Pia and Zach posed some interesting questions. Thanks for those.  Here is what they asked:

“i’m interested in hearing your take on the intersection of gender and race. my impression is that race and gender become important in situations of vulnerability, that is when these categories are noticed — what do you think? in my experience, a narrative has to arise in order to explain this position of vulnerability/inferiority, but do you think it could also arise out of a situation of perpetuating superiority/privilege? for me, race and gender are often interchangeable categories of hierarchy, and are hard for me to separate, but perhaps they are separate. additionally, do you think that we (even the learned liberals ) perpetuate disparities in health, in salaries, in social position? what’s your take on that? lotsa questions!”

Race and gender in my mind are not interchangeable but they can definitely intersect.  Is race real?  We all have a racial identity and that colors both opportunities and perceptions of self and others and is often a major contributor to policies that differentiate access, opportunity, and position in the social structure.  Given what we know now about biological diversity, is there good science behind race?  We know that most racial classifications are based on pheontype (skin color, hair type) and not on genetics and that there is more racial diversity within “racially classified groups” than between two different groups. Race is better understood as a social construct from which other policies and definitions have emerged.

There are social constructs about gender and there is a biologic basis for assignment in most cases, but not for beliefs about differences in capabilities.

Both gender and racial beliefs can play into health and health status, because much of what makes up health is from the social determinants. Health, defined by the World Health Organization in 1948, is “a state of complete physical, mental and social well-being and not merely the absence of disease of infirmity.”

If by vulnerable you mean at risk for poor health outcomes, less opportunity for optimal social and physical health, yes both race and gender can result in some group relegating based on “race” or gender to a status that has vulnerability.  First around the world, racial designation and gender are factors in what is being called social exclusion or having a lesser relationship than another group in the social, cultural, political, and economic domains.  This exclusion  results in less access to opportunities and resources, which impacts health.  Second, gender inequalities result in poor outcomes for women and children of both genders and we know that education of women plays a major role in improving the economic health of a country.  The drawing below from Dalgren and Whitehead (1991) outlines what impacts health; clearly there is much more than from genetic burden of disease.

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