For this module’s discussion, research a recent science news event that’s occurred in the last six months. The event should come from a well-known news source, such as ABC, NBC, CBS, Fox, NPR, PBS, BBC, National Geographic, The New York Times, and so on. Post a link to the news story, and in your initial post, identify the following:
Summarize your news story and its contributions to the science or STEM fields.
If your news event is overtly related to diversity, how does this event contribute to diversity studies? If your news event does not directly relate to diversity, how could the science behind your event be applied to diversity studies?
Chapter Title: Inequality
Book Title: How the World Changed Social Media
Book Author(s): Daniel Miller, Elisabetta Costa, Nell Haynes, Tom McDonald, Razvan
Nicolescu, Jolynna Sinanan, Juliano Spyer, Shriram Venkatraman and Xinyuan Wang
Published by: UCL Press
Stable URL: https://www.jstor.org/stable/j.ctt1g69z35.16
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9
Inequality
As one might expect, there is a considerable interest in the capacity of the
internet and social media to produce large-​scale social change. Yet the
question as to whether internet access and social media have improved
the plight of the world’s most disadvantaged populations or have rather
exacerbated inequalities continues and is far from resolved. As previous
chapters have pointed out, social media has had an important impact
on education, work and gender relations, all of which are major components of this wider question. Several of our field sites represent low
income and disadvantaged populations. Here we examine the ways in
which social media may impact on people who do not have easy access
to digital resources, and how their use may be a mode of change – or,
conversely, how it may sustain their current social positions.
The number of people using digital communication has increased
dramatically since the launch of commercial access to the internet in the
mid-​1990s. And it is not just the rich, cosmopolitan and educated; the
current combination of mobile technology and social media has created
a strong interest among various socially underprivileged populations,
including illiterate or semi-​literate people, low-​wage manual migrant
workers and migrants in places such as China, India and Brazil.1
As with all the chapters of this book the evidence will be presented
from our long-​term ethnographic engagement with nine different populations. We see that in each place inequality exists and is expressed in
different ways, depending upon historical processes and current political and social structures. Drawing comparisons, therefore, is not always
straightforward. In every site the disparities of income and wealth, as
well as of social status, are associated with other forms of social difference including gender, age, education, religion and racial inequalities.
Groups in every field site have a perception of their own social position
that is largely relative to others in the same society, rather than set
against some abstract scale.
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What is inequality?
If we contend that inequality exists in a variety of forms, what exactly
do we mean when we ask if social media affects inequality? Certainly
one form of inequality is wealth distribution and poverty. We often
think of the most disadvantaged people as living in slums, with no
possibilities of work and without hope for a brighter future. Yet economic inequalities are often co-​constituted with phenomena such as
racism, lack of political representation and poor access both to physical resources, such as drinkable water or electricity, and more abstract
resources such as education. In some of our field sites people are not
necessarily impoverished, but lack political power. In others a cursory
perusal of their belongings, which might include flat screen televisions
and new Samsung2 mobile phones, obscures the fact that they at times
cannot pay their electricity bill. In other instances inequalities simply
mean that certain parts of the population are discriminated against in
terms of accessing resources, based on characteristics such as race or
religion.3
Bourdieu outlined three different types of inequality corresponding to different types of ‘capital’. Economic capital generally refers to
access to money. Social capital describes the social relationships and
institutionalised networks of which an individual is a part. Cultural
capital includes knowledge or skills gained through education, cultural
goods and qualifications. Each of these types of capital is influenced by
the others, and Bourdieu’s main concern is how they are used by elite
groups to reproduce privilege.
Related to inequality is the concept of social mobility, which refers
to the ability of an individual or group to improve their social position.
Again this may take a number of forms, from better work opportunities to educational resources so that children will have better prospects
in the future. Social mobility is not just about having more money, but
about showing it in the right ways; in essence performing as part of a
particular social class. This may mean buying the ‘right’ brands, owning the ‘right’ appliances, sending children to the ‘right’ schools or even
dressing in a way that conforms to the norms of that social class. What
is ‘right’ is upheld through discourses on taste and ‘distinction’,4 which
are often given a moral value.5 This often requires either turning economic capital into social and cultural capital or indeed finding ways to
acquire the latter in the absence of economic capital. Media technology
has become one primary way in which some less privileged people may
be able to access resources such as information previously only available
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to those with more privilege. It is thus no surprise that the internet may
be posited as a tool for social mobility.
As a result facilitating access to new media is understood to have
become basic to modern development and to helping people find a
‘voice’.6 People who do not have internet access miss out on possible
resources that they could access online. Without the internet they may
experience new and further barriers to improving their access to economic, social and cultural capital, while the rest of society is able to
gain greater resources through its access to new technology. This lack of
access therefore emerges as a force able to exacerbate and widen prior
forms of inequality. Yet internet access does not automatically translate
into greater access to information and resources.7 In fact our field sites
have shown that prior discourses of distinction and difference continue
to influence, to a large extent, the particular ways people use the internet
and social media, often reflective of social class. Furthermore it is entirely
possible that the extraordinary spread of smartphones and social media
does in and of itself represent a form of greater equality, but without that
necessarily having any impact on inequality offline.
