Qualitative methods are not intrinsically progressive. Methods are simply tools to conduct research. Epistemology, the justification of knowledge, shapes methodology and methods, and thus is a vital starting point for a critical health equity research stance, regardless of whether the methods are qualitative, quantitative, or mixed. In line with this premise, I address four themes in this commentary. First, I criticize the ubiquitous and uncritical use of the term health disparities in U.S. public health. Next, I advocate for the increased use of qualitative methodologies—namely, photovoice and critical ethnography— that, pursuant to critical approaches, prioritize dismantling social–structural inequities as a prerequisite to health equity. Thereafter, I discuss epistemological stance and its influence on all aspects of the research process. Finally, I highlight my critical discourse analysis HIV prevention research based on individual interviews and focus groups with Black men, as an example of a critical health equity research approach.

1. https://doi.org/10.1177/1090198117728760
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2017, Vol. 44(5) 677–684
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Perspective
The decision of this special issue’s guest editors to use the
term health equity rather than health disparities in their call
for papers is noteworthy. It underscores feminist psycholo-
gist and qualitative researcher Jeanne Marecek’s (2003)
assertion that “a qualitative stance is grounded in a different
epistemology” (p. 49). Epistemology, the study of the nature,
scope, and justification of knowledge—in short, the answer
to the question, “How, and what can we know?” (Willig,
2013, p. 4)—is foundational to all empirical inquiry.
Epistemology shapes methodology and methods (Carter &
Little, 2007) and the theoretical/conceptual frameworks that
behavioral and social science (BSS) researchers apply to
their research. As such, epistemology is a critical starting
point for health equity research, regardless of whether
researchers use qualitative, quantitative, or mixed methods.
Qualitative methods such as focus groups and individual
interviews are ideally suited for eliciting rich, culturally
grounded, and contextually situated insights into people’s
lives and experiences. Qualitative methods are not intrinsi-
cally progressive, however. Because “epistemology modifies
methodology, and justifies and evaluates the knowledge pro-
duced” (Carter & Little, 2007, p. 1317), epistemological
awareness is an essential prerequisite to a critical health
equity stance in BSS research.
In support of my central premise that qualitative methods
are not intrinsically progressive, I have organized this com-
mentary into four themes. First, I criticize the ubiquitous use of
the term health disparities in U.S. public health and argue that
the uncritical use of this term reflects epistemologies of igno-
rance that function to bolster White privilege. Next, I champion
the need for the use of more qualitative methodologies—
namely, photovoice and critical ethnography—that align well
with critical approaches to health equity. Thereafter, I discuss
the role of the researcher’s epistemological stance and its
influence on all aspects of the research process. Finally, I
draw on one of my intersectionality-informed qualitative HIV
prevention studies as an exemplar of a critical health equity
research stance.
728760HEBXXX10.1177/1090198117728760Health Education & BehaviorBowleg
research-article2017
1
The George Washington University, Washington, DC, USA
Corresponding Author:
Lisa Bowleg, Department of Psychology, The George Washington
University, 2125 G Street, NW, Washington, DC 20052, USA.
Email: lbowleg@gwu.edu
Towards a Critical Health Equity
Research Stance: Why Epistemology
and Methodology Matter More Than
Qualitative Methods
Lisa Bowleg1
Abstract
Qualitative methods are not intrinsically progressive. Methods are simply tools to conduct research. Epistemology, the
justification of knowledge, shapes methodology and methods, and thus is a vital starting point for a critical health equity
research stance, regardless of whether the methods are qualitative, quantitative, or mixed. In line with this premise, I address
four themes in this commentary. First, I criticize the ubiquitous and uncritical use of the term health disparities in U.S. public
health. Next, I advocate for the increased use of qualitative methodologies—namely, photovoice and critical ethnography—
that, pursuant to critical approaches, prioritize dismantling social–structural inequities as a prerequisite to health equity.
Thereafter, I discuss epistemological stance and its influence on all aspects of the research process. Finally, I highlight my
critical discourse analysis HIV prevention research based on individual interviews and focus groups with Black men, as an
example of a critical health equity research approach.
