Kagan, Sarah H. PhD, RN
Author Affiliation: School of Nursing, University of Pennsylvania, Philadelphia.
The author has no funding or conflicts of interest to disclose.
Correspondence: Sarah H. Kagan, PhD, RN, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia PA 19104 ( firstname.lastname@example.org).
Accepted for publication January 27, 2014.
Many of us investigate health disparities in adult cancer care. Kagawa-Singer and colleagues1 note, however, that we have made little progress in racial and ethnic disparities here in America. Similarly, poor impact likely holds true in disparities emerging from poverty and old age. Disparate cancer care is not limited to any one society or culture; thus, persistent disparities concern us all.
Recent events in my own geriatric oncology practice prompt me to wonder if it is time to reappraise disparities research to achieve a more robust and actionable equity agenda by better capitalizing on our collaborative skills and values of holism in nursing to advance the science. Transdisciplinarity and intersectionality are tools by which we might achieve progress in crossing disciplinary boundaries and studying social identity in health.
Let me address transdisciplinarity first. As our knowledge of cancer branches in infinite ways, the number of disciplines relevant to inquiry within the scope of cancer nursing research expands proportionately. We rely on interdisciplinary teams to ensure our research is sharply conceived and well implemented, but I worry that the explosion of knowledge has outpaced our current collaborations.
In maintaining established interdisciplinary teams, we also tend to maintain disciplinary boundaries and epistemological domains. The questions “what to do with new data?” and “how to frame those data?” gravitate to familiar answers.2 We incline toward fitting new information into accepted models. As a result, teams may not offer sufficient energy to transcend disciplinary boundaries in order to advance research and may limit capacity to produce new data and new understandings that emerge in crossing those bounds.
Effective inquiry into the cancer experience is increasingly complex, informed by diverse sources of information that do not belong in any single discipline. For instance, demographic variables and data may be viewed within demography or claimed and reclassified by branches of anthropology and gerontology. These same variables may be used in research by a clinically oriented interdisciplinary team. The experience and genesis of disparate cancer care clearly warrant such pluralistic perspectives. I believe the study of disparities and practice of health and social equity must be ever more tangibly transdisciplinary in order to heighten the impact of research in redressing disparities.
Next, I address intersectionality—most approaches to health disparities depend on isolation of factors and reduction of influences in order to highlight outcomes.3 Conversely, our knowledge of cancer reveals a web of interconnecting influences, processes, outcomes, and experiences. The need to elucidate interconnection between and among concepts, principles, and relationships implies that continued reliance on reductionist frames limits value and progress in disparities research. Studies of health disparities are often straightforward explorations of outcomes for people who share one or a few characteristics. In structuring studies, the focus is commonly on defining separable disparities and using accustomed demographic variables to operationalize the social determinants of health hypothesized to create disparate care.
Disparate care is a complex and nuanced human experience, one generally not well represented by reducing it to 1 or 2 characteristics, such as socially ascribed race and gender. Increasingly, integrative and interpretive approaches reflect intricacy in the experience of disparities.3 Improved understandings of intersecting social identities result when the person is treated as an integral whole. Intersectionality provides critical conceptual perspective on those intersecting social identities. It helps explain the social and cultural dialectics that create more and less inequitable experiences in health and social care as well as society at large.
Opportunities to inquire into daily human experiences within cancer care burgeon if we shift our vantage point and our frames for inquiry. Investing in synthesis of health equity and social justice to closely examine person, relationships, processes, and outcomes implies utility in using transdisciplinarity and intersectionality. If Kagawa-Singer and colleagues1 voice what is surely a shared concern for us all, then it is time to try different strategies to achieve health equity for all.
1. Kagawa-Singer M, Valdez Dadia A, Yu MC, Surbone A. Cancer, culture, and health disparities: time to chart a new course? CA Cancer J Clin. 2010; 60:(1): 12–39.
2. Adler NE, Stewart J. Using team science to address health disparities: MacArthur network as case example. Ann N Y Acad Sci. 2010; 1186:(1): 252–260.
3. Williams DR, Kontos EZ, Viswanath K, et al. Integrating multiple social statuses in health disparities research: the case of lung cancer. Health Serv Res. 2012; 47:(3 pt 2): 1255–1277.