Approaches to social media and inequality:
the positive, the negative and the grounded8
The relevant literature can largely be divided into two –​almost entirely
opposed –​camps. The first argues that social media is bound to introduce greater inequality in society through concentrating educational
and networking resources among those who are already privileged.
Alternatively the ‘techno-​utopian’ approach sees social media as a panacea for problems of inequality, giving disadvantaged people access to
greater resources through the internet.
Literature falling within the category of ‘digital divide’ is often
informed by notions that new ICTs exacerbate pre-​existing inequalities
in societies: poorer individuals are excluded, while wealthier persons
are provided better access. Early studies, which focused on access to
the internet itself rather than social media, were conducted largely in
developed countries; they emphasised that, although the vast majority of people had internet access, an important minority either completely lacked or had sub-​standard connections. Often the constraints
that prevented people from benefiting from online communication
were dictated by factors such as age, household income, educational
achievement, English level, disability and rural/​urban location.9
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As internet access has improved and social media and other online
resources have become increasingly available, scholars are suggesting
that other kinds of divides are emerging. Much depends on the different
forms of access, and the specifics of local context, which impacted upon
how people used these technologies.10 It has been proposed that the
‘network divide’ has a greater impact than the ‘digital divide’, and that
the key distinction is now whether people are able to acquire the skills
needed successfully to cultivate their social networks online.11 This
transformation has been informed by an increasing stress on ‘digital literacies’ by some scholars, emphasising that mastering the use of these
networks has become as important as merely being able to access them
(as discussed in Chapter 5).12 Finally there are approaches that look
more to systematic global inequalities. Even if individuals have both
access and skills, there remain huge imbalances between the amount
of content available in different languages or produced in areas of the
world such as Latin America, Africa and India.13
Notwithstanding these issues of inequalities of access mentioned
above, techno-​utopian discourses claim the internet represents egalitarianism, freedom of speech and democracy.14 These works portray
social media as a tool that can be used to consolidate collective power
against powerful institutions, often represented through the polarity
of ‘individual against government’ or ‘consumer against corporation’.
These discourses therefore suggest that social networking acts as a kind
of empowerment, promoting civil protagonism that challenges systems
that produce inequalities.15
As demonstrated in the previous chapter on gender, early internet
commentators wondered whether the online virtual communities that
emerged during the 1990s would stimulate equality by allowing people
free reign to create imaginative online identities that were independent from their own bodies. Such a concept equally has implications for
inequalities based on other aspects of identity, for example age, race,
wealth or class.16 An associated question is whether, given the potential
for online anonymity, social relations could exist apart from differences
based in the body or other ‘offline’ circumstances, instead appreciating
the online domain as a new, independent space in which the mind may
be allowed to roam free of these prior constraints.17 This question is a
key component of the previous chapter on gender.
Less evident in both of these categories of literature, and of greater
significance to our project, has been the way that inequality itself may
mean different things to different people. A growing number of scholars have called for a move away from work that assumes social media
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must have either a good or bad effect on inequality, calling instead for
approaches that consider the complex, nuanced and often contradictory
range of effects that social media has on the ‘messy reality’ of people’s
lives.18 More grounded, ethnographic approaches to internet use by
teens in the US suggest that many of the problems young people face
online remain rooted in long-​running social and racial inequalities.19 For
instance, a study tracing the migration of educated, white, middle-​class
American teens from MySpace to Facebook compared the growing perception of Facebook as offering greater safety than MySpace to ‘white
flight’ (a phenomenon in which affluent whites move to suburbs, away
from the non-​white population living in urban centres).20 Another study
conducted in the US looks at how social media use may exacerbate class
differences, as under-​privileged parents exercise greater control over
their children’s social media use to balance the risks that these young
people face by living in less affluent neighbourhoods.21 Our own project
has endeavoured alongside others22 to broaden the scope of these enquiries, and in particular to use comparison of the inequality found within
each of our field sites with that found between these different field sites.
The diversity of difference
In our field sites in Brazil and rural China many individuals have high aspirations for social mobility connected to education. In our rural Chinese
field site in particular, education is seen to be the key to future social
mobility. Yet our work also acts as a caution in generalising this familiar
observation about education in China, since evidence from our industrial
Chinese site shows how the migration of similar rural workers into the
factory sector has created a class of hundreds of millions who may now
see education as of little value, recognising that they are destined to enter
the factory work force at a young age. Social media is, however, used for
sharing self-​help tips on QQ, particularly tips related to financial success,
which were very frequently shared. In general social media was seen as
a place for enhanced cooperation, providing a place to share information
related to work opportunities or non-​traditional education.
In Brazil lowpaid manual workers have aspirations to use education as a foundation for social mobility, but the actual quality of local
education available in the town was generally quite poor. These low
income populations of young people use social media as a valuable alternative educational resource. Educational YouTube videos that taught job
skills, such as Microsoft Word, were popular and often quite effective as
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a resource for young people hoping to find jobs that would allow them to
achieve their desired social mobility. Although it is not the main object
of our enquiry, we found in several of our sites that it would be hard
to exaggerate the increasing importance of YouTube, in particular, as a
mode for informal education.