Keywords
critical theories, epistemologies of ignorance, epistemology, qualitative methodology, qualitative methods, social determinants,
social inequalities

2. 678 Health Education & Behavior 44(5)
“Frightening the Horses”: On Health
Disparities, Health Equity, and
Epistemologies of Ignorance
The term health disparities is ubiquitous in U.S. public
health policy and research parlance. In an interview at the
2016 convention of the American Public Health Association,
Sir Michael Marmot (2016), a pioneer in the field of social
determinants of health and World Health Organization
(WHO) Chair of the Commission on Social Determinants of
Health stated, “Firstly, you notice that I don’t use the word
“disparity” which tends to be used in the U.S. for a variety of
reasons.” Then, he speculated, “I think [the word] equality
frightened the horses a bit. Equality doesn’t fit with the U.S.
model of doing things very well” (Marmot, 2016). Indeed.
Health equity research is not socially or politically neutral
territory. The WHO defines health inequalities as health dif-
ferences that are unnecessary and avoidable (Whitehead,
1990, p. 7). Obviously, not all health differences are avoid-
able; mobility differences between youth and elders, or mor-
tality rates of people of different social economic positions,
for example (WHO, 2016). But differences that are unneces-
sary and avoidable, by reasonable means, are unfair and
unjust and, hence, inequitable (Marmot, 2016; Whitehead,
1990).
The HIV/AIDS epidemic in the United States provides a
striking and stark example of a health inequity, one for which
the lead story, “America’s Hidden HIV Epidemic,” in the
June 2017 New York Times Magazine posed this subtitled
question: “Why Do America’s Black Gay and Bisexual Men
Have a Higher HIV Rate Than Any Country in the World?”
(Villarosa, 2017). The article detailed how advances in HIV
testing and medical treatments such as pre-exposure prophy-
laxis (PrEP) had resulted in vastly diminished rates of life-
time HIV risk in the general population (1 in 99), but not
Black men (1 in 20), particularly Black gay, bisexual, and
men who have sex with men (GBMSM) for whom the rate, if
current trends continue, will be 1 in 2 (Centers for Disease
Control and Prevention [CDC], 2016a)! By comparison, the
lifetime rate of HIV risk for Latino men is 1 in 48, and for
White men, 1 in 132.
At the most elemental level, HIV is a clearly a health dis-
parity, “Ahealth outcome . . . seen to a greater or lesser extent
between populations” (Office of Disease Prevention and
Health Promotion [ODPHP], 2017). But characterizing his-
torically observed health differences between dominant
groups such as White people and marginalized groups such
as Black and Latino people in the United States as mere dif-
ferences of magnitude distorts and obscures the root causes
of these differences. These differences are not naturally
occurring, nor are they randomly distributed between domi-
nant and nondominant groups. Instead, these differences are
foundationally grounded in intentional, systematic, and
structured discrimination based on the intersections of race,
ethnicity, gender, class, sexual minority status, and ability (to
name just a few). And these differences are avoidable by rea-
sonable means. Take PrEP as an example. PrEP is 92% effec-
tive in preventing people at very high HIV risk from
contracting HIV (CDC, 2016c). Yet a 2015 survey of phar-
macies (with race data available for 44% of the sample)
showed that Black people accounted for just 10% of PrEP
prescriptions compared with 74% of White people (Bush
et al., 2016). Other research has documented low knowledge
about PrEP among Black GBMSM (Eaton, Driffin,
Bauermeister, Smith, & Conway-Washington, 2015).
