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January/February 2023 Annals of Family Medicine Tip Sheet

Researchers Identify Physician and Patient Concerns Around COVID Digital Detection Surveillance in China Credit: Annals of Family Medicine University of…

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Researchers Identify Physician and Patient Concerns Around COVID Digital Detection Surveillance in China

Credit: Annals of Family Medicine
University of Michigan

Researchers Identify Physician and Patient Concerns Around COVID Digital Detection Surveillance in China

To highlight ethical considerations for promoting patients’ autonomy and health care rights, researchers from mainland China, Hong Kong and New Zealand present the results of interviews documenting patient and primary care physicians with digital surveillance of infectious disease (including COVID-19) in urban areas of northern and southern China. The authors conducted in-depth interviews with 16 primary care physicians and 24 of their patients, reflecting a range of ages, educational backgrounds and clinical experiences. Ethical approval was granted by the Institutional Review Board of the University of Hong Kong-Shenzhen Hospital in China.

The team identified five frequently mentioned concerns raised by primary care physicians and patients : 1) ambiguity around the need for informed consent about the usage of digital detection surveillance data; 2) the importance of autonomous decision-making; 3) the potential for discrimination with digital detection surveillance of people who have an infectious disease; 4) the risk of social inequity and divided care outcomes; and 5) authoritarian institutions’ responsibility for maintaining health data security. The adoption of digital detection surveillance meant some patients would be reluctant to go to a hospital for fear of either being discriminated against or forcibly quarantined. Certain groups such as older people and children were thought to be vulnerable to digital detection surveillance data misuse.

The authors argue that in establishing national and international ethical frameworks for digital detection surveillance that protects patients but allows for coordinated management during pandemics, guidelines should include protections against social inequity.

Primary Care Physicians’ and Patients’ Perspectives on Equity and Health Security of Infectious Disease Digital Surveillance

Eleanor Holroyd, PhD, et al
Department of Nursing, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.

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Primary Care Plays a Role in Helping Patients With Long COVID Symptoms by Providing Holistic, Trustworthy Care

Many people are experiencing a variety of long COVID-19 symptoms and are relying on some of their own methods to allay those symptoms. Others are in need of additional therapies from their medical care team. Researchers from Germany asked patients experiencing post-COVID symptoms about the therapies they used and found effective, as well as their ongoing medical needs. Almost 500 participants completed an online survey about individual experiences with various therapeutic strategies.

The most common symptoms included ​​fatigue, physical exhaustion, difficulty concentrating, and loss of taste and smell. Patient approaches to alleviating symptoms included mind-body medicine, the use of nutritional supplements, sports activities/exercise, and olfactory training in the case of loss of smell. When asked about their specific medical needs, only 13% of patients indicated they had no additional needs. Thirty-five percent of patients wanted more understanding and recognition of their situation and 33% indicated the need for specific post-COVID healthcare services, as well as more information. Additionally, study authors suggest that doctors be more attentive to patient’s needs for empathy and understanding.

Patients’ Experiences With Therapeutic Approaches for Post-COVID Syndrome: Results of a Crowdsourced Research Survey

Carina Klocke, MSc, et al
Institute for General Practice and Interprofessional Care, University Hospital and Faculty of Medicine, Tübingen, Germany

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Comprehensive Primary Care, Accessibility and Continuity Can Reduce Hospitalizations

Japanese researchers examined the association between primary care practice characteristics and total hospitalizations during the COVID-19 pandemic. They conducted a nationwide study and examined data from 1,161 participants ages 40-75. They assessed the quality of primary care attributes, including first contact between the patient and a primary care clinician, length of care, care coordination, comprehensiveness and the clinic’s orientation in the community. Researchers primarily sought to identify any hospitalizations among participants during a 12-month period between May 2021 and April 2022.

Each primary care attribute – such as accessibility, continuity, coordination and comprehensiveness – was associated with a reduction in hospitalizations. High-quality primary care was associated with decreased total hospitalizations, even during a pandemic when there are many barriers to providing routine medical care. The authors argued that these findings support policies intended to strengthen primary care systems during and after the COVID-19 pandemic. Theintegration of public health practice with the delivery of primary care services may be a more important process, especially during a pandemic.

Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan

Takuya Aoki, MD, PhD, MMA, et al
Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, and Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

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Primary Care Practices Implemented More Care Management Processes Despite the Impact of COVID-19

Although primary care clinics were disrupted by the COVID-19 pandemic, a study by Minnesota researchers showed that care management processes for chronic disease care in the primary care setting generally increased from 2019 to 2021. The team used data from 269 primary care clinics in 2017, 2019 and 2021, as well as data from 287 clinics that completed surveys in only one or two years, to learn whether the pandemic’s disruptions compromised health care for people with chronic conditions. Overall care management process scores increased by similar amounts (1.6% and 2.1%) from 2017-2019 and from 2019-2021. However, the score for two care management process areas, specifically performance and management of high-risk patients and hospitalizations, decreased in 2021.  Clinics affiliated with larger organizations had higher care management process scores when compared to clinics in smaller organizations. Scores were lower in rural areas compared to urban area clinics. This improvement occurred despite reports from 55% of clinic leaders that the pandemic had been extremely or very disruptive. According to the researchers, increasing highly organized care management practices may be an important step in recovering from losses in health care service quality.

COVID-19 Impacts on Primary Care Clinic Care Management Processes

Leif I. Solberg, MD, et al
HealthPartners Institute, Minneapolis, Minnesota

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Also in this Issue

National Research Team Examines Challenges, Responses and Innovations During COVID Pandemic

Investigators have written a special report about the Agency for Healthcare Research and Quality’s learning community, which operated from December 2020-November 2021. It provided a forum for individuals to share learning and gain peer support; to better understand the stressors and challenges confronting practices; to ascertain needs; and to identify promising solutions in response to the COVID-19 pandemic. The engagement of the community provided valuable insights that can inform future research and policy; identify primary care delivery improvements; and ensure that the primary care community is better prepared to respond and contribute to ongoing and future health challenges.

Primary Care’s Challenges and Responses in the Face of the COVID-19 Pandemic: Insights From AHRQ’s Learning Community

Sebastian T. Tong, MD, MPH, et al
University of Washington, Seattle, Washington and Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland

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Academic and Public Health Partnership Creates Data Bridge to Promote Information Sharing During COVID-19 Pandemic

Clinicians and administrators in Alberta, Canada, built a data bridge between primary care and public health stakeholders to improve the province’s community-based response to the pandemic. The authors traced the data bridge’s foundations to: policy commitments to the Patient Medical Home model as well as organizational and governance structures that actively drew together primary care and non-primary care stakeholders. Those commitments and structures opened the possibility for champions to emerge, trust to evolve, and integrative improvisation of health care practices to take place. Without a functional and well-established interface between independent primary care and the central health system, the authors argue that both pandemic responses, and everyday primary care integration efforts are likely to suffer.

Building a Data Bridge: Policies, Structures, and Governance Integrating Primary Care Into the Public Health Response to COVID-19

Myles Leslie, PhD, MJ, MA, et al
School of Public Policy and Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Alberta, Canada

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Community Health Information Exchanges May Reduce Likelihood of Re-hospitalizations and Follow-up Emergency Department Visits

Researchers examined whether primary care physicians’ use of a secure community health information exchange (HIE) to access data about patient care transitions reduced the likelihood of the patient being re-hospitalized. Doctors’ use of the HIE was associated with an increased length of time that patients were admitted to the ED from 99 to 238 days. The likelihood of a return visit to the ED was decreased by 53% while re-hospitalization decreased by 61%.

The Impact of Community Health Information Exchange Usage on Time to Reutilization of Hospital Services

Chantel Sloan-Aagard, PhD, et al
Paso del Norte Health Information Exchange, El Paso, Texas, and the Department of Public Health, Brigham Young University, Provo, Utah

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Study Suggests Primary Care Clinical Staff and Patients Prefer Self-Rooming During COVID-19 Pandemic

During the COVID-19 pandemic, clinic staff have had to adjust the ways in which they see patients in person so that they remain safe. Researchers conducted a study to determine patient and staff perceptions of a process that allowed patients, after check-in, to find their own exam rooms. Most of the 1,561 patients surveyed in this study preferred self-rooming, especially among patients aged 65 years and younger and in family medicine clinics. Few patients said they felt less welcomed, less cared about, more isolated, more lost or confused, or more frustrated with self-rooming compared to escorted-rooming. Over half of staff preferred self-rooming and thought most patients did as well.