In Brazil and in both our Chinese field sites the ability to access
these resources also gave people a sense of self-​esteem, as this technology evoked a feeling of moving from a ‘backwards’ lifestyle towards
‘modernity’. In all three sites informants saw the digital domain as
providing a degree of emancipation – not just allowing them to have
the same smartphones as members of wealthier classes, but also giving them a degree of control over their self-​presentations. Such control
allowed them to craft an appearance more closely approximating to
whom they now perceived themselves to be.
Yet opportunities for self-​presentation are not always considered
advantageous. In the Italian field site, where unemployment among
all groups is high, we have seen in Chapter 6 how young people with
degrees from prominent universities use social media to demonstrate skills that can help them obtain jobs. For young people from
less affluent backgrounds, however, social media can often present
unwelcome pressures to craft a public self-​image. These young people often attend schools that focus on professional skills, for instance
plumbing, mechanics or secretarial skills, and are encouraged to start
working as soon as possible to contribute to the household income.
For them being on social media can feel like a burden akin to a social
obligation –​for example going to a posh wedding where one has to
dress up –​thus making them more self-​conscious of their lower social
position. Here it is the parents who encourage their children to create
Facebook accounts, since they worry that the lack of such a presence
may expose their position of inequality. For these underprivileged
Italians, therefore, being on social media is often an obligation they
would prefer to avoid. Already, then, we can see quite profound differences among the basic relationships between social media and the
aspiration for social mobility.
Making visible social mobility
The control over presentation that was important to Brazilians and
Chinese factory workers reflects the sense that in modern life who one
can be depends increasingly upon who one appears to be. For this one
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needs a good knowledge of the prevailing attitudes to good taste, reflecting back to the earlier comment upon how people try to turn economic
capital into social and cultural capital. In Brazil attaining social visibility for newly enhanced material wealth and other signs of achievement
allowed those from disadvantaged groups to claim entrée into new communities. The implication is that social media has shifted social status
still further in the direction of visibility; today it is simply easier and
more common actually to see people, at least online.
Sandra’s wedding is an example of this process. Sandra, an Afro-​
descended Brazilian, was given up by her parents to work as a domestic servant when she was five years old. This practice of ‘dar os filhos’23
(‘giving their children’) was common among the poorer families in the
region, particularly those of African descent.24 In doing so the parents
ensure that the child will be fed, dressed and sometimes sent to school
while they acquire working practice and skills, such as domestic expertise for girls. Unfortunately, as was common in such circumstances,
Sandra and her sisters were exposed to physical, emotional and sexual
abuse.25 However, Sandra regards one outcome of the experience as positive –​her introduction to evangelical Christianity.
Christianity gave Sandra an incentive to learn to read, so that
she could understand the Bible. Later through church connections she
found a job as a part-​time salesperson at the local Christian bookstore
in the village. This informal job pays only half the minimum wage and
does not include benefits, but she is able to use the store’s computer during quieter hours to play online games and watch Christian movies on
YouTube. Sandra’s primary concern at this point, considering she feels
she has done her share of hard work in life, is not for greater economic
capital; rather she desires a form of cultural capital that has value within
her specific church community.
When Sandra was planning her wedding, she saw it as an important
way to gain full membership in the evangelical community. Evangelical
Christians in the Brazilian field site are often among the most prosperous local families. With the financial help of friends and family, her ceremony included decorations equal to those seen on wedding programmes
on television: flowers, fruits, colourful cloth and fancy illumination, a
proper wedding dress and party food for over 300 guests. With such fanfare she successfully portrayed herself as a socially mobile individual
and part of the evangelical community.
In addition her family asserted their own form of social mobility by selecting many of the official photographs of the wedding to be
displayed on her sister’s Facebook account. This provided a week-​long
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opportunity for all guests to find themselves on the images and comment eloquently on how wonderful the event was. In essence both
Sandra and her wedding guests were able to access a form of cultural
capital through planning, attending and then reminiscing and representing the event through photographs on social media. Just as young
people in the Brazilian field site would rather take a selfie at the gym or
swimming pool than against a plain brick wall, Sandra and her guests
knew that portraying themselves as socially mobile was just as important as actually being able to afford fancy wedding decorations or a gym
membership. This is because of the way different forms of capital, such
as economic resources, taste and social connections, work in conjunction, giving a natural appearance to the fact that some people have more
privileges than others.
A key lesson from the example of Sandra is that we cannot assume
the emphasis on visibility is to be interpreted as a new form of superficiality that comes with social media and its focus upon appearance. In this
case the key driving force is the fundamental principles of Protestant
Christianity, which centuries before social media argued that it was only
through outward appearance that an individual could establish whether
they were among the ‘saved’, which is the primary aspiration for this
branch of Christianity.26 Such principles were also behind the drive for
upward social mobility through hard work and wealth. Zuckerberg may
have provided the means, but Calvin devised the cause.