In light of findings such as these, the steadfast (and seem-
ingly uncritical) reliance on the language of health dispari-
ties in U.S. public health circles to describe health outcomes
that are clearly avoidable by reasonable means, and thus
inequitable, reflects epistemological ignorance. With its ori-
gins in philosophy, epistemologies of ignorance highlight the
role and function of ignorance in the practice and production
of knowledge (Alcoff, 2007; Sullivan & Tuana, 2007). For
example, conventional biomedical, biobehavioral, and psy-
chosocial frameworks and the public health research, inter-
ventions, and policies they inform typically conceptualize
health primarily as a property of individuals and the result of
individual behaviors (Weber & Parra-Medina, 2003). In so
doing, they obscure the role of social–structural factors (e.g.,
political, economic, institutional discrimination) that con-
strain the health of historically marginalized individuals,
communities, and societies (Blankenship, Bray, & Merson,
2000). Epistemologies of ignorance illustrate that willful
ignorance is functional (Alcoff, 2007; Mills, 1997, 2007).
Neglecting the historical legacy of how race (as well as the
other marginalized social positions that intersect with race)
has structured social inequality for people of color in the
United States serves to center the health experiences of
White people as normative, “color blinds” White privilege to
highlight positive health outcomes among White people as
the product of their individual actions, and reifies negative
stereotypes about the “irresponsible” health behaviors of
people of color (Bowleg et al., 2017).
Epistemological ignorance also has political implications.
It stifles the moral and ethical urgency for research, interven-
tions, policies, and laws to address and eliminate the social–
structural inequalities that undergird and contribute to
inequities in health. The fact that almost 40 years into the
HIV/AIDS epidemic—despite tremendous advances in life-
saving treatment and care, and despite abundant evidence that
Black MSM are no more likely to engage in risky sex, use
condoms less consistently, or have more sex partners than
their White counterparts (Maulsby et al., 2014; Millett et al.,
2012; Millett, Flores, Peterson, & Bakeman, 2007)—HIV
rates among Black GBMSM in the United States exceed the
HIV rates in poor nations such as Swaziland and Haiti, indeed
any country in the world (Villarosa, 2017), affirms a dire need
to “frighten the horses” in U.S. public health research and
policy (Marmot, 2016). Desperately needed is a critical
health equity stance that prioritizes research, interventions,

3. Bowleg 679
and policies designed to dismantle the social–structural
inequalities that contribute to health inequities in the first
place; and not just documents them (Ford & Airhihenbuwa,
2010). As for the methods of research, these matter less than
the epistemology that informs them.
Expanding the Use of Qualitative
Methodologies in Critical Health Equity
Research
Epistemology is also integral to methodology. Although
methodology is often “used loosely” (Carter & Little, 2007,
p. 1318) in the research literature and confounded with
method, methodology is “the study—the description, the
explanation, and the justification—of methods, and not the
methods themselves” (Kaplan, 1964, p. 18). Like epistemol-
ogy, methodology is often invisible but fundamental to
research. And as with epistemology, that many—most?—
qualitative health equity researchers show no or little under-
standing of methodology likely reflects the relative dearth of
formal qualitative research training in the traditional BSSs.
The countless gratuitous references to grounded theory in the
many peer-reviewed journal articles and grant applications
that I have read or reviewed over the years affirm this. These
references often lack mention, discussion, or citation of
foundational aspects of grounded theory such as theoretical
sampling, constant comparison method, simultaneous data
collection and analysis, or coding stages (Glaser & Strauss,
1967; Strauss & Corbin, 1990); no demonstrated awareness
of the rifts between the originators of grounded theory and
the implications of this for analyses and interpretation (see,
e.g., Glaser, 1992); and no acknowledgment of epistemologi-
cal debates (see, e.g., Charmaz, 2000).
Qualitative methodologies or strategies of inquiry (Denzin
& Lincoln, 2000) include a rich array of approaches such as
grounded theory, discourse and narrative analysis, diverse
ethnographies, participatory action research, phenomenol-
ogy, and case studies (Carter & Little, 2007). Methodological
diversity in U.S.-based qualitative health research is scant,
however. Recognizing this, in 2013 Health Psychology, a
high-impact journal of the American Psychological
Association, invited manuscripts for a special issue focused
on expanding the scope of qualitative methods that can be
used in health psychology research (Gough & Deatrick,
2013). The call for papers asserted:
There is much more scope to exploit and showcase the breadth
and depth of qualitative methods in health psychology and their
contributions to the development of scientific advances in the
field. In Health Psychology and other leading journals, several
major qualitative methodologies are absent, including discursive,
narrative, phenomenological and psychosocial approaches.
