MHDI FACULTY SPOTLIGHT
Julia McQuillanWilla Cather Professor of Sociology
Date that you joined UNL: August 1998
Hometown: Lincoln, Nebraska
Describe your research and how it contributes to alleviating or understanding health disparities?
My research focuses on social inequality, with special emphasis on changing structures and practices to increase equity and wellbeing. Early in my career at UNL, I got to collaborate on a National Institutes of Health funded study of women and their partners (if they were willing) who were interviewed twice about their fertility and health. We created the National Survey of Fertility Barriers that is available as a public use data set. The study was designed to represent the experiences of women during the ages most vulnerable to infertility (initially 25-45) and was designed to ensure that women who identify as Black or Hispanic were represented in the data (i.e. there was a Spanish language version). Collaboration with Arthur L. Greil and many graduate students, helped answer questions about psychosocial dimensions of fertility and infertility – including health disparities by race/ethnicity and education in outcomes such as rates of infertility, unwanted births, getting medical help for infertility, and sterilization regret.
Through collaborations, I have also explored disparities in non-fatal work injuries by the race/ethnicity of workers and the racial composition of their workplaces, gender, and race/ethnicity differences in self-rated health over time and in depressive symptoms associated with rheumatoid arthritis. Through my work on the under-representation of women and Black, Indigenous, and People of Color in Science, Technology, Engineering, and Mathematics, I was led to work on efforts to attract people from groups historically underrepresented to health fields. Therefore, our National Institutes of Health funded Science Education Partnership Award, Worlds of Connections, brings activities that engage youth with network science concepts to afterschool programs in middle schools, and we connect what we do in club to population health careers. The schools are in high poverty high racial/ethnic minority neighborhoods. We are evaluating the idea that having college students engage middle-school youth with network science based approaches to population health will be more effective than simply having teachers tell youth about careers. Ultimately, our goal is to bring more diversity of experiences, perspectives, and insights to health professions to help meaningfully advance efforts to reduce disparities in the long run. I combine my interests in social inequality and health to work on informal science education as a vehicle for engaging youth with science and meaningful careers. With team members Patricia Wonch Hill and Amy Spiegel, we conducted a four-wave Science Identity Study on middle-school youth. In addition to publications from this project, I was honored that the TEDxYouthLincoln team invited me to give a talk (“How do we find science kinds of people?”) at the 2017 youth event.
As a sociologist, I’m trained to focus on social structures and social systems such as gender, racial/ethnic, and economic stratification as important context for shaping outcomes such as rates of depressive symptoms, access to health care, and infertility. It is hard to directly measure stratification, therefore, much of my work uses self-reported information in surveys of individuals. We use indicators such as gender or racial/ethnic categories or level of education to capture historical practices such as basing medicine on men’s bodies, discrimination in hiring and housing, or the safety of jobs that are segregated as White, Black, Hispanic, Asian, or other groups. Most of my health disparities research has focused on people’s experiences with fertility and infertility. For example, we found that Black women were more likely to experience infertility but less likely to get medical help to treat infertility. Even though we might think of fertility as a “women’s” issue, the variation in women’s social location (e.g. being married or not, lower or higher education, more or less vulnerable to racism, risk of stigma or discrimination based upon sexuality) shapes how women experience fertility barriers. For example, women who identify as Native American are much more likely to report involuntary sterilization than women who identify as White, and women with higher education are less likely to report a birth that they did not want compared to women with lower education. From a Sociological perspective, to call a difference in a health outcome by social categories such as gender, race/ethnicity, education, sexuality, immigration status, rural/urban differences, etc. a “disparity” it needs to reflect socially modifiable conditions.
What inspired you to study health disparities and/or your field of research?
