The coin model of privilege and critical allyship: implications for health
The coin model of privilege and critical allyship: implications for health
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DOI：
10.1186/s12889-019-7884-9
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发表时间：
2019-12-05
影响因子：
4.5
通讯作者：
Nixon, Stephanie A.
中科院分区：
文献类型：
--
作者：
Nixon, Stephanie A.
健康不平等现象普遍而持久，其根源是社会、政治和经济原因，而不仅仅是行为或遗传原因。变革性变革的一个障碍是，人们倾向于将这些不平等视为社会结构的不公平后果，从而导致不利，而不考虑这些相同的结构如何给其他人带来不劳而获的优势或特权。在医疗公平的讨论中压倒特权是一个严重的缺陷，因为一个人如何框定问题决定了随后可能的解决方案的范围。如果不平等完全被视为弱势群体面临的问题，那么应对措施将永远只针对这些群体的需求，而不会纠正造成劣势的社会结构。此外，回应将忽视从这些相同的结构中获得不劳而获和不公平优势的必然群体的共谋。换句话说，我们错过了更大的图景。在这种对健康不平等的概念化中，我们限制了采取颠覆性行动来结束这些持久模式的可能性。本文的目标是通过引入一个变革性变化的框架：特权和关键平等的硬币模型，促进对健康不平等和健康的社会决定因素的理解和行动。首先，我介绍了这个模型，该模型解释了社会结构如何产生不劳而获的优势和劣势。该模型采用了一种交叉的方法，以理解性别歧视、种族主义和能力主义等不平等体系如何相互作用，从而产生复杂的特权和压迫模式。其次，我描述了实践批判性联盟的原则，以指导处于特权地位的人抵制产生健康不平等的不公正结构的行动。该条呼吁所有从事卫生工作的人采取行动，(1)承认自己的特权地位，(2)利用这一理解，将他们的方法从拯救不幸的人转变为团结一致地工作，并对不平等制度采取集体行动。
Health inequities are widespread and persistent, and the root causes are social, political and economic as opposed to exclusively behavioural or genetic. A barrier to transformative change is the tendency to frame these inequities as unfair consequences of social structures that result in disadvantage, without also considering how these same structures give unearned advantage, or privilege, to others. Eclipsing privilege in discussions of health equity is a crucial shortcoming, because how one frames the problem sets the range of possible solutions that will follow. If inequity is framed exclusively as a problem facing people who are disadvantaged, then responses will only ever target the needs of these groups without redressing the social structures causing disadvantages. Furthermore, responses will ignore the complicity of the corollary groups who receive unearned and unfair advantage from these same structures. In other words, we are missing the bigger picture. In this conceptualization of health inequity, we have limited the potential for disruptive action to end these enduring patterns.The goal of this article is to advance understanding and action on health inequities and the social determinants of health by introducing a framework for transformative change: the Coin Model of Privilege and Critical Allyship. First, I introduce the model, which explains how social structures produce both unearned advantage and disadvantage. The model embraces an intersectional approach to understand how systems of inequality, such as sexism, racism and ableism, interact with each other to produce complex patterns of privilege and oppression. Second, I describe principles for practicing critical allyship to guide the actions of people in positions of privilege for resisting the unjust structures that produce health inequities. The article is a call to action for all working in health to (1) recognize their positions of privilege, and (2) use this understanding to reorient their approach from saving unfortunate people to working in solidarity and collective action on systems of inequality.