There is a dire need to expand the qualitative methodolo-
gies that researchers use in health equity research. This issue
transcends innovation and plurality. There is a host of under-
utilized qualitative methodologies such as ethnography,
observation methods, photovoice, archival analysis, and dis-
course analysis. Many of these such as photovoice (see, e.g.,
Wang & Burris, 1997) and critical ethnography (see, e.g.,
Kincheloe & McLaren, 2000) align epistemologically with
critical approaches that emphasize the dismantling of oppres-
sive structures and catalytic validity—the extent to which the
research process prompts participants to understand their
lives and experiences in order to transform them (Stiles,
1993). Moreover, these methodologies are ideally suited to
advancing new knowledge and understanding about the
social–structural context of health inequities in the United
States. Because an overview of all of these methodologies is
beyond the scope of this work, I will briefly highlight just
two: ethnography and photovoice.
Ethnography, which, broadly defined, “combines research
design, fieldwork, and various methods of inquiry to produce
historically, politically, and personally situated accounts,
descriptions, interpretations, and representations of human
lives” (Tedlock, 2000, p. 455), is woefully underrepresented
in U.S. qualitative health equity research. This dearth has
substantial disadvantages. Ethnographic approaches, partic-
ularly those that incorporate participant observation and
visual methods, are uniquely suited to provide more in-depth,
meaningful, and situated understandings of people and the
material and social–structural conditions (e.g., environmen-
tal conditions, poverty, neighborhood context) that shape
their lives and health, and manifest as health inequities
(Tedlock, 2000). Writing about his ethnographic work on
injection drug use, Phillippe Bourgois (1998) asserted,
At the very minimum, participant-observation ethnography can
increase the reliability of information collected in large-scale
surveys of risky behavior that rely on self-reporting [and
facilitate] focused user-informed questions that respond to more
relevant analytical categories . . . and increase the effectiveness
of strategic sampling. (p. 2340)
Photovoice is another underrepresented methodology in
qualitative health equity research. Photovoice is a participa-
tory action methodology in which participants receive cam-
eras to photograph their life conditions. The goals of
photovoice include the following: (a) documenting and
reflecting on personal and community strengths and weak-
nesses; (b) the use of group discussion about photographs to
facilitate critical dialogue about personal and community
issues and concerns; and (c) to target policy makers (Wang &
Burris, 1997). Photovoice has made inroads in public health
research (Catalani & Minkler, 2010) and has been applied to
health equity–related topics such as Latina girls’ perception
of health (Vaughn, Rojas-Guyler, & Howell, 2008), access to
health care among transgender people transitioning from
female-to-male (Hussey, 2006), and poor and racial/ethnic
minority women living with HIV/AIDS (Teti, French,

4. 680 Health Education & Behavior 44(5)
Bonney, & Lightfoot, 2015). With its explicit attention to
critical consciousness, catalytic validity, and targeting of pol-
icy makers, Photovoice is ideally suited to health equity
research.
Against “Methodolatry”: The Lightbulb
and the Electricity
With notable exceptions such as women’s studies, sociology,
and anthropology, many conventional BSS disciplines pro-
mulgate “methodolatry” (Marecek, 2003, p. 50), a venera-
tion of methods and statistics that “sometimes verges on
festishization” (Marecek, 2003, p. 49). Quantitative research-
ers hold no monopoly on methodolatry, however. Many qual-
itative researchers valorize qualitative methods as more
progressive than quantitative methods. They are not.
Research methods are simply tools and techniques. They
represent the practical steps—“sampling, data collection,
data management, data analysis, and reporting” (Carter &
Little, 2007, p. 1318)—necessary to accomplish the action of
research. The notion that qualitative methods are intrinsi-
cally progressive is akin to the idea that lightbulbs, and not
the electric current coursing through them, are the source of
the light. Methods are like lightbulbs. As for the potential for
research to advance health equity, a critical health equity
research stance is like electricity.
