Putting MIGRATION and ETHNICITY on the Women's Health Map

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by BILKIS VISSANDJÉE, MARIE DES MEULES AND ALISHA APALE

Health is more than a biological or genetic construct. It is also a reflection of social determinants, including the socio-cultural, political and economic conditions and circumstances of one’s life.

Income, education and marital status are known as the classic social determinants of health. But the conditions and circumstances of our lives are always changing, sometimes only a little, sometimes drastically. These classic determinants are interactive and responsive to other social determinants that affect our health, such as family dynamics, care-giving responsibilities, knowledge of resources and personal and collective access to them. Use of and control over health care services, products and research, as well as how, when and to what extent one contributes to the decision-making processes in homes, communities, and the national and international arenas also determine health status.

The “staple” social determinants of health such as income, education and marital status provide a helpful starting point in unpacking the dimensions of women’s health. However, some women’s health researchers are asking if it is enough to look at these classic determinants in isolation. Out of context, how relevant are such determinants to the health experiences of all Canadians, including women who have only recently come to know Canada as their home? If we have not yet grasped the full picture, how does a limited understanding of the determinants of health contribute to disparities in health status between women and men, recent immigrants and Canadian-born citizens, rich and poor?

Perhaps an analogy is most helpful here.

If we think of women as a conceptual map, detailed with the markings of a busy inner-city, multi-lane system of pathways, routes and directions, we can visualize ourselves as a composition of multiple intersections, called identities. Gender, the social norms and perceptions associated with being female or being male, has long been understood as the main intersection within which women interact. However, we also encounter various other intersections—or identity markers—such as age, sexual orientation, ability, religion, and language.

Migration experiences and ethnicity are also part of the complex system of pathways and “identity intersections” women navigate, and a strong body of research demonstrates that both play a large role in shaping the classic social determinants of women’s health and illness experiences. Yet, neither has been systematically integrated into women’s health research. For example, although ethnicity, sometimes—mistakenly—used interchangeably with race, is often interpreted based on how one looks, this aspect of ethnicity only scratches the surface. More substantially, ethnicity refers to several overlapping variables of our identity, including birthplace, language, religious affiliation, and duration of residence in a given country. Ethnicity is both a product and producer of culture—the ideas, symbols and traditions that shape our worldview. It shapes both the meaning of health and illness as well as health behaviours.

Migration broadly refers to mobility and can occur either within a country or internationally. It can be voluntary, forced or a combination of the two. An “immigrant population” is not always homogeneous. Rather, in the context of migration, women and men can fit into any one or more of the broad categories associated with identity, including age, length of residence in a country, religion, ethnicity, and knowledge of host country languages.

When women encounter unequal access to economic, social or political resources or opportunities as a result of their ethnicity and/or migration experiences, they are much more likely to suffer persistent disparities in health and illness. But if ethnicity and migration are systematically locked out of the analysis—if they are not represented on the map of pathways and “identity intersections” women navigate—these significant aspects of women’s lives remain invisible. Travelling without a comprehensive map does not facilitate a successful journey.

Integrating ethnicity and migration into how we understand women’s health challenges the uni-dimensional definition of a woman, where gender is the primary unit of analysis, defining who women are, what we need, what our interests are and what challenges, frustrates and motivates us. Researchers affiliated with the Metropolis Project (Centres of Excellence for Research on Immigration) as well as contributors to the “Women’s Health Surveillance Report: A Multi-Dimensional Look at the Health of Canadian Women” are working to refine such an understanding in order to better understand the effects of social determinants such as ethnicity and migration experiences on women’s health.

While we may not have a lot of control over which intersections we encounter as we live our lives, we can decide which direction we take at each intersection. In the context of the evolving nature of Canadian society, the challenge is to assess on an on-going basis the myriad of conditions which influence, in one way or another, women’s diverse health needs and interests, as well as to create opportunities to re-think programs and policies in order to reduce inequities and work towards increasing a common experience of good health.