The Coin Model of Privilege and Critical Allyship
Introduction: The Problem of Health Inequities and the Invisibility of Privilege
Health inequities are widespread, persistent, and rooted in social, political, and economic factors, not solely behavioral or genetic causes.
A significant barrier to transformative change is the tendency to frame inequities only as problems of disadvantage without acknowledging corresponding unearned advantage or privilege.
Eclipsing privilege in discussions of health equity is a crucial flaw because problem framing determines available solutions.- If inequity is seen only as a problem for disadvantaged individuals, responses will only target those groups, failing to address the underlying social structures or the complicity of groups benefiting from these structures.
This limits disruptive action necessary to end enduring patterns of inequity.
Goal of the article: To advance understanding and action on health inequities and the social determinants of health by introducing: 1. The Coin Model of Privilege and Critical Allyship: Explains how social structures produce both unearned advantage and disadvantage, using an intersectional approach to understand how systems of inequality (e.g., sexism, racism, ableism) interact.
Principles for practicing critical allyship: Guides actions for people in positions of privilege to resist unjust structures contributing to health inequities.
Call to action: For all in health to (1) recognize their positions of privilege and (2) use this awareness to reorient their approach from "saving unfortunate people" to solidarity and collective action against systems of inequality.
Background: "Seeing the Gorilla" – The Analogy of Privilege
The article uses a YouTube video analogy where viewers are asked to count ball passes by a team in white, often missing a person in a gorilla suit walking through the scene.- The experiment highlights: It's possible to miss something obvious, like the gorilla, especially when attention is directed elsewhere.
Connection to privilege: Privilege is like the gorilla – often obvious but unseen, especially by those who possess it, because their capacity to see it has not been built up.
If one misses the "gorilla" (privilege), engaging in a conversation about it is impossible, and one might even question its existence.
Building the capacity to "see privilege" requires both learning and unlearning, which is a core aim of this article.
Problem Framing: Efforts to address inequities typically focus on unfair consequences of social structures leading to poor health, without considering the unearned advantage these same structures provide others.- Unearned advantage, or privilege, is the gorilla.
Critical allyship: An orientation to guide action for those in positions of privilege in relation to a specific system of inequality.
Ignoring privilege in health equity discussions is a major shortcoming, as solutions depend on how the problem is framed.- Framing inequity exclusively as a problem for marginalized groups leads to responses only addressing their needs, without tackling causal social structures or the complicity of advantaged groups.
These ideas (privilege and oppression) are not new; they have been articulated for decades, largely by marginalized groups, but often unheard by those in privilege.
The author, a person "on the top of many coins," aims to translate these ideas for a general health audience, acknowledging their position's influence on uptake.
The Coin Model: Understanding Oppression and Privilege
The Coin Metaphor: Adapted from Kathryn Pauly Morgan's work, it frames social structures as having two inextricable sides, much like a coin. Each social structure, from broader societal systems (e.g., capitalism, patriarchy) to more localized policies and practices, simultaneously produces:
One side: Unearned Advantage (Privilege): Benefits, resources, and opportunities that individuals receive not because of their merit or effort, but solely due to their membership in a dominant social group (e.g., being a man in a patriarchal society, being white in a racist society).
Other side: Unearned Disadvantage (Oppression/Marginalization): Systemic barriers, lack of resources, discrimination, and stigma experienced by individuals due to their membership in a marginalized social group (e.g., being a woman, being a person of color, being disabled).
Key Principles of the Coin Model:
Inseparability: Privilege and oppression are two sides of the same coin, meaning one cannot exist without the other. They are coconstitutive, generated by the same social structures.
Intersectionality: Individuals are often simultaneously on the privileged side of some coins and the disadvantaged side of others. For example, a white woman may experience gender-based disadvantage but racial privilege. The model emphasizes that these different systems of inequality (e.g., sexism, racism, classism, ableism, heteronormativity) interact and compound to create unique experiences of advantage and disadvantage.
Systemic Nature: The model highlights that privilege and oppression are not individual attitudes or isolated incidents, but rather embedded in societal norms, institutions, policies, and cultural practices. They are structural and operate often invisibly to those who benefit.
Impact on Health: These systemic advantages and disadvantages directly translate into health inequities. Privilege often grants access to better healthcare, healthier environments, and more resources, while disadvantage leads to chronic stress, limited access to care, unsafe living conditions, and exposure to discrimination, all of which negatively impact health outcomes.
Understanding privilege through the coin model requires:
Acknowledging that the benefits received are unearned, rather than solely the result of personal effort.
Recognizing that these benefits often come at the expense of marginalized groups.
Developing empathy and a critical awareness of how societal structures operate.
This model shifts the focus from blaming individuals for their health status to examining the systemic forces that shape health, providing a foundation for critical allyship aimed at dismantling unjust structures.