The notion that methods are not intrinsically progressive is
neither novel nor revolutionary. Almost 40 years ago, femi-
nist social psychologist Bernice Lott (1981) advanced a femi-
nist epistemology that prioritized the researcher’s “choice of
problems and ultimate objectives” (p. 8) over methods.
Following suit, Marecek (2003) eschewed the term qualita-
tive methods in favor of qualitative stance to emphasize that
qualitative research transcends the tools and techniques of
qualitative data collection and analysis, and to foreground
“the different epistemology” (p. 49) of the qualitative
approach. Like Lott, Marecek (2003) demurred about the pro-
gressive potential of methods: “Neither quantitative nor qual-
itative researchers are immune from such values; neither
procedure offers protections against biased interpretations. In
short, any research approach can be used for progressive ends
or reactionary ones” (p. 55). For Marecek, the distinction
between progressive and reactionary research rests with “the
politics and values that infuse the researcher’s interpretations
of the results” (p. 55). Indeed, epistemological positions also
shape how researchers interpret qualitative data.
Qualitative psychologist Carla Willig (2013) outlines three
key epistemological positions that shape researchers’
approach to and interpretation of qualitative research: realist,
phenomenological, and social constructionist. Realist
approaches presume that there is a social reality out there that
researchers, if they are sufficiently skilled, can discover, iden-
tify, and understand. In this “discovery orientation,” the
researcher assumes the role of a detective with skills, training,
and experience to discover “what is really going on” (p. 15).
By contrast, a critical realist approach does not consider data
to be a direct reflection of the world, but one that must be
interpreted to advance understanding about the “underlying
structures” that shape the topic of study (Willig, 2013).
Phenomenological approaches seek to understand the subjec-
tive experiences of participants, not “discover what is ‘really’
going on or what causes social and/or psychological events to
take place” (Willig, 2013, p. 16). Finally, social construction-
ist approaches attend to how people—researchers in conjunc-
tion with participants—construct knowledge, typically
through language (Willig, 2013). These varying epistemo-
logical stances explain why it is always possible for the same
qualitative data set to yield varying interpretations (Willig,
2013). My own qualitative research reflects this. Using the
same set of individual interviews conducted with a sample of
30 Black heterosexual men in Philadelphia, I used a critical
realist approach to examine the intersectional and social–
structural context of HIV risk (Bowleg, Teti, Malebranche, &
Tschann, 2013), a phenomenological approach to understand
Black men’s subjective experiences of masculinity relevant to
sexual risk (Bowleg et al., 2011), and a social constructionist
critical discourse approach to examine talk about safer sex
and masculinity (Bowleg, Heckert, Brown, & Massie, 2015).
Other factors that shape the extent to which research is
progressive include, but are not limited to, the group identi-
ties (e.g., race, gender, sexual identity, class) and shared
social locations of knowers (Alcoff, 2007); the researcher’s
disciplinary background, in particular, the theoretical/con-
ceptual frameworks that researchers learn during their aca-
demic training; and the role of academic and professional
gatekeepers (e.g., curricula, tenure and promotion commit-
tees, grant and publication peer reviewers, formal and infor-
malpoliciesandpracticesofacademicjournals).Collectively,
these factors combine to influence every aspect of research:
development of research questions/hypotheses, design,
choice of methodology and methods, data analysis, interpre-
tation, and research dissemination (e.g., academic journals,
professional conferences and presentations, social and tradi-
tional media, community stakeholders, research participants,
policy makers).
