How we can improve diversity in our research by understanding intersectionality with A/Prof Nada Hamad

In undertaking our research, we seek to develop theories and models to help us better understand haematopoiesis and blood related disorders. What is overwhelmingly clear and supported by extensive data is that our research can be improved by increasing both inclusivity and diversity in our workforce^1,2. When scientists come from diverse backgrounds, they bring with them different experiences, perspectives, and ways of thinking that enrich scientific research. For example, a diverse group of scientists might approach a problem from different angles, or ask different questions, leading to a more comprehensive understanding of the subject. To help us understand more about inclusion and diversity in our own research, the ISEH Junior Faculty Committee asked A/Prof Nada Hamad to help explain the concept of intersectionality.

Dr Hamad began the webinar but outlining her personal journey and in particular an event from around 10 years ago for when she had her first child. During labour she was discouraged from having an epidural as the comment was made that “Your people are really good at childbirth, bearing and birthing, and you don't really need it”. Soon Dr Hamad was struggling with so much pain and ended up on the floor but when one of the nurses walked straight past, they just said, “just suck it up. You can do it!”. Some 10 years later and with 3 children, Dr Hamad went to a talk by a black obstetrician who was talking about black women's experiences with childbirth, and how this issue with dismissal of pain and the negative obstetric outcomes for black women was universal and that obstetric outcomes are worse for black women. This catalyzed Dr Hamad into thinking that her experience was not unique but part of a more universal narrative with accurate medical advice not always provided, in part, because advice was based on research that did not include women of color.

Dr Hamad then went on to explain that ‘Intersectionality’ is a concept that was originally coined by law professor Kimberle Crenshaw in 1989 and provides a framework for understanding how different aspects of a person’s identify (e.g., race, gender, sexuality, class) overlap and interact with each other to shape their experiences of oppression and/or privilege. One of the key points that Nada emphasized was the need to move beyond our simplistic ideas around identity and oppression. She explained that while we often think of identity in terms of single, discrete categories (such as race or gender), the reality is much more complex. For example, we do not simply have a race problem here, or a gender problem there because a person may identify as both black and queer, and their experiences of oppression and privilege will be shaped by the intersection of these two aspects of their identity. In this sense, intersectionality highlights the ways in which different forms of oppression and privilege are interconnected and interdependent.

To help illustrate this, Dr Hamad introduced the Wheel of Power as a visual representation of the different forms of power and privilege that exist in society (Figure 1). The wheel is divided into different sections, each of which represents a different form of power, such as wealth, race, gender, and sexuality. To help navigate this schematic through one’s “intersectionality glasses”, the more characteristics you have on the outside, the more compounded your oppressive experiences are. One of the key insights of the Wheel of Power is that different forms of power are interconnected and reinforce one another. For example, someone who is wealthy is likely to have more access to education, healthcare, and other resources that can contribute to their overall well-being. These various forms of power create a self-reinforcing system which will benefit some groups at the expense of others.

Figure 1 The Wheel of Power

Using the Wheel of Power can help raise your awareness of your own opportunity and oppression while understanding the needs of others. For example, you may not know what it's like to live in a place where the language you speak is not widely used, or to be poor, or to be uneducated, or to or to be in a wheelchair, but you can understand how those experiences are different. Conversely, you may not have considered that body size or not owning a home can lead to marginalization, especially when compounded with other factors.

How does this help us with our research? First, it is important to understand that diversity in science refers to both the diversity of scientists themselves, as well as the diversity of the subjects that are studied. Dr Hamad emphasized that intersectionality is not just a theoretical concept, but a practical tool for creating change. By centring the experiences of those who are most marginalized and recognizing the complex interplay of different forms of oppression, we can create more inclusive and equitable systems and policies. Dr Hamad further explained that one of the actions we can all take when reading papers and analysing clinical datasets, is to ask several questions such as: (i) Whose stories are we missing in our research? (ii) Is the research serving the needs of the community? (iii) What implicit biases are reflected in my research material that will reinforce exclusion of marginalized people? For example, when it comes to AML in black patients – Dr Hamad showed that they are underrepresented in clinical trials, have poorer outcomes, and have less genomic information. Indeed, in black patients with AML, the NPM1, ASXL1 or TP53 status does not have the same prognostic relevance and inevitably leads to incorrect treatments because much of the molecular risk stratification used clinically is based on white patients.

What now? All people, regardless of their race, gender, sexuality, or other characteristics, have the right to participate in science, and to have their voices and perspectives heard. Excluding certain groups from science, whether intentionally or unintentionally, can perpetuate existing inequalities and injustices. But inclusion, equity and accessibility are not end-points to be achieved and moved on from, rather they are a continuous process that everyone, even experts, can continue to learn about and work towards. Nada suggested each of us can check out your own implicit biases here:

https://implicit.harvard.edu/implicit/

https://idiinventory.com

Finally, Nada noted it takes a lot of energy to continuously think about intersectionality and build inclusive, and diverse research environments. However, we can all have a positive impact on the world we live in and be part of the change we want to see. Nada concluded with a simple but important message: if you see bias, kindly call it out, but call it out kindly.

To view the full recording of the webinar, please visit the ISEH website.

1. Science benefits from diversity. Nature vol. 558 5 (2018).

2. Powell, K. These labs are remarkably diverse - here’s why they’re winning at science. Nature 558, 19–22 (2018).

Blog post contributed by members of the ISEH Junior Faculty Committee:
Charles de Bock - @charles_debock
Kellie Machlus - @theclotthickens
Vanessa Scanlon - @VanessaScanlon

Please note that the statements made by Simply Blood authors are their own views and not necessarily the views of ISEH. ISEH disclaims any or all liability arising from any author's statements or materials.