Primary Care Patients’ and Staff’s Perceptions of Self-Rooming as Alternative to Waiting Rooms

Edmond Ramly, PhD, et al
Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Primary Care Academics Transforming Healthcare Collaborative, UW Health, Madison, Wisconsin

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Insulin Underuse in Primary Care Requires Clinicians to Remove Barriers to Patient Access

The rising cost of insulin has created problems in diabetes management. Researchers conducted a survey study to determine the prevalence of cost-related insulin underuse in a primary care environment. They examined the frequency of cost-related underuse of insulin within a year of a patient being diagnosed with diabetes. Ninety respondents completed the survey. Among those who completed the survey, 44% experienced cost-related substandard therapy. Participants who reported underuse were approximately nine times more likely to have difficulty purchasing diabetes supplies than those who did not report underuse. However, the majority of respondents experiencing cost-related issues said they discussed it with their prescribers, which significantly increased the likelihood of their doctor changing their insulin. Participants experiencing poor diabetes control were not more likely to report underuse. The authors recommend that primary care physicians use empathy when asking about cost barriers as some patients may be reluctant to speak up about their challenges in obtaining insulin.

A Survey Snapshot Measuring Insulin in Underuse in a Primary Care Clinic

Rick Hess, PharmD, CDCES, BCACP, et al
Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee

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Tool for UTI Detection Performs Well in Primary Care Setting, May Reduce Unnecessary Antibiotics Use

Urinary tract infections (UTI) are commonly diagnosed and treated in primary care. The gold standard for diagnosing a UTI is a urine culture. However, waiting for culture results delays treatment, so doctors often prescribe antibiotics while awaiting those results. Researchers modified a UTI detection algorithm developed and validated in an emergency room population to be usable in a primary care setting. The main modification was removing the requirements for microscopy since results are often not available in primary care. Researchers found that the removal of microscopy features did not severely compromise performance of the UTI detection algorithm in emergency department patients. Additionally, the algorithm performed well in the primary care sample. Results suggest that the new algorithm could be used to safely withhold antibiotics in low risk patients, thereby reducing antibiotic overuse.

Adaptation and External Validation of Pathogenic Urine Culture Prediction in Primary Care Using Machine Learning

Daniel J. Parente, MD, PhD, et al
Department of Family Medicine and Community Health University of Kansas Medical Center, Kansas City, Kansas

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“The Trust Circle” Promotes Inclusion of American Indian and Alaska Native Populations in Clinical Trials

Indigenous populations, including people of American Indian and Alaska Native origin, are underrepresented in clinical trials. Researchers collaborated to modify the “trust triangle” model used in clinical trial recruitment and expanded it to a new model called, “The Trust Circle.” This new model takes into account the various entities that are part of the recruitment process and the trust that must be developed between trial participants, researchers and other individuals such as physicians, ministers and community leaders. The authors assert that physicians, ministers and community leaders can promote trust and assist in the recruitment of AI/AN populations to clinical trials. This in turn can promote health improvement of these populations.

Recruiting Indigenous Patients Into Clinical Trials: A Circle of Trust

Arch G. Mainous III, PhD, et al
Department of Community Health and Family Medicine and Department of Health Services Research Management, and Policy, University of Florida, Gainesville, Florida

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Despite Benefits, Use of Clinical Decision Support Systems is Curbed by Workload Challenges

French researchers conducted a systematic review of qualitative, quantitative and mixed methods studies to identify and quantify the barriers and facilitators primary care providers (PCPs) experience when using clinical decision support systems (CDSSs) – software designed to facilitate clinical decision-making. The greatest barrier to using CDSSs was an increased workload through use of CDSS. Human and organizational factors also had negative impacts on CDSS use, whereas technological factors had a neutral impact. The net benefits dimension of the Human Organization Technology framework the authors used to study the barriers and facilitators had a positive impact, including CDSSs’ potential to improve quality of care, particularly for preventive care. Although PCPs find benefit from and support the potential effectiveness of CDSSs in improving the quality and safety of care, they also highlight their lack of efficiency due to increased workload. The authors concluded that CDSS developers need to better address human and organizational issues, in addition to technological challenges. They also proposed a list of 11 features of CDSSs expected to improve their usability in primary care.