The limits to social media’s impact on social mobility
While visually portraying upward mobility in the Brazilian field site
is important, the mere photographic evidence of goods considered to
be in good taste does not grant access to elite class membership in all
contexts. Anthropologists encounter many strategies for social mobility that fail, while class differences are reproduced through everyday
actions, often unknowingly.27 These same everyday discourses of taste
are used to maintain inequality among groups with similar levels of
wealth: certain tastes are denigrated as vulgar, kitsch or unsophisticated28 in strictures often associated with race, religion, region, urban/​
rural divides or even a sense of ‘old’ versus ‘new’ class identities (i.e. the
new middle class vs. the old middle class). As much as people in Trinidad
make more use of Facebook’s visibility to make claims to wealth others
find creative and humorous ways to ridicule their attempts as simply
vulgar and unsophisticated. Denigration of taste when going through
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other people’s Facebook accounts is a substantial part of Trinidadian
entertainment today.
We can see these limits by returning to the case of Sandra. Her
ability to use social media to create a new visual identity making clear
what she has now achieved worked with respect to the main part of this
field site that comprised the lower income population. However, there
is also a new, gentrified part of the village, a touristic ocean front resort
area, only about one kilometre away from the core of the village where
low-paid manual workers such as Sandra live. Despite this proximity
the daily contact between these two worlds happens almost exclusively
as a consequence of labour relations: one group works for the other.
Wealthier employers, both online and offline, tend to stay in contact
only with those who share the same class background and thus sense
of taste. They see their values as contrasting with those of the employed
villagers, whom they describe as loud, uncultured and either overly sexualised or overly religious.
These social distances, which developed from centuries of slave-​
based work in that region, remain naturalised and unquestioned. Only
recently have these wealthier residents even recognised that social
media is equally popular among the low-paid families in the region, but
they have no desire to friend the domestic workers they employ. Online
these affluent locals may share among themselves progressive politÂÂ
ical and social views, but this rarely results in transcending the social
boundaries between them and their less well-​off neighbours. Instead
they voice concerns about ecology, often complaining that problematic
low income settlements negatively affect the environment or require
heightened policing to prevent crime. Social media may therefore have
changed the social position of Sandra relative to her peers, but it will
have made no impact upon this wider social chasm between her part of
the village and where the employers reside.
Similarly in Italy many elite social media users become involved in
progressive political activism through Twitter or Facebook, demonstrating their sympathy for left-​wing positions. As in Brazil, however, this
rarely connects to any practical actions that would reduce inequality in
their own village. In Italy ‘caring about the poor’ is a culture in and of
itself that is easy to express on social media, but which may have very
little to do with actual impoverished people in the local area. Their welfare is left to state organisations and the church.
In the same manner that ‘caring about the poor’ signals a certain
class position in Italy and Brazil, portraying oneself as cosmopolitan
or international achieves a similar goal in other field sites. In the south
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Indian field site traditional social divisions were rigidly retained and
policed online, particularly through the content that people shared. On
Facebook wealthier locals share articles, often in English and produced
by international media outlets such as The Guardian or The New York
Times. Both the college-​educated IT executives and the traditional villagers from lower castes have a keen interest in local cinema, politics
and cricket. However, only the content related to cricket is equally likely
to be found on the timelines of the more and less affluent. News about
politics and cinema are differentiated according to caste and class, so
that the affluent post about international art films and Hollywood while
lower income people post clips of Tamil movies. The main impact of
social media is the extended use of claims to cosmopolitanism which
exacerbate prior social differences.
In the Trinidadian field site young female professionals in their
early 20s with university degrees also share images on social media that
display global influences. These images include fancy cuisine served
in high-​class restaurants and photographs of international holidays.29
Other references include the content of fashion bloggers and YouTube
‘vloggers’30 based in the US, UK and Singapore. These online resources
help them to forge a sense of cosmopolitanism based on exchanging
references to global trends in beauty, consumption and lifestyle. Social
media posts make still more visible the differential access that these
individuals have to such international experiences. This same higher
class tries to avoid online forums that discuss sexual relationships and
romance, a key interest and practice for lower income Trinidadians.
Instead they post material about being close to one’s family, sustaining a long-​lasting marriage and the companionship that can be gained
from a partner. Social boundaries are also made explicit by the online
use of derogatory expressions, for example ‘ghetto’ refers to people
who display attributes such as loudness, lack of taste and limited formal education, all associated with lower income Afro-​Trinidadians.
In the case of Trinidad, however, we also find considerable evidence
for how lower income groups contest these attempts to maintain separation through the manipulation of taste. Many humorous and ironic
phrases and gestures on social media are explicitly aimed at puncturing the pretentions and claims made by those who think they are more
sophisticated.
Trinidad has always had a powerful undercurrent of egalitarian
pressure, which has its own weapons in this fight. If social media favours
a visibility that allows the wealthier to portray their sophistication, it
has also become a key site for humour, memes and entertainment. One
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of the most common versions of these is a vast array of fun material
aimed at disparaging the pretentions of these same cosmopolitans and
mocking the ‘arrogance’ of those who appear to ‘think they are better
than everyone else’. This is the flip side to the previously mentioned
entertainment that the elite gain from disparaging the vulgarity of their
social inferiors.
