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399 Hits

by Jena Webb, Director of Programmes, CoPEH-Canada

October 20, 2022

399 hits header

I recently represented CoPEH-Canada in a project to uncover, describe and systematize best practices for integrating sex and gender (s/g) into integrated knowledge translation (iKT) projects in the fields of occupational and environmental health with the CIHR funded team GESTE (French acronym for “Gender, Environment, Health, Work and Equity”). Among other research activities, we carried out a critical evaluation of the inclusion of sex, gender, and integrated knowledge translation in graduate research projects following the 2018 CoPEH-Canada hybrid course (Vansteenkiste, Saint-Charles and Fillion, 2019). I was also involved in a scoping review of the scientific and grey literature that described such practices. After removing doubles from a second search of scientific databases, we were left with 399 hits. This blog describes my personal journey screening those 399 articles. 

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Through reading the 399 abstracts, I was struck again and again by the multiple injustices that are handed to people, primarily women and non-binary people. Mid-way – in the Ks – I was learning about the European Union’s system to offload refugee screening to Morocco and the sexual violence that the men in charge of checkpoints inflict on refugee women (Keygnaert, et al. 2014). After 75 pages of abstracts on knowledge mobilization in studies on health, equity and gender I came across the first sentence that got to the root of the injustice: “They [the men in charge of checkpoints] seem to proceed in impunity.”

They seem to proceed in impunity.

Such a short sentence. With so much meaning. First, the emphasis was finally removed from the victim and placed on the perpetrator. At last. But, like we do in academia, it was done meekly, hedged. They seem to proceed in impunity.

Later, while I was reading the full articles we had retained from the second screening (n=59), toward the end, in the Ss, I began the only full article yet that dealt explicitly with men’s health, an article about African American men’s experiences with prostate cancer. Here, I read that one of the common supportive themes for these men were the women in their lives (Schoenfeld and Francis, 2016). I had just finished reading 26 articles about women’s health and not one of the articles pointed to the men in their lives being a supportive factor. And here, one of their three main findings was that in order to reach the men, you have to go through the women.

Floored.

Working with women in order to reach men was one of the most recommended solutions offered in this paper. “Repeatedly informants told us that “women [are the ones who] talk about preventative care. We tell everything, you know. And share everything,” and that “[women are] the ones who push their husbands ... to make appointments and so forth” (Schoenfeld and Francis, 2016, p11).

The implications of this are two-fold. First, the women followed by the studies in this review had all these imposed health problems of their own, resulting in some cases from societal inequities begun, at least in part, at the behest of patriarchy, meanwhile, in this example, they are also assuming the responsibility of men’s health problems too.

Second, where were the men in the 26 previous full articles I read? Many of these articles were about cervical or breast cancer. Why wasn’t one of the main findings that men were a supportive structure in their healing or proactive health strategies? Not a peep about this. Nada, ziltch. Perhaps it wasn’t asked, which is in and of itself telling, but in at least one case, as I would discover soon enough, the opposite was found.

A kind of toxic masculinity was on display in this sample of 399 articles focusing on health, equity and gender. Either perpetrator or absent.

Walloped.

Another moment. Among how many moments? I’m 5 articles away from finishing the screening process. Ironically, I’m reading about cervical cancer screening among Latina immigrants. I see the finish line. I see it. This morning, maybe two coffees later, I’ll be done the screening. And I come across this sentence: “because the promotoras identified male attitudes as a barrier to screening” (Gregg et al. 2010). My reflections regarding women being the main supporting factor in men’s prostate cancer process reverberate and are shattered. I had been feeling a “weight” of patriarchy either being the root cause of the inequity-based health issues I was reading about (e.g. violence against women) or, at best, when not to blame, men were neutral (i.e. basically absent). But here I was learning that even when they could very well have played the analogous role as women in the prostate cancer study, that of support, they were a barrier. A reef. Definition of reef: a hazardous obstruction. Barrier/reef. A process of disempowerment.

Great barrier reef

Credit: Wise Hok Wai Lum. This file is licensed under the Creative Commons Attribution-Share Alike 4.0 International license.

 

“A slice of truth” (term Gregg 2010 uses)

Granted, cervical cancer and prostate cancer are far from analogous. Cervical cancer can shine a light on infidelity in a couple, making it rife for conflict, a reef, whereas prostate cancer is unlinked to contentious issues and can, therefore, be a moment to come together.

Yet, then what of breast cancer?

These “399 hits” are a drop in the bucket compared to the incessant set-backs, injustices and slaps in the face dealt to women daily, for 1000s of years. 399 hits of an incalculable harm.

Time, time heals all wounds? No, that is a stance of privilege. The majority of the world is barely out of their previous hardship before the next hits. I have been comfortably reading these articles from the safety of my home during a pandemic through which I was able to continue to work. I made it through the screening. I am on the last of the 19 articles retained and needing a full reading for data extraction. I am seeking a path forward; how I can, not just be witness to this aggression, but be an agent, an authentic agent. And I am gifted these words by Nina Wallerstein, a white settler researcher from an academic, middle-class background:

  • "I began to ask how can I work as a guest on this land? That perception has kept me able to be myself, to say, this is what I can offer, these are the skills I have, and to seek to be a good guest ... then I can work with integrity." (Muhammad, 2015)

We can all - men, women, non-binary people - be guests to other people’s realities. The posture of a guest, it seems to me, is one of humility, gratefulness and care.   

 

References

The 19 articles retained for the scoping review can be found here: Lefrançois, M., Sultan-Taïeb, H., Webb, J., Gervais, M.-J., Messing, K., Blanchette-Luong, V., Riel, J., Saint-Charles, J., Faust, R., Fillion, M., Vaillancourt, C., Laberge M. (submitted the 18th of July 2022, under review). How to carry out participatory research projects that takes account of sex and gender issues? A scoping review of guidelines targeting health inequities. Canadian Journal of Public Health

Gregg, J., L. Centurion, J. Maldonado, R. Aguillon, R. Celaya-Alston and S. Farquhar (2010). "Interpretations of interpretations: combining community-based participatory research and interpretive inquiry to improve health." Progress in community health partnerships: research, education, and action 4(2): 149-154.

Keygnaert, I., et al. (2014). "Sexual violence and sub-Saharan migrants in Morocco: a community-based participatory assessment using respondent driven sampling." Globalization and health 10: 32. 

Muhammad, M., N. Wallerstein, A. L. Sussman, M. Avila, L. Belone and B. Duran (2015). "Reflections on Researcher Identity and Power: The Impact of Positionality on Community Based Participatory Research (CBPR) Processes and Outcomes." Critical sociology 41(7-8): 1045-1063.

Schoenfeld, E. R. and L. E. Francis (2016). "Word on the Street." American Journal of Men's Health 10(5): 377-388.

Vansteenkiste, Jennifer, Saint-Charles, Johanne, Fillion, Myriam. Évaluation de la prise en compte du sexe et du genre dans l’application des connaissances dans des projets de recherche en santé environnementale à la suite d’une formation. In: conference proceedings Le 89e Congrès de l'Acfas; 2019.