Barriers and Facilitators to the Use of Clinical Decision Support Systems in Primary Care: A Mixed-Methods Systematic Review

Pierre-Yves Meunier, MD, et al
Collège Universitaire de Médecine Générale and Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France

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Editorial: While Key to Pandemic Response, Primary Care Could Not Overcome Socioeconomic Inequities and Reduction in Care-Seeking Behaviors

Trisha Greenhalgh, MD, professor of primary health care sciences and co-director of Interdisciplinary Research In Health Sciences at the University of Oxford, writes the editorial in this edition of Annals of Family Medicine. She mentions the numerous papers in this edition that explain the ways in which primary care members in various countries surveilled the virus; bridged information gaps; managed patient care and clinical practices; and in general, affected health outcomes in individuals affected by the COVID pandemic. From the patient perspective, researchers also studied how people affected by COVID managed long-term symptoms themselves. Greenhalgh adds that primary care contributes to overall health system resilience. She also challenges primary care clinicians to continue fighting for the resources they need to restore the existing workforce, incentivize the next generation of primary care providers, and defend the core values that underpin the field’s critical work with individuals, families and communities.  

Covid-19 and Primary Care: Taking Stock

Professor Trisha Greenhalgh, MD
University of Oxford, Oxford, England

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Primary Care Doctor Who Experienced Hacking Outlines Strategies for Preventing Online Attacks

Ed Bujold, MD, a family medicine doctor, writes about his solo practice being attacked by ransomware. He describes how he was able to get his practice back in operating order and offers recommendations to other primary care practices in protecting themselves from potential hackers.

You Have Been Hacked!

Ed Bujold, MD, FAAFP
Family Medical Care Center, Granite Falls, North Carolina

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Medical Doctor Writes a Letter to her Unborn Daughter About Importance of Abortion Access and Bodily Autonomy

While pregnant with her first child, Laura Krinsky, MD, writes a letter to her daughter about the experience of providing abortions in Massachusetts (a state that has protected abortion access) and Tennessee (a state that has restricted abortion access). In light of the U.S. Supreme Court overturning the constitutional right to abortion, Krinsky writes that she hopes to raise her daughter to be compassionate and humble, to care about people and to respect their bodily autonomy and their health care decisions.

On Abortion and Autonomy: A Letter to My Unborn Daughter

Laura Krinsky MD
Cambridge Health Alliance, Malden, Massachusetts

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# # #

Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and The College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal’s website, www.AnnFamMed.org.

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Government

President Biden Delivers The “Darkest, Most Un-American Speech Given By A President”

President Biden Delivers The "Darkest, Most Un-American Speech Given By A President"

Having successfully raged, ranted, lied, and yelled through…

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3 hours ago

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March 8, 2024

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President Biden Delivers The "Darkest, Most Un-American Speech Given By A President"

Having successfully raged, ranted, lied, and yelled through the State of The Union, President Biden can go back to his crypt now.

Whatever 'they' gave Biden, every American man, woman, and the other should be allowed to take it - though it seems the cocktail brings out 'dark Brandon'?

Tl;dw: Biden's Speech tonight ...

  • Fund Ukraine.

  • Trump is threat to democracy and America itself.

  • Abortion is good.

  • American Economy is stronger than ever.

  • Inflation wasn't Biden's fault.

  • Illegals are Americans too.

  • Republicans are responsible for the border crisis.

  • Trump is bad.

  • Biden stands with trans-children.

  • J6 was the worst insurrection since the Civil War.

(h/t @TCDMS99)

Tucker Carlson's response sums it all up perfectly:

"that was possibly the darkest, most un-American speech given by an American president. It wasn't a speech, it was a rant..."

Carlson continued: "The true measure of a nation's greatness lies within its capacity to control borders, yet Bid refuses to do it."

"In a fair election, Joe Biden cannot win"

And concluded:

“There was not a meaningful word for the entire duration about the things that actually matter to people who live here.”

Victor Davis Hanson added some excellent color, but this was probably the best line on Biden:

"he doesn't care... he lives in an alternative reality."

*  *  *

Watch SOTU Live here...

