culture war—which has occurred primarily in the social sciences and humanities—but it is important that epidemiologists remain mindful of the questions we ask and the assumptions and frameworks that ground our work, lest we fall into the trap of ideological diversity. The subtle gesture of including political leaning in SER’s survey is substantial in that it quietly elides the distinction between diversity and politics.

The inclusion of political leaning in the survey may seem inconsequential or even justified at face value. Why would we not want to know the political leaning of epidemiology as a field? The political constitution of epidemiology may be an interesting research question in its own right, but we argue that the inclusion of politics in a survey expressly designed to capture diversity and inclusion in the field is important insofar as campaigns for ideological diversity primarily have been used as red herrings by reactionary conservative movements to garner institutional acceptance of racism, sexism, homophobia, and Islamophobia (15). Legacies of oppression and exclusion in the United States are indisputably associated with race, sex, sexual orientation, class, and creed. Minority groups, on the basis of all these dimensions, are under attack in the present day by the current US federal administration (16–20). No such legacy exists with respect to political conservatives in the United States. These historical and present contexts make diversity in research and higher education an imperative for members of these communities. If we view the function of increasing diversity as a means to give power to those who structurally have been denied power, it becomes clear that promoting the equal representation of political ideologies, including ideologies that work to maintain power imbalances, works against our collective goal to increase diversity and inclusion.

It is true that as social mores have changed and science has documented the harmful effects of discrimination, persecution, and exclusion on the basis of identity, the broad trajectory of intellectual inquiry in the sciences has changed (21). But these changes as justification for ideological diversity prove hollow on closer inspection; for many scholars, these changes are long overdue. For example, race-based biological research in genetics and the cognitive sciences justifiably has been largely abandoned (22). However, under the guise of ideological diversity, race-differences research persists (23). A similar parallel exists between the overwhelming consensus about carbon-driven climate change among environmental researchers and the persistence of climate change denial couched as ideological diversity (24). As scientists, we know structural inequities have harmful effects on health, and the banner of ideological diversity is no excuse to introduce harm into our collective work.

DIVERSITY IN EPIDEMIOLOGY AND PUBLIC HEALTH

As both an elite profession and a scientific discipline, epidemiology historically has been White, male, upper class, and exclusionary to persons with identities falling outside that narrow scope (25). Historical research has shown that the dominance of White, affluent men in the health sciences has shaped the questions that were asked, the methods that were used, and the answers that were accepted (26). The history of epidemiology is burdened by the historical legacies of racism, misogyny, and Eurocentrism that are part of the histories of science and medicine (27, 28).

Despite the broad public visibility and impact of epidemiology and medicine, these fields have lagged behind correlate social science disciplines with respect to the development and application of robust theories of social stratification and inequality (29). In recent years, however, structural racism and social inequality rightly have become accepted in the health sciences as primary barriers to population health promotion (30, 31). The social determinants of health framework that now predominates thinking about population health and health care delivery is a tremendous step forward with respect to the types of questions we are asking and the types of problems we are solving.

However, closing the diversity gap in epidemiology requires more than asking new questions. It means opening the doors to people of color, queer and transgender individuals, and women, particularly women of color. It means thinking intersectionally by acknowledging the spectrum of interlocking identities that contribute to individual and population health outcomes (32). Centering marginalized voices in the discipline through representation and formal leadership structures (e.g., faculty appointments, journal editorships, leadership at applied institutions such as the Centers for Disease Control and Prevention, National Institutes of Health, and local and regional health departments), is critical to ensure that our discipline’s work is and remains committed to eliminating structural inequities in health (33).

But as the results of SER’s survey demonstrate, representation alone is not enough to build equity and inclusion. Despite their minority in the discipline, that White men felt the most welcomed of all the social groups captured is reflective of structural inequities in society. To ensure that epidemiology contributes science in the public interest and that our findings are used to undo and move beyond structural inequities in and beyond the discipline, it is important that researchers and practitioners engage an explicitly antiracist and intersectional model for science.

The epidemiologist and scholar of health equity Chandra Ford and her colleagues have developed one such model, termed Public Health Critical Race Praxis (PHCR) (34, 35). The PHCR model for conducting public health research places racism and intersecting inequities such as misogyny, homophobia, and economic inequality in the broader structural context that, wittingly or not, is situated as background for all our work. It maintains four focuses (i.e., phases) for conducting research: 1) focus on contemporary race relations for a given study at hand, because epidemiologic research occurs in the present time; 2) focus on knowledge production, including how race and other inequities have been articulated and situated within the background literature and historical context grounding any project, as well as a given researcher’s own racialized beliefs; 3) focus on conceptualization and measurement through questioning how race is operationalized in research, what data are collected or used, and whether the knowledge generated is valid within an intersectional framework for social inequity; and 4) focus on action, which means situating our research findings in a larger social context and striving to see the policy and practice implications of our work (34). We argue that epidemiology would benefit from adopting the PHCR model as standard research practice. In particular, steps 2 (knowledge production) and 4 (action) are critical if we intend for our scientific work to be used in ways that can build a more just world.

Adopting the PHCR model of doing epidemiology can work as an antidote to ideological diversity, which has functioned as a tool to silence marginalized voices. We see the PHCR model as a means of privileging a diversity of inquiry over a diversity of ideology, ensuring that epidemiology remains and expands into a discipline with a broad range of voices asking a broad range of questions using a broad range of methods.

CONCLUSION

In this commentary, we have briefly outlined the need for diversity in epidemiology and extended our support to the work conducted by SER thus far. We have offered an overview of why political leaning is not an appropriate metric of diversity and why prioritizing ideological diversity counterintuitively can work against equity-building initiatives. Finally, we have identified an existing framework for building diversity and inclusion through research that can be applied to public health practice and is compatible with the disciplinary goals of improving population health.

As epidemiologists, our work has illuminated the inequities in our society and offered solutions to undo and eliminate those inequities. Science has shown us that structural racism harms health (36, 37). Science has shown us that cultures of sexism and misogyny harm health, with worse outcomes for women of color (38, 39). Science has shown us that homophobia and stigma toward queer and transgender individuals harm health (40, 41). Science has shown us that economic inequality and austerity policies harm health (42, 43). Science has shown us that Islamophobia and religious bigotry harm health (44, 45). As the discipline builds out its commitment to diversity and inclusion and SER moves forward with the next phase of this research, it is the responsibility of us all to ensure this work happens in ways that truly welcome those whose voices have been excluded.