The Chilean field site, situated in the north of the country, is characterised by a certain kind of inequality. The region is quite rich in mineral resources, which are translated into a great deal of wealth for elite
classes in the country as a whole. However, most people in the specific
city of the field site are low-paid manual labourers, who do not receive a
great deal of financial benefits from the mines that extract the minerals.
While steady work is readily available in the mines, and pays more than
other work options, local people still regard themselves as marginalised
and exploited by the international companies and the national government who extract most of the benefits.
This was another site where some people would display pictures on
social media of luxury goods, brand name clothing or vacations in order
to make visible their new wealth. Yet this disrupts the wider solidarity
of the local region31 that is defined in relation to the country as a whole.
As a result such people were portrayed as selfish for not sharing their
wealth and foolish for spending their money unwisely – or even gossiped
about for having possible connections to the drug trade. It was suggested
that people who are too quick to display wealth would really be better
off in a larger city, where those around them valued material goods over
community mindedness. They could thereby become excluded through
social boundaries constructed around an ideology of mutual benefit and
solidarity.
A more successful use of social media than flaunting individual
wealth is as a method of connecting with others through humour. From
disenfranchisement in politics to frustrations with not being able to pay
one’s phone bill or buy a special meal such as sushi, memes, photographs
and text on Facebook often fall into the genre of ‘it’s funny how poor
I am’. Even the relatively well-​off residents of Alto Hospicio post this
genre of comic memes and texts about how funny it is to be poor, recognising this wider solidarity based on the idea that no one is privileged
in the grand scheme of things. This in turn means cultivating a certain
type of pride in their collective marginality.
Though these complaints are usually aimed simply at making
the local audience laugh, in April 2014 an earthquake of 8.2 Richter
magnitude struck the region and the intended audience changed.
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During the weeks and even months that followed the earthquake, social
media – primarily Facebook and Instagram – became spaces to draw
attention to the plight of those affected and highlight the lack of assistance offered by the national government. In particular more than
4000 families were left without homes; they lived in tents for almost
two months before the governmental natural disaster relief agency provided them with temporary housing. During this time social media posts
turned outward from the usual in-​community form of sociality in order
to draw attention to the victims’ plight, and thus pressure the national
government to provide resources.
Conclusion
As shown in our review of the literature, we have to be careful about
what we mean by inequality and how it is generalised. We also have to
differentiate two potential consequences of access to social media: the
equality that this represents in its own right and its potential subsequent
impact on wider forms of inequality. In one sense our evidence is that
social media has created a form of equality. The possession of a smartphone and access to social media by a vast population of low income
people in places such as Brazil, China and India does represent a profound change in their lives. They now have devices of extraordinary
sophistication, often identical to those used by the wealthy. There are
many examples described throughout this book which show how they
are thereby enabled to do much that was not previously possible. So it
would be quite wrong to deny or ignore this form of equality. Yet the
main concern of this chapter has been a more difficult question: what
is the consequence of this online equality for offline inequality? What
most of the examples have shown is that possession of a smartphone
and access or even skill with social media is absolutely no guarantee of
any change at all in inequality offline; it may lessen, but equally may
increase.
This is one of the chapters that most clearly justifies our choice of
title for this volume. Instead of just considering the way in which social
media changes the world, our emphasis has been on the way the world
has diversified social media. As it has become increasingly embedded
in our lives, it comes to reflect the cultural diversity of our world. More
specifically we see that the relationship between social media and social
mobility is extremely different when viewed across all nine field sites.
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This more fully reflects the prior literature on this topic, which was also
found to contain a huge variety of positions from extremely optimistic
to highly pessimistic. So in a way our conclusion is to support this broad
range within the literature, but to then suggest that rather than encountering it as a fight between global generalisations as to an assumed overall impact, it would be better to recognise that most of these stances on
the impact of social media on equality may be appropriate, but to different regions and populations.
One of the simplest examples of how the world changed social
media occurs in the case of south India. Here highly rigid and hierarchical social structures that have developed over many centuries in turn
colonised these new media and made them reflect such distinctions.
Social media has an impact mainly though laying greater emphasis on
differential claims to cosmopolitanism, which can be supported by acts
of sharing international materials found online. This increased emphasis
upon cosmopolitanism is found in most of our field sites, where it generally exacerbates prior inequalities. A similar problem develops in our
Italian field site. Here social media is perceived as an oppressive obligation to take part in something that is bound to make one still more conscious of one’s lower position in society. In all of these cases social media
makes inequality more visible and entrenched.
However, when we turned to the relations between social media,
education and social mobility we found some extremely different cases.
As noted in Chapter 5, the attention to the role of social media with
respect to a high commitment to formal education in rural China is very
different from the use of social media in informal education. This may
be because people do not care much about formal education, which
is the case in industrial China, or because they cannot get access to a
decent quality of formal education, as in the Brazilian site. The use of
social media as a resource within informal education is probably the
most important additional component noted in the first section, which
helps people to struggle against inequality.