*   *   *

Mises' Connor O'Keeffe, warns: "Be on the Lookout for These Lies in Biden's State of the Union Address." 

On Thursday evening, President Joe Biden is set to give his third State of the Union address. The political press has been buzzing with speculation over what the president will say. That speculation, however, is focused more on how Biden will perform, and which issues he will prioritize. Much of the speech is expected to be familiar.

The story Biden will tell about what he has done as president and where the country finds itself as a result will be the same dishonest story he's been telling since at least the summer.

He'll cite government statistics to say the economy is growing, unemployment is low, and inflation is down.

Something that has been frustrating Biden, his team, and his allies in the media is that the American people do not feel as economically well off as the official data says they are. Despite what the White House and establishment-friendly journalists say, the problem lies with the data, not the American people's ability to perceive their own well-being.

As I wrote back in January, the reason for the discrepancy is the lack of distinction made between private economic activity and government spending in the most frequently cited economic indicators. There is an important difference between the two:

  • Government, unlike any other entity in the economy, can simply take money and resources from others to spend on things and hire people. Whether or not the spending brings people value is irrelevant

  • It's the private sector that's responsible for producing goods and services that actually meet people's needs and wants. So, the private components of the economy have the most significant effect on people's economic well-being.

Recently, government spending and hiring has accounted for a larger than normal share of both economic activity and employment. This means the government is propping up these traditional measures, making the economy appear better than it actually is. Also, many of the jobs Biden and his allies take credit for creating will quickly go away once it becomes clear that consumers don't actually want whatever the government encouraged these companies to produce.

On top of all that, the administration is dealing with the consequences of their chosen inflation rhetoric.

Since its peak in the summer of 2022, the president's team has talked about inflation "coming back down," which can easily give the impression that it's prices that will eventually come back down.

But that's not what that phrase means. It would be more honest to say that price increases are slowing down.

Americans are finally waking up to the fact that the cost of living will not return to prepandemic levels, and they're not happy about it.

The president has made some clumsy attempts at damage control, such as a Super Bowl Sunday video attacking food companies for "shrinkflation"—selling smaller portions at the same price instead of simply raising prices.

In his speech Thursday, Biden is expected to play up his desire to crack down on the "corporate greed" he's blaming for high prices.

In the name of "bringing down costs for Americans," the administration wants to implement targeted price ceilings - something anyone who has taken even a single economics class could tell you does more harm than good. Biden would never place the blame for the dramatic price increases we've experienced during his term where it actually belongs—on all the government spending that he and President Donald Trump oversaw during the pandemic, funded by the creation of $6 trillion out of thin air - because that kind of spending is precisely what he hopes to kick back up in a second term.

If reelected, the president wants to "revive" parts of his so-called Build Back Better agenda, which he tried and failed to pass in his first year. That would bring a significant expansion of domestic spending. And Biden remains committed to the idea that Americans must be forced to continue funding the war in Ukraine. That's another topic Biden is expected to highlight in the State of the Union, likely accompanied by the lie that Ukraine spending is good for the American economy. It isn't.

It's not possible to predict all the ways President Biden will exaggerate, mislead, and outright lie in his speech on Thursday. But we can be sure of two things. The "state of the Union" is not as strong as Biden will say it is. And his policy ambitions risk making it much worse.

*  *  *

The American people will be tuning in on their smartphones, laptops, and televisions on Thursday evening to see if 'sloppy joe' 81-year-old President Joe Biden can coherently put together more than two sentences (even with a teleprompter) as he gives his third State of the Union in front of a divided Congress. 

President Biden will speak on various topics to convince voters why he shouldn't be sent to a retirement home.

According to CNN sources, here are some of the topics Biden will discuss tonight:

  • Economic issues: Biden and his team have been drafting a speech heavy on economic populism, aides said, with calls for higher taxes on corporations and the wealthy – an attempt to draw a sharp contrast with Republicans and their likely presidential nominee, Donald Trump.

  • Health care expenses: Biden will also push for lowering health care costs and discuss his efforts to go after drug manufacturers to lower the cost of prescription medications — all issues his advisers believe can help buoy what have been sagging economic approval ratings.

