Conceptualization of Othering in public health

Abstract

Background Othering refers to various constructed notions of belonging and creates boundaries between Us and Them, which is embedded in power relations. Othering, thus, provides an essential contribution to understanding the link between minority status and health inequalities. So far, Othering is not considered in explanatory models on health inequalities; one reason for this is that Othering for this field of research has not yet been sufficiently investigated either theoretically or empirically. Also, there is no systematic concept that provides well-founded knowledge of the mechanisms of Othering. Methods A theoretical-analytical investigation was carried out to establish Othering as an analytical concept in public health research. The use of the term Othering varies among research areas. A theoretical framework was developed by drawing insights from a socio-psychological, postcolonial, and intersectional theory. After fundamental differences and similarities of the different theoretical approaches have been worked out, Othering was conceptualized as a multidimensional construct. Results Othering affects health in different ways as it occurs in multiple dimensions and forms that vary according to marginalized groups and institutional as well as social contexts. Othering takes place as a semantic differentiation between Us and Them and constitutes a material hierarchy within a dominant order of belonging. On this basis, Othering has an inclusive effect by treating Others as a particularly vulnerable group and then offering support to them. Othering also creates social exclusion and reinforces disparity in material resources of othered groups. Exclusions of the Other affect access to material resources such as health, for example, by legitimizing restrictions and access barriers in health care. Conclusions The developed conceptual framework provides an analytical lens through which the relationship between Othering and public health can be further explored. Key messages Othering refers to various constructed notions of belonging and difference that engender marginality and structural inequality. Othering can be considered as an essential social determinant of health.

‘Us-Versus-Them’: Othering in COVID-19 public health behavior compliance

“…Othering is a construct that creates boundaries of ‘us-versus-them’ and has implications for health outcomes based on power relations. Othering has been used to understand health inequities in marginalized (othered) groups as well as other social contexts [ 1 ]. Although our study was not originally conceptualized using the othering framework, the findings resulted in an analysis that involved contextualization of results through the othering lens because participants attributed negative COVID-19 behaviors to other groups, setting them apart as representing characteristics opposite to the participants.…”

“…Othering has been described in the context of healthcare service disparities and discrimination against a variety of groups in other healthcare contexts, including among minority groups, drug users, or who identify as non-binary [ 30 , 32 , 33 ]. Othering is gaining recognition as an explanation for disparities in public health [ 1 ].…”

“…Othering is a construct that creates boundaries of 'us-versus-them' and has implications for health outcomes based on power relations. Othering has been used to understand health inequities in marginalized (othered) groups as well as other social contexts [1].…”

“…The polarization of viewpoints and politicization of issues related to public health recommendations has become commonplace. Othering, which is described as a generic construct that may explain disparate public health outcomes based on perceived group identity within a society [1], has become apparent across the globe, with heightening misconceptions, xenophobia, and negative racial undertones particularly against those of Asian descent but also towards migrants, refugees, or other marginalized groups [2][3][4][5][6].…”

The power struggle: exploring the reality of clinical reasoning

“…This occurs because the birthplace of healthcare professions and practice can be understood as imperial rule (Moore, 2019). Imperials systems have their roots deeply imbedded in the oppression and disenfranchisement of those perceived as ‘other’ (Akbulut et al, 2020; Hafiz, 2020; Ramugondo, 2015) and therefore still linger in models of healthcare which favour a minority of the population (McKenna, 2012). Based on these findings, we suggest that clinical reasoning cannot be seen as a static skill, rather it is a complex and multi-layered process that needs to be used to account for the influences of imperialism and power dynamics within institutions, policy and practice.…”