To be marginal is to be marginalized. Taken broadly, the term "marginalization" evokes a dynamic between two social analytic categories: the "center" (or mainstream), and an area called the "margins." The center is normally associated with dominance, privilege, and power; the margins, with relative powerlessness. To be marginalized is to be placed in the margins, and thus excluded
The concept of marginalization is useful in public health to highlight, understand, and ultimately change processes by which social relations mark and maintain boundaries that produce ill health. Social relations, particularly those that have become codified and institutionalized, may not be recognized as problems by all members of a given society, despite being shown to have a determining affect on health. An example of this is social stratification based on ethnicity, class, or income, by which the relative quality of experience in the psychosocial and socioeconomic environment expresses itself through biological mechanisms, as heterogeneity in health and well-being throughout the life cycle.
A focus on social relations in explaining how people come to occupy more or less favorable conditions of living offers a contrast to primarily asocial interpretations of correlative data showing a disproportionate burden of ill health among certain ethnic groups. Instead of viewing these correlative data as a result of an interplay between potentially modifiable behavioral risk factors and presumably nonmodifiable risk markers (e.g., genes), marginalization broadens its theory of causation to include distal factors beyond the individual or group. In this sense, marginalization views ill health as a result of larger forces impinging on populations, rather than as a problem of populations.
Marginalization can be used to appraise these larger forces in numerous ways. One such way has been to focus on a group's distance from the center of society and to highlight marginalized people's exposures to inadequate housing, racism, unemployment, and lack of education. Such conditions of living can be conceptualized as risk conditions—environmental factors that affect the expression of individual-level risk factors, whether behavioral, physiological, or genetic. Risk conditions are the living standards and social conditions that define a marginal group's relations to the mainstream, and can manifest, for example, in a group's cultural history or current economic circumstances. These risk conditions are often more meaningful, yet less convenient, than standard measures of race or ethnicity in understanding population differences in health status.
Another way in which marginalization has been used is to highlight how social processes make individuals and groups feel about themselves, their beliefs, or their place in a greater social order. In this sense, marginalization can invoke feelings of oppression and alienation, with alienation being understood in its general sense as a disassociation of people from meaningful work, their organic social collectivities, or their own identities. At another level, marginalization has been used to conceptualize how ill health is produced through the unequal distribution of power and property, information, patterns of production and consumption, and the biological impact of social inequality. In this regard, the risk conditions or environmental factors that create ill health among marginalized people are understood as products of conflicting social interests among competing groups. To be marginalized, in this sense, is to be distanced from power and resources that enable self-determination in economic, political, and social settings. At yet another level, marginalization has been used to conceptualize how certain groups experience a disease in ways not experienced by mainstream groups. An example of this is the way in which AIDS (acquired immunodeficiency syndrome) is suffered among gay men in Western countries as a condition of shame and moral culpability, characteristics which seldom compound the difficult experiences of AIDS among nonmarginal groups.
Public health interventions suggested by the concept of marginalization have sought policies and environmental regulations to aid healthful living by enabling people, individually and collectively, to gain greater control over their environment, broadly understood. The means for reducing marginalization and its effects on health, through the development of personal skills, the strengthening of communities, and the promotion of more egalitarian social, political, and economic
G. FLETCHER LINDER
(SEE ALSO: Acculturation; Assimilation; Cultural Norms; Ethnicity and Health; Ethnocentrism; Immigrants, Immigration; Minority Rights; Traditional Health Beliefs, Practices; Values in Health Education)
Green, L. W., and Kreuter, M. W. (1999). Health Promotion Planning: An Educational and Ecological Approach. Toronto: Mayfield.
Hertzman, C.; Frank, J.; and Evans, R. G. (1994). "Heterogeneities in Health Status and the Determinants of Population Health." In Why Are Some People Healthy and Others Not? The Determinants of Health of Populations, eds. R. G. Evans, M. L. Barer, and T. R. Marmor. New York: Aldine de Gruyter.
Krieger, N. (1999). "Embodying Inequality: A Review of Concepts, Measures, and Methods for Studying the Health Consequences of Discrimination." International Journal of Health Services 29:295–352.
Wallace, R., and Wallace, D. (1997). "Community Marginalisation and the Diffusion of Disease and Disorder in the United States." British Medical Journal 314:1341–1345.