  • Israel's war with Hamas: Also looming large over Biden's primetime address is the ongoing Israel-Hamas war, which has consumed much of the president's time and attention over the past few months. The president's top national security advisers have been working around the clock to try to finalize a ceasefire-hostages release deal by Ramadan, the Muslim holy month that begins next week.

  • An argument for reelection: Aides view Thursday's speech as a critical opportunity for the president to tout his accomplishments in office and lay out his plans for another four years in the nation's top job. Even though viewership has declined over the years, the yearly speech reliably draws tens of millions of households.

Sources provided more color on Biden's SOTU address: 

The speech is expected to be heavy on economic populism. The president will talk about raising taxes on corporations and the wealthy. He'll highlight efforts to cut costs for the American people, including pushing Congress to help make prescription drugs more affordable.

Biden will talk about the need to preserve democracy and freedom, a cornerstone of his re-election bid. That includes protecting and bolstering reproductive rights, an issue Democrats believe will energize voters in November. Biden is also expected to promote his unity agenda, a key feature of each of his addresses to Congress while in office.

Biden is also expected to give remarks on border security while the invasion of illegals has become one of the most heated topics among American voters. A majority of voters are frustrated with radical progressives in the White House facilitating the illegal migrant invasion. 

It is probable that the president will attribute the failure of the Senate border bill to the Republicans, a claim many voters view as unfounded. This is because the White House has the option to issue an executive order to restore border security, yet opts not to do so

Maybe this is why? 

While Biden addresses the nation, the Biden administration will be armed with a social media team to pump propaganda to at least 100 million Americans. 

"The White House hosted about 70 creators, digital publishers, and influencers across three separate events" on Wednesday and Thursday, a White House official told CNN. 

Not a very capable social media team... 

The administration's move to ramp up social media operations comes as users on X are mostly free from government censorship with Elon Musk at the helm. This infuriates Democrats, who can no longer censor their political enemies on X. 

Meanwhile, Democratic lawmakers tell Axios that the president's SOTU performance will be critical as he tries to dispel voter concerns about his elderly age. The address reached as many as 27 million people in 2023. 

"We are all nervous," said one House Democrat, citing concerns about the president's "ability to speak without blowing things."

The SOTU address comes as Biden's polling data is in the dumps. 

BetOnline has created several money-making opportunities for gamblers tonight, such as betting on what word Biden mentions the most. 

As well as...

We will update you when Tucker Carlson's live feed of SOTU is published. 

Tyler Durden Fri, 03/08/2024 - 07:44

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What is intersectionality and why does it make feminism more effective?

The social categories that we belong to shape our understanding of the world in different ways.

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3 hours ago

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March 8, 2024

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Mary Long/Shutterstock

The way we talk about society and the people and structures in it is constantly changing. One term you may come across this International Women’s Day is “intersectionality”. And specifically, the concept of “intersectional feminism”.

Intersectionality refers to the fact that everyone is part of multiple social categories. These include gender, social class, sexuality, (dis)ability and racialisation (when people are divided into “racial” groups often based on skin colour or features).

These categories are not independent of each other, they intersect. This looks different for every person. For example, a black woman without a disability will have a different experience of society than a white woman without a disability – or a black woman with a disability.

An intersectional approach makes social policy more inclusive and just. Its value was evident in research during the pandemic, when it became clear that women from various groups, those who worked in caring jobs and who lived in crowded circumstances were much more likely to die from COVID.

A long-fought battle

American civil rights leader and scholar Kimberlé Crenshaw first introduced the term intersectionality in a 1989 paper. She argued that focusing on a single form of oppression (such as gender or race) perpetuated discrimination against black women, who are simultaneously subjected to both racism and sexism.

Crenshaw gave a name to ways of thinking and theorising that black and Latina feminists, as well as working-class and lesbian feminists, had argued for decades. The Combahee River Collective of black lesbians was groundbreaking in this work.

They called for strategic alliances with black men to oppose racism, white women to oppose sexism and lesbians to oppose homophobia. This was an example of how an intersectional understanding of identity and social power relations can create more opportunities for action.

These ideas have, through political struggle, come to be accepted in feminist thinking and women’s studies scholarship. An increasing number of feminists now use the term “intersectional feminism”.

The term has moved from academia to feminist activist and social justice circles and beyond in recent years. Its popularity and widespread use means it is subjected to much scrutiny and debate about how and when it should be employed. For example, some argue that it should always include attention to racism and racialisation.