Many conventional disciplines, such as psychology—the
discipline in which I was trained, are epistemologically
rooted within postpositivism. The postpositivist tradition
asserts that researchers can approximate reality, but not cap-
ture it (as positivists once claimed), and that the use of mul-
tiple methods and strategies best accomplishes this quest
(Guba & Lincoln, 1994). In the qualitative research realm,
this often manifests as a reliance on Kappa statistics, multi-
ple coders, and member-checking to establish “accuracy”
(Carter & Little, 2007). The postpositivist tradition also val-
ues the verification of theories and “discovery.” In qualita-
tive work, this often manifests in the language of “themes
that emerged” as if the themes were there all along just wait-
ing to be discovered (Braun & Clarke, 2006; Charmaz,
2000). That many—most?—of the researchers who conduct

5. Bowleg 681
qualitative health “disparities” or health equity research lack
consciousness about their own epistemological moorings,
and/or the epistemological foundations that undergird the
theoretical/conceptual frameworks that inform their research,
reflects the relative dearth of exposure to formal training in
the philosophy of science, critical theories, and qualitative
research at either the undergraduate or graduate level. A per-
sonal case in point, the qualitative research course that I have
taught in my department since 2014 is the first qualitative
course offered in the history of my almost 100-year old
department. The fact that many researchers, regardless of
their methods, “swim in the waters” of postpositivist episte-
mology “without knowing they are wet” (Marecek, 2003, p.
51) has vital implications for the potential of research to
advance health equity.
Critical Health Equity Research
in Action: An Example From My
Qualitative Research
“Responsible Men, Blameworthy Women: Black
Heterosexual Men’s Discursive Constructions of Safer Sex
and Masculinity” (Bowleg et al., 2015), my critical discourse
analysis study based on individual interviews and focus
groups with Black heterosexual men in Philadelphia, exem-
plifies the synergistic interplay between epistemological
stance (critical health equity) and conventional (i.e., mascu-
linity) and critical (i.e., intersectionality) conceptual frame-
works, methodology (i.e., critical discourse psychology),
and methods (i.e., individual interviews, focus groups).
Although I am excited about the burgeoning developments in
quantitative intersectionality BSS research (Bauer, 2014;
Bowleg & Bauer, 2016; Else-Quest & Hyde, 2016), I still
maintain that qualitative methods are ideally suited to the
built-in complexities of critical theoretical frameworks like
intersectionality (Bowleg, 2008). Intersectionality asserts
that people’s multiple marginalized social positions (e.g.,
race, gender, and sexual minority status) and the social pro-
cesses based on those positions (e.g., discrimination) inter-
sect to reflect socially structured privilege and inequality
(Bowleg, 2012; Collins, 1991; Crenshaw, 1989). Since space
constraints limit an in-depth recounting of the study, I will
focus on the points most relevant to the study’s critical health
equity research stance and direct interested readers to the
study for more detail.
U.S. Black heterosexual men are at increased risk for
HIV compared with heterosexual men from other racial/eth-
nic groups. In 2015, for example, Black men accounted for
65% of new HIV cases among men who named heterosexual
contact as their mode of HIV exposure (CDC, 2016b). Yet
HIV prevention research and messages focused on Black
heterosexual men, and studies that center the experiences
and narratives of Black heterosexual men, are surprisingly
rare. Informed by research on masculinity, and discourses
about safer sex and HIV risk, and guided by a core tenet of
intersectionality that the vantage point of historically mar-
ginalized groups is foundational (Bowleg, 2012), we exam-
ined how a sample of predominantly low-income Black
heterosexual men in Philadelphia constructed safer sex and
masculinity in their discourses about relationships and sex
with women. Critical discursive psychology, our chosen
methodology, was well aligned with our epistemological
stance. Critical discursive psychology highlights the action
orientation of language, essentially how people construct
identities, motives, selves, and so forth through talk
(Wetherell & Edley, 2009), as well as how broader “external
public dialogues” shape everyday talk (Wetherell & Edley,
1999). The following extract from one of the study’s focus
groups highlights a key finding, a construction that we
named “blaming women for STI/responsibility for safer
sex.” In response to the focus group facilitator’s question
about how women communicated their interest in condom
use, speakers engaged in a lively call and response exchange.
The boldface text highlights loud and animated talk.
Speaker 1: No! No a lot of ‘em [women] don’t say nothin’
[about condoms]!
Speaker 2: They don’t care!
Speaker 3: They don’t care! And that could stop a lotta
the issues [of sexually transmitted infections]!
