Spotlight: Tanisha Spratt on the importance of intersectionality in racial health equity

Dr Tanisha Spratt is currently a Senior Lecturer in racism and health at King's College London. Her PhD is in Sociology from the University of Cambridge, and she completed her postdoctoral research in the Nuffield Department of Primary Care Health Sciences, University of Oxford. Tanisha has since worked at the University of Greenwich as a Lecturer in Sociology and was a Visiting Research Scholar in the Center for Health and Wellbeing (CHW), Princeton University.

Susanna: Hi Tanisha it's really great to meet you. Thank you for your time in discussing this very relevant topic. Would you like to give a brief introduction about what your role entails and how you came to it?

Tanisha: Sure. People often ask me what it means for me to study racism and health and I basically explain it in that I seek to understand how racism impacts health. So, for example, by looking at how racist environments, social structures, ecosocial practices, and day-to-day experiences affect our health. And here I’m talking about racism in different forms, so it could be institutional, interpersonal, internalised, systemic, or all of the above. I’m really interested in questions around individual responsibility when it comes to racism-induced ill health. For example, when thinking about how environmental racism impacts our health considering where the responsibility for this impact lies. Should the state provide us with environments that allow us to live healthy lives that aren’t shaped by racism or should we as racially minoritized people find individual interventions that help us cope with the everyday effects of racism? Should it be a combination of the two? Someone with a positivist mindset might say, how can you know that it's racism that's affecting your health and not something else? And you, as the person who experiences racism, might not know how to describe it in ways that effectively communicate that experience or you might not feel like you want or need to prove it to them. These are very real struggles that people grapple with day-to-day and they come up a lot in my work.

In terms of how I came to this, I actually have a really interdisciplinary background. So, I did my first degree in English and American literature. Then I did my masters at KCL in North American Studies before completing my PhD in Sociology at the University of Cambridge. I then went on to Oxford to complete my postdoc in the primary care department there. Shortly before joining KCL, I was a visiting research Fellow at Princeton University in the US. So I've been all over the place and in lots of different departments and, for me, all of these disciplinary shifts make sense. I think the humanities and the social sciences are so closely related to each other and, when used together, offer really useful ways to think through multifaceted concepts like how racism impacts health.

Susanna: And today's topic is precisely this complexity that we find when we study probably any social topic, but specifically discrimination such as racism, because we may think of racism as discrimination on the basis of race, ethnicity or skin colour. But actually, the topic we will talk about today is intersectionality, [MH1] which means the interconnectedness of different social categorisations including skin colour, race, ethnicity, but also gender, disability or health status, religion, migration, status, nationality, language, etc… the many categories that create overlapping discrimination. To start talking about this topic, we could take your recent published paper on the nuances of colourism, which focuses on understanding light skinned privilege in relation to anti-black racism for Black British women. Could you briefly describe your study and how it relates to intersectionality, in this case regarding the spectrum of light skinned privilege?

Tanisha: Sure. So in 2022 I interviewed Black British women who self-identified as being Black, British, and women to ask them about their experiences of everyday racism and how that affects and/ or has affected their health. I was really interested in whether colourism can be understood as a mitigating factor in this. So, when thinking about colourism, whether lighter skinned Black British women experience less racism than their darker-skinned peers because of their skin colour and, if so, whether this has a positive effect on their health relative to their peers. This kind of work has been done in the US but not really in the UK.

At Harvard, for example, Professor Ellis Monk has looked at how different forms of light skin privilege benefit lighter skinned people of colour compared to their darker skinned counterparts. Experiences of racism are universal, but by looking at this through an intraracial lens Monk shows that there are health differences between both groups that are related to levels of discrimination. In my study, all participants said that they experienced racism. What I didn’t anticipate was the belief that lighter skinned Black British women (who were described by some participants as Mixed) either don’t experience racism at all or experience it to a much lesser extent than their darker-skinned peers. Some participants also conflated white privilege with light skinned privilege, which we know are two separate things. Light-skinned privilege only works at a local level if you are the light skinned person in the room. If you live in a predominantly white environment you might still be thought of as Black despite having light-skin, which means you might still experience anti-Black racism. This doesn’t in any way cancel out the light-skinned privilege that you benefit from at a systemic level, but rather exists in relation to it.

Susanna: And if we were to see this spectrum in terms of health outcomes, could you maybe outline some of the health outcomes for example, for someone who has darker skin compared to someone with lighter skin or white?

Tanisha: There’s a lot of work that's been done in the US showing that there are very clear differences between lighter skinned Black people and darker skinned Black people in terms of health risks and outcomes. For example, Margaret Hunter writes about how colourism shapes the social determinants of health that lead to poor health outcomes. There have been studies showing that lighter skinned Black women are more likely to marry partners in a higher socio-economic bracket than their darker-skinned peers. This means that, in the US, they're more likely to have access to health-promoting resources like health insurance. Studies have also shown that lighter-skinned women are more likely to achieve higher education levels or stay in higher education longer than their darker-skinned peers, which increases their job prospects and earning potential. This, in turn, has numerous positive effects on health.

Susanna: And how does skin colour intersect with gender? Are there differences between the discrimination that a Black woman experiences compared to the discrimination that Black men could experience in the UK or in the US or in other parts of the world based on what you know?