Recognising more issues makes feminism more effective

In writing about intersectionality, Crenshaw argued that singular approaches to social categories made black women’s oppression invisible. Many black feminists have pointed out that white feminists frequently overlook how racial categories shape different women’s experiences.

One example is hair discrimination. It is only in the 2020s that many organisations in South Africa, the UK and US have recognised that it is discriminatory to regulate black women’s hairstyles in ways that render their natural hair unacceptable.

This is an intersectional approach. White women and most black men do not face the same discrimination and pressures to straighten their hair.

View from behind of a young, black woman speaking to female colleagues in an office
Intersectionality can lead to more inclusive organisations, activism and social movements. Rawpixel.com/Shutterstock

“Abortion on demand” in the 1970s and 1980s in the UK and USA took no account of the fact that black women in these and many other countries needed to campaign against being given abortions against their will. The fight for reproductive justice does not look the same for all women.

Similarly, the experiences of working-class women have frequently been rendered invisible in white, middle class feminist campaigns and writings. Intersectionality means that these issues are recognised and fought for in an inclusive and more powerful way.

In the 35 years since Crenshaw coined the term, feminist scholars have analysed how women are positioned in society, for example, as black, working-class, lesbian or colonial subjects. Intersectionality reminds us that fruitful discussions about discrimination and justice must acknowledge how these different categories affect each other and their associated power relations.

This does not mean that research and policy cannot focus predominantly on one social category, such as race, gender or social class. But it does mean that we cannot, and should not, understand those categories in isolation of each other.

Ann Phoenix does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Government

Biden defends immigration policy during State of the Union, blaming Republicans in Congress for refusing to act

A rising number of Americans say that immigration is the country’s biggest problem. Biden called for Congress to pass a bipartisan border and immigration…

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March 8, 2024

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President Joe Biden delivers his State of the Union address on March 7, 2024. Alex Brandon-Pool/Getty Images

President Joe Biden delivered the annual State of the Union address on March 7, 2024, casting a wide net on a range of major themes – the economy, abortion rights, threats to democracy, the wars in Gaza and Ukraine – that are preoccupying many Americans heading into the November presidential election.

The president also addressed massive increases in immigration at the southern border and the political battle in Congress over how to manage it. “We can fight about the border, or we can fix it. I’m ready to fix it,” Biden said.

But while Biden stressed that he wants to overcome political division and take action on immigration and the border, he cautioned that he will not “demonize immigrants,” as he said his predecessor, former President Donald Trump, does.

“I will not separate families. I will not ban people from America because of their faith,” Biden said.

Biden’s speech comes as a rising number of American voters say that immigration is the country’s biggest problem.

Immigration law scholar Jean Lantz Reisz answers four questions about why immigration has become a top issue for Americans, and the limits of presidential power when it comes to immigration and border security.

President Joe Biden stands surrounded by people in formal clothing and smiles. One man holds a cell phone camera close up to his face.
President Joe Biden arrives to deliver the State of the Union address at the US Capitol on March 7, 2024. Chip Somodevilla/Getty Images

1. What is driving all of the attention and concern immigration is receiving?

The unprecedented number of undocumented migrants crossing the U.S.-Mexico border right now has drawn national concern to the U.S. immigration system and the president’s enforcement policies at the border.

Border security has always been part of the immigration debate about how to stop unlawful immigration.

But in this election, the immigration debate is also fueled by images of large groups of migrants crossing a river and crawling through barbed wire fences. There is also news of standoffs between Texas law enforcement and U.S. Border Patrol agents and cities like New York and Chicago struggling to handle the influx of arriving migrants.

Republicans blame Biden for not taking action on what they say is an “invasion” at the U.S. border. Democrats blame Republicans for refusing to pass laws that would give the president the power to stop the flow of migration at the border.

2. Are Biden’s immigration policies effective?

Confusion about immigration laws may be the reason people believe that Biden is not implementing effective policies at the border.

The U.S. passed a law in 1952 that gives any person arriving at the border or inside the U.S. the right to apply for asylum and the right to legally stay in the country, even if that person crossed the border illegally. That law has not changed.