Speaker 1: . . . In some cases, they may think it’s up to
us to have the condoms.
Speaker 4 (interjecting): They’re ignorant! That’s their
excuse!
Speaker 2: Yeah, they don’t care!
Our analyses relevant to the role of discursive context—
specifically, focus groups versus individual interviews—pro-
vided valuable insights about how each method shaped our
findings. We found that compared with participants who were
interviewed individually, focus group participants used more
frequent profanity, particularly sexual profanity, and more
sexist language to describe casual sex partners. The focus
groups, as is characteristic of the method, also featured more
discussions about norms such as what Black men should do
and think, more point and counterpoint interactions, and more
concurrent speech. In our discussion of the implications of the
study, we highlighted how the men’s discourses about blame-
worthy women aligned with public health HIV prevention
discourses and campaigns such as the CDC’s (2014) Take
Charge, Take the Test that positioned Black heterosexual
women, but not heterosexual men as responsible for condom
use and HIV prevention. We believe that this interpretation
provides a key illustration of how a critical health equity
research approach paired with qualitative methods can
advance new knowledge about health inequality and inequity.
Rather than reinforce negative stereotypes or pathologize
how Black men in these studies spoke about women and sex,
our epistemological frames and interpretation relevant to van-
tage point and social–structural context allowed us to

6. 682 Health Education & Behavior 44(5)
highlight how factors beyond the level of the individual (i.e.,
public health campaigns and discourses) may shape Black
men’s discourses and, in turn, condom use.
Towards a Critical Health Equity
Stance: Dismantling Versus
Documenting Health Inequity
Black lesbian feminist scholar Audre Lorde’s (1984) admo-
nition that “the master’s tools will never dismantle the mas-
ter’s house” (p. 110) is, for researchers who conduct health
equity research, a mantra worth remembering. Notably,
research was not Lorde’s focus. Rather, the subject of Lorde’s
ire was a feminist conference that neglected the experiences
of women at the intersection of race, sexuality, class, and
age. Nonetheless, Lorde’s questions and answers have pro-
found implications for epistemology and methodology in
health equity research: “What does it mean when the tools of
a racist patriarchy are used to examine the fruits of that same
patriarchy? It means that only the narrowest perimeters of
change are possible and allowable” (p. 111).
Health equity research devoid of a critical epistemologi-
cal stance and praxis risks “examining the same fruits” of
social–structural inequity regardless of whether researchers
use qualitative methods or not. Conscious or unconscious
adherence to conventional epistemologies (e.g., “methodola-
try,” fidelity to objectivity), clinging to theoretical frame-
works that neglect critical or social–structural perspectives,
and the reiteration of semantic euphemisms such as “health
disparities,” reflect epistemologies of ignorance that thwart
the ability of research “ . . . to bring about genuine change”
(Lorde, 1984, p. 112). Nor is research the only or most
important route to advancing health equity. Grassroots mobi-
lization, political activism and advocacy, engagement of
community stakeholders and research participants, and tar-
geting policy makers to work to address, reduce, and elimi-
nate the social–structural inequities that disproportionately
affect historically oppressed groups are all critical steps in
the fight for health equity in the United States. Research that
documents health differentials among these groups but lacks
a critical consciousness about the moral and ethical urgency
of dismantling the social–structural inequity that contributes
to health inequity in the first place offers just a “narrow
perimeter of change” (Lorde, 1984, p. 111). To affect genu-
ine change in health equity, qualitative health equity research-
ers must defy epistemologies of ignorance about the root
causes of health inequity in the United States, utilize critical
theoretical frameworks and methodologies, and commit to
critical praxis and political engagement in the fight to dis-
mantle social–structural and health inequities.
Acknowledgments
I am grateful for the research assistance of Team Represent Project
Director Carolin Pérez, MPH; the George Washington University
Honor’s Program undergraduate research assistant Kara Schwerdt;
and applied social psychology doctoral candidate, Sidney L. Holt,
who proofread and provided feedback on the final manuscript.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, author-
ship, and/or publication of this article.
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