Tanisha: It’s interesting because a lot of work’s been done on beauty capital and the idea that women are under more pressure than men to conform to aesthetic preferences or aesthetic norms through grooming or beauty practices. So when it comes to skin colour, women are believed to be more susceptible to things like bleaching creams and other lightening agents that people think will “improve” or “enhance” their appearance by allowing them to conform to an idealised aesthetic. Aisha Phoenix and Nadia Craddock have conducted studies that have looked at Black British men’s experiences of colourism and found that it’s an issue for some Black men but not for others, so a bit of a mixed bag. Anecdotally, I have Black male friends who would say that this is more of an issue for women and that there’s greater acceptance of lighter-skinned or Mixed Black men within Black male groups.

Susanna: It comes down to social determinants of health, social capital, economic capital, and how much access you have to education, health, housing, etc. So adding yet another layer of complexity: we have, for example, a Black person who is a woman and on top of that, she may be a migrant with undocumented status or maybe an asylum seeker with less rights to social services compared to a citizen. How could this impact health?

Tanisha: I think it adds another layer of complexity, particularly when it comes to healthcare access. In the UK, we technically have free health care at point of access, but this is often a theoretical assessment rather than practical one. There are a lot of barriers in place that make it significantly harder for migrant women to access NHS services than women like me who are from the UK. Whether it’s paying the required immigration surcharge fee, experiencing language barriers, or not trusting healthcare systems that are associated with histories of racial violence. I’m sure you’ll remember there were a lot of conversations about “vaccine hesitancy” during the Covid-19 pandemic within racially and ethnically minoritized groups, and the importance of that history in shaping this.

Susanna: Yeah, and there is this huge difference. For example, in recent history about how Ukrainian white European migrants were treated compared to Syrian and Afghan, or even in the US compared it to Honduran, Venezuelan etc. And there's a disturbing relation to skin colour.

Tanisha: I think all of this is set against a really interesting backdrop of racism denial. Our current UK Government largely adopts a position of racism denial to argue that our country isn’t a racist one despite overwhelming evidence of institutional racism, amongst other forms of racism. The 2021 publication of the Commission on Race and Ethnic Disparities report (commissioned by the sitting Prime Minister) basically denied the existence of institutional racism, citing class amongst other things as the primary driver of racial and ethnic disparities in health. There’s a constant pushback against even using the term racism, which makes this an even more difficult conversation to have when it comes to tackling racial health inequities at policy level. How do you create upstream changes in health policy when there’s a denial that racism even exists? This is another challenge that I think about a lot in the work that I do. 

Susanna: And this denial is a really big barrier because if we are to really tackle this problem, we enter the sphere of transformative justice, involving a radical cultural change. And if we include in this reparative justice, then there should also be a huge historical compensation. What are your thoughts on these two big issues? Who’s responsible for this?

Tanisha: This question about responsibility comes up a lot in my work. When you talk about systemic changes that are needed through forms of transformative justice there are different opinions about how, specifically, this should be done. Do I need to individually manage my health by using lifestyle interventions when I'm engaging with a racist world and, if so, how effective are they in tackling the root cause of the issue? I would argue not very effective at all. It might help me cope day to day but it's not going to transform the society that I live in. It won’t help subsequent generations have improved health outcomes compared to current ones. I also think it's a potentially dangerous proposition because it risks absolving the State from any kind of responsibility for the situations that they often either directly cause or exacerbate through harmful policy decisions. Going back to racism denial this is really key here, because a lot of people who would have read that commissioned report or heard news stories about it would have been really angry because it completely denies any experience they might have of racism in this country. When that experience negatively harms their health, it further denies that correlation. So when reports like this are used to bolster individual-level approaches to health they either do nothing to shift the needle or directly risk causing harm. Transformative justice offers a vital response to this investment in individual-level approaches. Some would say that what we need is abolition and others would say that we need to reform current systems. It would be beneficial to start from this point rather than to question the existence of racism altogether.

Susanna: Totally. And just to close up, I was thinking in terms of age in this spectrum of intersectionality and how that intersects, for example, as a possible intervention of reparative justice. Could we focus on newer generations who may be impacted by historical and intergenerational racism but at the same time offer a unique chance to buffer that racism, for example, through the family? And that could also be a key to transforming future generations because it's a State responsibility, but the State is made by people, so you build this collectively.

Tanisha: That's a really great question. It makes me think about how racism can become embodied. There’s a lot of research that's looked at trans-generational transmissions of trauma. So, for example, thinking about people who survived the Holocaust and the effects that trauma had (and continues to have) on subsequent generations. Studies that have looked at this in relation to stress have shown that trauma doesn't have to be directly experienced to be felt and embodied. Younger generations can carry the stress of older generations forward and not necessarily know that it’s happening. Many people would argue that it’s key for people who raise children to act as buffers against racism by creating an awareness of the fact that children experience racism not because they’re bad but because this thing called racism is bad. The logic follows that, when children understand what’s happening to them, they’re more likely to resist internalized racism and its damaging effects. In this way, this offers an important intervention but it needs to happen alongside policies and initiatives that aim to tackle racism at its root.

Susanna: I agree. Thank you so much