Over much of the chapter we saw a tension between two of the
most commonly observed properties of social media. The first of these is
the increase in visibility that it accords, but the second, arguably equally
important, is the use of social media as a site for humour and ironic disparagement. In the case of Sandra and Brazil we found that visibility
can change one’s social position by demonstrating one’s respectability,
and thus be an instrument of social mobility. Yet equally we discovered
the limits to this process, since neither of these goals are achieved with
respect to a larger social distinction that includes employers as well as
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employees. Indeed the use of social media to express concern about the
poor is found to be one of the key boundaries that separate the wealthy
from the poor.
In both Trinidad and Chile we saw people’s use of visibility to
try and portray cosmopolitanism and wealth countered by the use of
humour to prick these bubbles of pretentiousness and advance a more
egalitarian agenda. However, in the final case of Chile we also saw
that, as previously in our Brazilian case, much depends on whether
one’s focus zooms into, or takes a wide-​a ngle perspective on, the
larger landscape. When the people of this locality consider themselves in respect to the larger country, as they were forced to do by
an earthquake, internal divisions become less important than their
bigger relationship to the nation or to the international contexts in
which they all live.
To conclude, this chapter has shown the difficulty in making
claims respecting the impact of social media on inequality. We clearly
do not wish to add to such inequality by failing to respect the different
ways in which people in each site understand and experience social difference. At the same time there is another equally important sensitivity
that consists of not conflating equality of access with any assumed consequences, since one of our most general observations is that the vast
increase in access to social media is no guarantee in and of itself of any
change in other forms of social inequality.
I ne q u a lity
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Multicultural America: A Multimedia
Encyclopedia
Medicine and Ethnic Diversity
Contributors: Author:Kimberly Vess Halbu, Duane A. Halbur & Alexis Rossi
Edited by: Carlos E. Cortés
Book Title: Multicultural America: A Multimedia Encyclopedia
Chapter Title: “Medicine and Ethnic Diversity”
Pub. Date: 2013
Access Date: November 21, 2020
Publishing Company: SAGE Publications, Inc.
City: Thousand Oaks
Print ISBN: 9781452216836
Online ISBN: 9781452276274
DOI: http://dx.doi.org/10.4135/9781452276274.n561
Print pages: 1431-1434
© 2013 SAGE Publications, Inc. All Rights Reserved.
This PDF has been generated from SAGE Knowledge. Please note that the pagination of the online
version will vary from the pagination of the print book.
SAGE
© 2013 by SAGE Publications, Inc.
SAGE Reference
As the 2010 census shows, the United States is becoming increasingly diverse. The shifting demographics
have a strong impact on the practice of medicine in various ways, particularly because patients belonging to
a minority ethnic group such as African American, Hispanic American, American Indian, Alaska Native, Asian
American, Native Hawai’ian, and Pacific Islander tend to have worse health outcomes than their Caucasian
peers. According to the Office of Minority Health, patients from these groups are at a higher risk of illness
and death from heart disease, stroke, diabetes, HIV/AIDS, asthma, hepatitis B, obesity, and certain cancers.
Additionally, the Institute of Medicine found that minorities are less likely to receive certain types of treatment
such as dialysis and transplants, and particular cardiac procedures like bypass surgery.
Ethnic and racial minorities are more likely to receive more drastic procedures, such as amputations, as a
result of diabetes. In order to best provide quality health care for a diverse patient population and overcome
increasingly pronounced health disparities, medicine must take ethnicity and related factors such as religion,
language, and health care beliefs, as well as social determinants of health, into consideration in medical
practice, research, and education.
History of Mistreatment
Ethnic and racial minorities have not always been treated well within the medical field, which has resulted in
mistrust of the medical system within some ethnic communities. Before the civil rights movement demanded
equal treatment, ethnic and racial groups were often separated from Caucasian patients in hospitals, clinics,
and other health care services. Often, these segregated areas for patients of minority racial and ethnic
backgrounds were less equipped than medical institutions that catered to the Caucasian population. Ethnic
and racial minority patients were at risk for being refused treatment, discriminated against, and not given
adequate care, and were often blamed for their condition.
Therefore, taking into account ethnic diversity in the practice of medicine is vital to the diverse population in
the United States. One cannot have the discussion of ethnic diversity and the practice of medicine without
approaching the essential presence of cultural competency for those who practice or are involved in the
process of medical care. Cultural competency is not just the simple knowledge of facts about each culture, it is
also an acquired set of positive beliefs, attitudes, and values that allows for positive and effective interactions
with individuals and groups of people who are culturally different from one’s own group. Cultural competency
is a multifaceted set of knowledge and actionable skills that is essential for application in every interaction,
including relationships from the casual setting to the professional setting. Specifically, cultural competency
in the practice of medicine is a topic of discussion that is now, more than ever, an essential and currently
ongoing discussion as a result of the cultural, racial, and ethnic diversity of individuals in our communities and
workplaces.
