2022 Academy Health Comments

Health Equity Tourism Panel — Organized by Dr. Elle Lett

Thank you, Dr. Lett for organizing this panel and providing us an opportunity to address this important issue. I am also grateful for you agreeing to join me as Associate Editor for the journal Health Equity. Before I begin my formal remarks, I’d like to state that I use she/her pronouns and attendees have my affirmative consent for photos, posting on social media and sharing my thoughts, I do ask that you tag me @mclemoremr on all platforms. If Nazis, bots, and trolls are the only content people have access to on social media, then we can’t complain about rampant misinformation.

Let me open my comments with some brief definitions. Reproductive justice (RJ) was coined by 12 Black women as a response to the limited frameworks of individual choices. RJ simply defined as the human right to maintain bodily autonomy, have children, not have children, and parent existing children in safe and sustainable communities. The specific definition I use was more developed using a participatory process (Black Mamas Matter Alliance [BMMA] Research Working Group, 2020) and posits that every person has the human right to:

• Decide if and when to become pregnant and to determine the conditions under which they will give birth;
• Decide they will not become pregnant or have a baby and options for preventing or ending pregnancy are accessible and available;
• Parent children they already have with dignity and with the necessary social supports in safe environments and health communities without fear of violence from individuals or the government;
• Disassociate sex from reproduction; health sexuality and pleasure are essential components to whole and full human life.

This framework is comprehensive and developed, widely theorized and published in 2 books in 2017 and 2018. So, you can imagine my horror to receive a manuscript for peer review lead by an almost all white team using concept analysis of existing literature to attempt to retrofit reproductive justice on to public health nursing. I won’t detail all of the missteps in the process of how this paper was ultimately published, nor the co-authors I assembled to rebut the piece and the rupture and repair process I’m currently engaged in with the senior author of the paper as that has been beautifully documented by Usha Lee McFarling in Stat News. I would like to use my minutes here to help our community of scholars present at this session to understand the early warning signs of Health Equity Tourism and how to develop and simulate courage to reduce it.

GATEKEEPERS: Right now, I’m talking specifically to peer reviewers. Journal Editors you are our first and last lines of defense for what makes it into our scientific repositories. I would ask you to take seriously the subject matter, author list, and conceptional and operational definitions prior to deciding to send out manuscripts for peer review. At some point as a field, perhaps we need a paid meta-consortium of community-members, people with lived experience, and actual race and racism scholars to provide contextual reviews similar to how we use biostatisticians on journal review boards. Peer reviewers, you need to carefully be watching for positionality, collaboration, and co-optation of ideas, work, and citational practices. Authors, you need to realistically assess and yourself these questions: Just because data exist, are available, and can be analyzed — is it you that needs to be doing it? What are your epistemological stances when selecting reference groups for analyses? What are the operational definitions of the variables you are using? What assumptions are embedded but not named in your work? Let me use a concrete example to make this clear. I think marital status is the most ill-defined variable we have after race and/or ethnicity. I often state that when two poor people marry and have children, they tend to be poorer because now there are more people who are supported by the same income.

Moving from publications to hoarding of resources and grantsmanship, I would also push teams who want to do health equity research without being tourists to take seriously the notion that your process should match your content. Team composition cannot and should not be predicated upon decoration. In other words, all the Black, Indigenous, Latinx and other people of color cannot languish in lowest paid, employee ranks without budgetary and/or other decision-making authority. I have an entire lecture on health care reparations that I could do, however if community members and people with lived experience are expert by experience enough for you to extract their data, like you they can be included in grant applications to be compensated for the expertise and not just honoraria and gift cards to be remunerated for their time.

I could go on, but I would like to ensure enough time for about these important issues. I will end with a word to the funders of research in the room as well. Demanding interprofessional teams that are intergenerational — a mix of early career, mid-career, and more senior people needs to become normalized. Providing community generated mechanisms for research participation including community based institutional review boards is necessary or accountability and oversight. Finally, I would ask that you reimagine high-risk/high-reward research, timelines, requests for applications and distribution of resources based on need. One thing that I think needs to be said is that as long as federal funders, specifically NIH continues to have problems funding Black scientists, ideas, and innovation, but will fund all white teams or established investigators who conduct neutered research that is harmful — it is your job as a philanthropic community to not perpetuate that harm.

I will end my comments here and look forward to hearing and learning from the other panelists and the discussion after their comments.