Diversity & Inclusion Intersection of Disability and Race or Gender (Then and Now): A Disproportionate Effect

Intersection of Disability and Race or Gender (Then and Now): A Disproportionate Effect

By Anika Backster, MD; Wendy Coates, MD; Jeff Siegelman, MD; and Jason Rotoli, MD, on behalf of the Accommodations Committee Subgroup of the SAEM Academy for Diversity & Inclusion in Emergency Medicine Introduction

People with disabilities represent the largest minority group in the United States (U.S). Native Americans and African Americans stand out as the U.S. groups with the highest prevalence of disability. Both racial minorities and people with disabilities experience marginalization — but what happens when you identify with both groups? In 1989, Kimberle Crenshaw introduced the concept of intersectionality as the complex interaction between social forces, social identities, and ideological instruments through which power and disadvantage are expressed and legitimized. She discussed how singleaxis analyses (i.e. viewing only one’s race or gender or ability but not any combination of them) of a person often fails to capture the complexity of one’s lived experience.

Are there compounded socioeconomic, educational, or health effects of being a member of more than one minority group? There may be challenges to finding such information because the traditional medical perspective of disability pervades our culture and scholarly research, often dismissing disability as a natural consequence of biological deficiency or aging and conflating disability with poor health.

Historical Perspective

Use of disability to justify slavery was common in U.S. history. Both sides in the U.S. civil war promoted the idea of slaves having intellectual disability. The antislave movement expressed the horrors of intellectually impaired slaves being mistreated, and the pro-slavery side expressed the need for continued slavery to “protect the weak.”(Forret). Such is our history, that the entanglement or intersection of race and disability should not be overlooked, much less ignored. Marginalization from society and the sustaining of cultural normalcy was often accomplished using oppressive discourses. These took place between the majority and minority groups and often between different minority groups to pit the oppressed groups against each other. Thus, groups felt the need to stress being “abled” and a woman, or “abled” and black as a reason for their equality. For example, ableism was sometimes used to advocate for a marginalized group’s rights. If a marginalized group was “able” then they could and should be equal. The 1848 Declarations of Sentiments and Resolutions (the Seneca Falls Women's Rights Convention) states: "the equality of human rights results necessarily from the fact of the identity of the race in capabilities and responsibilities.” Here we see, ableism prevails, and disability is seen as being less than. Another example is seen in the case of Sojorner Truth (a women’s rights activist and abolitionist). If you look, her

“Kimberle Crenshaw introduced the concept of intersectionality as the complex interaction between social forces, social identities, and ideological instruments through which power and disadvantage are expressed and legitimized.”

photographs depict her holding knitting needles with her disabled right hand (with knitting being a task she would not have been able to perform). Also consider the line from Truth’s famous speech, "I have plowed, and planted, and gathered into barns, and no man could head me —and ar'n't I a woman?” Here you can see how she portrays her own ableism in order to challenge the cultural discourses that sustained race and gender hierarchies (Minister).

Recent History

Health impact

Despite this more evolved understanding of race and disability, there is still evidence to show that racial minorities receive more negatively stigmatized disability labels in comparison to white counterparts with the same disability. For example, “learning disability” was initially created to justify underperformance of white middle class children. More recently, this term (and intellectual disability) is more commonly applied to racial minorities and economically disadvantaged children while white children are more commonly diagnosed with attention-deficit/ hyperactivity disorder (ADHD) or autism.

Another place where health, race, and disability intersect is with COVID-19. The COVID-19 pandemic disproportionately impacted racial minorities both in acute disease and Long Covid resulting in significant numbers of disabled people. These patients, who are also majority female, must now face many hurdles including protecting their family’s income through Social Security Disability Insurance (especially for an invisible illness like Long COVID) and worker’s compensation, as well as long standing dismissiveness of doctors towards invisible illnesses.

Education Impact

Cumulative effects of disability and race are seen in the early educational system: minority students may have reduced opportunities in early education. Additionally, they may have disabilities identified later or may not receive the same level of accommodation as others. Over time, this widens the gap.

The school suspension rate of children with disabilities for Black boys is one in four and for Black girls it is one in five. As of 2015–2016, schools suspended black students (8 percent) at rates more than twice as high as white (3.8 percent) and Hispanic students (3.5 percent). Further, schools suspended children with disabilities (8.6 percent) at rates more than twice as high as children without disabilities (4.1 percent).

What’s Next?

Increasing our awareness of the intersectionality between race or gender and disabilities helps us address individuals and become more inclusive. Listen to each other’s lived experiences and learn from them. Lastly, recognize that someone may belong to more than one marginalized group and there may be socioeconomic, educational, and health implications for this intersectionality.

ABOUT THE AUTHORS

Dr. Coates has been a disability rights advocate for more than 25 years. She is a professor of emergency medicine at UCLA Geffen School of Medicine/ Harbor-UCLA Emergency Medicine where she specializes in education research. She is the 2022-2023 president-elect on the SAEM Board of Directors. Dr. Backster is an assistant professor of emergency medicine, Emory School of Medicine. Dr Backster is interested in promoting and educating on all forms of diversity and creating an inclusive environment for them. Dr. Seiegelman is associate program director in the department of emergency medicine, Emory University School of Medicine, and an attending emergency medicine physician at Atlanta's Grady Memorial Hospital. Dr. Rotoli is the associate residency director of the emergency medicine residency and director of the Deaf Health Pathways at the University of Rochester. He has a passion for improving the health literacy and health care for anyone who requires an accommodation, especially the deaf ASL user.

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