For every stakeholder in medicine, from the patient to the doctors and staff who provide care, culture
touches every aspect of health care: patient treatment plans, medication, medical procedures, and the
working relationship of the doctors and staff who deliver these services to benefit the patient. In effect, there
are numerous cultures working together, including the patient, in an effort to provide the best health care
and treatment. Therefore, such an enormous amount of cultural variety calls for knowledge and actionable
skills that address the intersection of many different cultures working together and understand cross-cultural
dynamics in medicine.
The practice of medicine involves a number of culturally sensitive components. Specifically, treatment plans
that involve doctor-prescribed medications and health behaviors must be communicated and articulated in
ways that result in patient ability, understanding, and willingness to follow the prescribed medications and
health behaviors. Therefore, effectively weaving ethnic diversity into the practice of medicine must involve
treatment, treatment plans, and communication that are amenable to patients of all cultural backgrounds.
A few factors that can play into effective medical treatment of ethnically diverse patients include environmental
racism; access to and affordability of treatment; access to and ability to live in healthy environments;
access to and ability to practice a healthy diet; the culture of the individual and the family; family roles in
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SAGE Reference
decision making; views of leaders and authority figures; religious practices; and culturally specific behavioral
factors such as dietary restrictions, use of home remedies, cultural communication styles, and mistrust or
misconceptions about the health care system. In addition, the approach to medications might vary by culture,
ethnicity, and race. An individual’s or group’s decision on when to seek care, levels of pain tolerance, and
genetic differences in medication metabolism and response might also be factors to consider in terms of
medical treatment and culturally related medicines. Therefore, application of diversity to the practice of
medicine while following ethical protocols in treatment is key.
Historically, ethical protocols were not consistently followed when ethnically diverse patients underwent
medical treatment, including the lack of prior consent for medical research. One of the most well-known
instances was the Tuskegee Study of Untreated Syphilis in the Negro Male. From 1932 to 1972, the
U.S. Public Health Service conducted a longitudinal study on syphilis in poor, rural African American
sharecroppers, who were given the impression that they were being provided with free health care when in
fact they had not given informed consent and were denied treatment, even though penicillin had become
the standard treatment for syphilis as early as the late 1940s. As a result of the undisclosed information
concerning diagnosis and possible treatment for the disease, many participants died of syphilis or spread
it. When the story about the unethical study broke, public outcry led to the establishment of the National
Commission for the Protection of Human Subjects of Biomedical and Behavioral Research and federal
laws and regulations that further protect participants in medical research. Additional efforts related to the
development, revision, and enforcement of ethical standards in biomedical research continue today.
Another well-known example of the mistreatment of minorities in medical research is the case of Henrietta
Lacks, who had cervix cells removed, without her explicit permission or knowledge, while undergoing
treatment for cervical cancer. Her cells were then multiplied in the lab, sold, and used extensively in research,
with no financial recompense to Henrietta Lacks (who passed away from the disease) or her family. As a result
of Henrietta Lacks’s case, the ethical issue of informed consent became standard protocol within the medical
system. These two infamous cases, as well as countless other instances of discriminatory medical practices
based on stereotypes, prejudice, and ignorance, widened the power gap between the medical community of
mostly Caucasian male doctors and the ethnically and racially diverse patient populations that they served.
Ethnic and racial minorities were also barred from entering medical school, with the first African American
doctor graduating from an American medical school in 1847. However, it was not until much later that medical
schools were desegregated. Continued discrimination, lower access to quality education and mentoring, and
socioeconomic factors still create barriers that prevent ethnic and racial minorities from applying to and
entering medical school.
Contemporary Medicine
As U.S. demographics have diversified and the struggle for equal rights has reshaped American society, the
practice and teaching of medicine have changed. Since the 1960s and 1970s, medical schools across the
nation have focused efforts on programs designed to increase and diversify the physician workforce so that
doctors will better reflect and serve the diverse demographic populations that make up American society.
Efforts include continued work on pipeline and baccalaureate programs that help prepare underserved,
underprivileged, and ethnic and racial minority students to become competitive applicants for medical school
through academic counseling, standardized test and interview preparation, and rigorous biomedical courses.
However, certain ethnic populations are still underrepresented in medicine, and more work needs to be done
earlier to encourage young students to dream about and prepare for a career in medicine and to help them
graduate from college. The Supreme Court will rule on whether or not race can be considered as one of
many factors in the admissions process, and the Association of American Medical Colleges (AAMC) has
filed an amicus brief in support of race as an important component to consider in the holistic admissions
process, as a way to help diversify the student body to the benefit of all students and future patients.
Expanding the definition of diversity to also include students from rural backgrounds, those who are financially
disadvantaged, first-generation college graduates, members of single-parent households, and nontraditional
students will also help ensure that the physician workforce better mirrors society at large.
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Related to diversifying the physician workforce is a focus on primary care and serving the underserved.
Despite having one of the highest rates of spending on health care per individual, the United States lags
behind other nations on health outcomes. Part of the reason for this is that there are many populations in
the United States that have restricted access to care, lower education and awareness of positive health
behaviors, and a lack of health insurance and access to nutritious food and preventative care.