It is hard to pinpoint one thing. When I look back I see many experiences that lead to my interest in identifying unnecessary and socially constructed inequalities that, if removed, could lead to less human suffering. In high school, I was part of a project through our local YWCA called “Peer Health Educators” that was run through the university medical school. Students from each of the high schools in town were trained to provide information to peers about “hot topics” such as sexually transmitted diseases, birth control, illicit drug use, alcohol abuse, smoking, sexuality, and mental health (e.g suicide prevention). We did presentations on these topics in our schools based upon our training and research, and we had coaching on how to give information 1-1 if asked. I was the only white peer educator in the group, most were Black or their families were from Puerto Rico. It is doubtful that I actually helped any peers, but I did learn about racism and poverty in my community that I, as someone growing up white and middle class, was not aware of in my town.
In graduate school, I took a course at the medical school on cross-national differences in health care that emphasized the politicization of health care to control populations. Learning how much social policies matter for seemingly individual outcomes, such as depression or fertility, seemed important and “fixable” to me. I had no idea how hard it can be to change socially constructed practices and policies, but it seemed worth pursuing. I also found inspiration in a series of reading groups, graduate research assistantships, and attending National Institutes of Health conferences and workshops on health disparities (plus discovering the work of David R. Williams) and the creating of MDHI to support fostered, sustained work in this area. If we are successful, I hope we can end the need for health disparities research, but the recent dramatic disparities in COVID19 deaths suggest that there is still much work to do.
What advice would you give to incoming students (graduate or undergraduate) who are interested in studying health disparities?
Your perspectives, questions, challenges to assumptions, and lived experiences matter for efforts to identify and reduce multiple kinds of health disparities. It seems that every day I learn of new ways to think about health, relationships, theories, methods, and the questions that matter. Even naming topics such as decolonizing feminism or One Health frameworks for synthesizing human, animal, and environment connections could become out of date before I even fully grasp their relevance. So often I have done research when I thought I knew the answer I was going to get, and I was surprised to learn that the data did not support my claim. I had to learn more, talk to others, dig deeper, find new collaborators, or try a new methodological approach and/or reflect upon what I learned.
For example, I had an undergraduate student who was very interested in the idea that the congruence or lack of congruence of the race/ethnicity of physicians and their patients could matter for patient outcomes. We looked for data to explore this question (this was in the early 2000s before electronic medical records were more common) and could not find the information that we needed. We did have a large dataset that asked women if they had a regular doctor. We were surprised to find that women who identified as Black were more likely to have a regular doctor than women who self-identified as white. Why? Because we assumed that the historically marginalized and oppressed group would have less access to medical care than the historically privileged group. In another study with another data set I assumed that among women of color, higher education would be protective and support better health with aging compared to lower education, but we found the opposite. These and other projects that produced findings we did not expect reinforced to me why we do the research and how important it is to test assumptions. Open and curious conversations with others who study similar questions has pushed me to explain, in clear terms, what my assumptions are and to justify the theories and methods that I use. Learning to focus on answering questions rather than proving that I am right (a strong tendency I work to suppress) has helped me learn and provide more than being defensive.
What advice would you give to incoming faculty who are interested in health disparity research?
Strive to explain your theories, methods, and findings in ways that an eighth grader could understand, or at least appreciate. Why? Because health disparities research is inherently interdisciplinary and it will be important for people who do not have your training to understand what you do, why you do it in the way that you do, and how it can matter for the larger goal of helping more people have the best chance to have health as conceptualized by the World Health Organization as “a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.” At the same time, for faculty who have a tenure clock, be sure to focus on meeting the criteria and promotion within your home discipline. As exciting, synergistic, and engaging as collaborations will likely be, to be in a position to keep pursuing knowledge that will reduce disparities and increase wellbeing, it is important for most of us to stay employed. Similar to what helpful mentors told me, it is also useful to ask for help, be curious, and admit when you are wrong.
What would your colleagues/students be surprised to learn about you?
Not much! I’m pretty open. I do feel incredibly fortunate that, thanks to my cousin, I discovered Sociology and it has been meaningful and fulfilling to me since the beginning. The only other job I have really enjoyed was scooping ice-cream and doing “mix-ins” on a marble slab. Whenever I think I might not be able to accomplish the next academic challenge, I always know I have at least one other way to bring something good to people.