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A New Paradigm for Understanding Health Disparities

By Barbara Wallace

A teacher may enjoy the beautiful leaves of autumn, but once in the classroom may be stunned by empty seats – particularly in an inner-city school. Asthma, which in some neighborhoods disproportionately affects children of color by a 6-to-1 margin, is contributing to absenteeism.

Researchers must recognize the impact of asthma and other health disparities on diverse populations. But they also must avoid engaging in "blame-the victim" or "deficit-oriented" research.

“Blame-the-victim” research identifies key factors producing a health disparity as being located within  the individual -- effectively neglecting factors in the social-environmental context that have helped produce that disparity, both historically and in contemporary times. “Deficit-oriented” research focuses on deficits attributed to members of the diverse group, while neglecting evidence of their strengths and resilience in the face of stress. Far too much research tells this same sad story over and over again: Members of historically oppressed racial-ethnic groups fare worse than whites.

A new paradigm investigates relationships among health status; experiences of specific sources of stress in the socialenvironmental context, such as racism or factors associated with poverty; various coping strategies that respond to that stress; and demographic and other variables. By adopting this paradigm, researchers can not only conceptualize and document the resilience of many diverse groups, but also understand ways that many “problem behaviors” represent attempts to adapt and cope with stress. Researchers can then focus on distinguishing between adaptive and maladaptive attempts to cope with stress. Not to be forgotten, social action for social justice and advocacy may be among the adaptive responses — whether by members of diverse populations, researchers or teachers.

Before this century's end, I believe that teachers will enter urban classrooms and encounter greater evidence of health equity. However, key to this vision is a paradigm shift, away  from “blame-the-victim” and “deficit-oriented” research and toward  research that identifies adaptive coping with stress. A diverse population may become a source of vital information on adaptive coping responses that can guide the creation of prevention strategies and interventions within health education. Within the new paradigm I am recommending, those formerly studied from "blame-the-victim" and “deficit-oriented” perspectives can emerge as resilient teachers of "what works" in coping.

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