More attention also needs to be placed on raising the awareness and skills of physicians for understanding
and addressing social determinants of health. Knowledge of the external factors that impact the health of
patients is an important factor in designing relevant health care plans. Further understanding of how medical
treatment and prescriptions may differ for patients of various ethnicities also needs to increase through
targeted recruitment efforts for medical research and trials, as well as research topics that consider the social
determinants of health in prevention and treatment procedures.
Funding for this type of research also needs to be provided and encouraged on all levels. Grants with a
public health focus can contribute to a knowledge base and medical innovations that can help the most at-risk
populations while benefiting the health care system as a whole by decreasing health care costs and improving
patient health outcomes. Established in 1986, the Office of Minority Health focuses on the development of
programs and policies targeting racial and ethnic minority populations, with the goal of improving health and
eradicating health disparities. Continued work needs to be done on how inequities in medicine perpetuate
health disparities, and how to better address social determinants of health and health outcomes through
changes in the medical system, a shift from a focus on treatment to prevention, and an increase in access to
quality care.
Great strides have also been made in raising the general level of awareness and acceptance of the
importance of culturally competent health care that engages diverse patients. An additional focus on patientand family-centered care that takes into consideration each unique individual’s situation, environment, health
beliefs, and practices, has recently become ingrained into the medical school curriculum and general policies
of hospitals throughout the country.
These changes in medical practice, which allow patients to have a voice in their treatment, enhances
the delivery and effectiveness of health care through the creation of relevant health care plans that are
tailored to the individual. Additionally, curriculum in medical schools and professional development training for
physicians needs to include elements related to diversity and inclusion, health disparities, social determinants
of health, and how these factors influence medical care, treatment, and patient outcomes.
Topics focusing on the development of cultural competence skills, such as communication, addressing
language barriers by working with an interpreter, knowing and addressing religious barriers, and ethnic health
beliefs and practices, are just a few of the skills that physicians need in order to accurately treat a diverse
patient population. Additionally, ethnically diverse faculty members are at higher risk for being unsatisfied
in their positions, for experiencing a longer period before and between promotions, and for leaving medical
education more quickly than their Caucasian peers. More work needs to be done to improve the medical
education and working environments to create a more inclusive and welcoming environment for diverse
faculty. Improving the retention rates of diverse faculty in academic medical centers and teaching hospitals
will help provide students from underrepresented ethnic backgrounds with mentors and role models who may
have had similar experiences and barriers that they overcame.
Technological advances in medical care may help improve the health of all patients and allow for focused
attention to be placed on addressing health disparities. The move toward electronic medical records allows
for better communication and access to medical information between health care professionals and the
people they serve. The practice of medicine continues to expand its recent focus on interprofessional and
interdisciplinary teams, which increase the chances of relevant care and adequate followup and improves the
information flow between health care professionals in various settings that serve the same patients.
Transcript
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SAGE Reference
Interprofessional and interdisciplinary teams also help address certain challenges in treating ethnically
diverse patients, such as potential language barriers and religious beliefs. Culturally and Linguistically
Appropriate Services developed standards for working with patients who have diverse cultures and languages
in order to provide equal opportunity for representation and access to health care services in a manner that
will ensure that the best and most appropriate care will be provided to the patient. Related is health literacy, or
the ability to obtain and understand health care information. Even when a patient’s mother tongue is English,
he or she may still have a low health literacy that affects medical care by preventing him or her from taking
medication properly, understanding where best to seek care for particular ailments (such as a primary care
facility versus the emergency room), communicating with the physician, or understanding health care costs
and reimbursements.
Addressing the linguistic barriers of language and health literacy, alongside the possession of awareness and
understanding of the social determinants of health, disparities, and historical reasons for mistrust within ethnic
and racial minority communities are important factors in the provision of quality, culturally competent medical
care for all patients. With culturally competent care, medicine can eradicate health disparities.
•
•
•
•
•
•
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patients
racial minorities
health disparities
medical schools
cultural competency
health care
medicine
Kimberly VessHalbu, Georgia Health Sciences University
Duane A.Halbur & Augusta State University
Alexis RossiGeorgia Regents University
http://dx.doi.org/10.4135/9781452276274.n561
See Also:
•
•
•
•
•
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Culturally Responsive Pedagogy/Culturally Relevant Teaching
Disability and Ethnic Diversity
Ethnopharmacology
Health Beliefs and Practices
Health Disparities and Ethnic Diversity
Public Health and Ethnic Diversity
Further Readings
Chin, M. H., et al. “Interventions to Reduce Racial and Ethnic Disparities in Health Care.†Medical Care
Research and Review, v.64/5 Suppl. (2007). http://dx.doi.org/10.1177/1077558707305413
Jones, James H.Bad Blood: The Tuskegee Syphilis Experiment. New York: Free Press, 1992.
Nelson, Alan. “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.†Journal of the
National Medical Association, v.94/8 (2002).
Skloot, Rebecca.The Immortal Life of Henrietta Lacks. New York: Crown Publishing Group, 2010.
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