Courts struck down many of former President Donald Trump’s policies that tried to limit immigration. Trump was able to lawfully deport migrants at the border without processing their asylum claims during the COVID-19 pandemic under a public health law called Title 42. Biden continued that policy until the legal justification for Title 42 – meaning the public health emergency – ended in 2023.

Republicans falsely attribute the surge in undocumented migration to the U.S. over the past three years to something they call Biden’s “open border” policy. There is no such policy.

Multiple factors are driving increased migration to the U.S.

More people are leaving dangerous or difficult situations in their countries, and some people have waited to migrate until after the COVID-19 pandemic ended. People who smuggle migrants are also spreading misinformation to migrants about the ability to enter and stay in the U.S.

Joe Biden wears a black blazer and a black hat as he stands next to a bald white man wearing a green uniform and a white truck that says 'Border Patrol' in green
President Joe Biden walks with Jason Owens, the chief of the U.S. Border Patrol, as he visits the U.S.-Mexico border in Brownsville, Texas, on Feb. 29, 2024. Jim Watson/AFP via Getty Images

3. How much power does the president have over immigration?

The president’s power regarding immigration is limited to enforcing existing immigration laws. But the president has broad authority over how to enforce those laws.

For example, the president can place every single immigrant unlawfully present in the U.S. in deportation proceedings. Because there is not enough money or employees at federal agencies and courts to accomplish that, the president will usually choose to prioritize the deportation of certain immigrants, like those who have committed serious and violent crimes in the U.S.

The federal agency Immigration and Customs Enforcement deported more than 142,000 immigrants from October 2022 through September 2023, double the number of people it deported the previous fiscal year.

But under current law, the president does not have the power to summarily expel migrants who say they are afraid of returning to their country. The law requires the president to process their claims for asylum.

Biden’s ability to enforce immigration law also depends on a budget approved by Congress. Without congressional approval, the president cannot spend money to build a wall, increase immigration detention facilities’ capacity or send more Border Patrol agents to process undocumented migrants entering the country.

A large group of people are seen sitting and standing along a tall brown fence in an empty area of brown dirt.
Migrants arrive at the border between El Paso, Texas, and Ciudad Juarez, Mexico, to surrender to American Border Patrol agents on March 5, 2024. Lokman Vural Elibol/Anadolu via Getty Images

4. How could Biden address the current immigration problems in this country?

In early 2024, Republicans in the Senate refused to pass a bill – developed by a bipartisan team of legislators – that would have made it harder to get asylum and given Biden the power to stop taking asylum applications when migrant crossings reached a certain number.

During his speech, Biden called this bill the “toughest set of border security reforms we’ve ever seen in this country.”

That bill would have also provided more federal money to help immigration agencies and courts quickly review more asylum claims and expedite the asylum process, which remains backlogged with millions of cases, Biden said. Biden said the bipartisan deal would also hire 1,500 more border security agents and officers, as well as 4,300 more asylum officers.

Removing this backlog in immigration courts could mean that some undocumented migrants, who now might wait six to eight years for an asylum hearing, would instead only wait six weeks, Biden said. That means it would be “highly unlikely” migrants would pay a large amount to be smuggled into the country, only to be “kicked out quickly,” Biden said.

“My Republican friends, you owe it to the American people to get this bill done. We need to act,” Biden said.

Biden’s remarks calling for Congress to pass the bill drew jeers from some in the audience. Biden quickly responded, saying that it was a bipartisan effort: “What are you against?” he asked.

Biden is now considering using section 212(f) of the Immigration and Nationality Act to get more control over immigration. This sweeping law allows the president to temporarily suspend or restrict the entry of all foreigners if their arrival is detrimental to the U.S.

This obscure law gained attention when Trump used it in January 2017 to implement a travel ban on foreigners from mainly Muslim countries. The Supreme Court upheld the travel ban in 2018.

Trump again also signed an executive order in April 2020 that blocked foreigners who were seeking lawful permanent residency from entering the country for 60 days, citing this same section of the Immigration and Nationality Act.

Biden did not mention any possible use of section 212(f) during his State of the Union speech. If the president uses this, it would likely be challenged in court. It is not clear that 212(f) would apply to people already in the U.S., and it conflicts with existing asylum law that gives people within the U.S. the right to seek asylum.

Jean Lantz Reisz does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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