The BIAS FREE Framework Mary Anne Burke Global Forum for Health Research Geneva, Switzerland Margrit Eichler Ontario Institute for Studies in Education at the University of Toronto
Structure of Presentation • Introduction to the BIAS FREE Framework • Concepts and theoretical basis • Presentation of the BIAS FREE Framework • Examples of applications
Introducing The BIAS FREE Framework Part 1
BIAS FREEstands for Building an Integrative Analytical System for Recognizing and Eliminating inEquities The BIAS FREE Framework
The BIAS FREE Framework • Statement of a goal, not an achievement • May never be fully realized
The BIAS FREE Framework • Rights-based • Systematic • Integrative • Deals with biases that derive from any social hierarchy • Applicable to research, legislation, policies, programmes, service delivery and practices
The right to health • The UN Committee on Economic, Social and Cultural Rights states that the right to health, like other human rights, “ is closely related to and dependent upon the realization of other human rights, as contained in the International Bill of Rights, including the right to food, to housing, to work, to education, to human dignity, to life, to non-discrimination, to equality, the prohibition against torture, the right to privacy, to access to information, and the freedoms of association, assembly and movement. These and other rights and freedoms address integral components of the right to health.”
The right to health • The realization of the right to health “depends on different factors, which do not derive directly from medical services but from the realization of other rights, including civil and political rights such as the participation in decision-making and the right of association, indispensable, for example, to the planning and setting up of an effective and nondiscriminatory system of health care.”
Framework Properties • Consists of a set of open-ended questions • Answers need to be given anew in each situation by users • Transferable to all socio-cultural contexts • Theoretically based • Systematic and comprehensive
Framework Properties (cont.) • Identifies problems • Identifies appropriate solutions • Can be used at all stages of the research (policy etc.) process -- the earlier, the better
Concepts to be covered • Hierarchy • Objectivity • Equity • Equality • The logic of domination • The bias triangle
Hierarchy A vertical social system in which people are ordered on a continuum of power
Gender Ability Age Sexual orientation Class Caste Language Socio-economic status Race/Ethnicity Religion Aboriginal status Immigrant Status Geographical location etc. Social hierarchies are built on:
Hierarchy • Placement determines access to all types of resources • Manifests in knowledge construction • Ignoring hierarchies leads to their maintenance
Objectivity • Research is never "value-free." • A decision to conduct research in a given area reflects a value judgement. • Failure to conduct research also reflects a value judgement.
Four criteria for objectivity • Recognised avenues for criticism • Community response • Shared standards 4. Equality of intellectual authority
Equity and Equality • Equity is the process of being fair to all people , respectful of differences, and free from discrimination. • Equality is the outcome reached through equity and reflects the goal of fostering equitable conditions of all people, rather than treating them the same.
Logic of Domination Rests on 3 Aspects: • Value-hierarchical thinking • Value dualism • Justification of subordination
Logic of Domination (cont.) • Each hierarchy results in types of discrimination that are specific to that hierarchy. • The logic of domination and discrimination is the same for all social hierarchies.
Exploring The BIAS FREE Framework Part 3
The Bias Triangle Maintaining an existing hierarchy Failing to examine Using differences double standards
A 3-dimensional matrix There are 3 dimensions: • The type of hierarchy (e.g. sex, race, age) • The type of problem (H, F and D problem) • The type of application (research, legislation, policy, programme, service delivery, practice)
Three main problem types • H: Maintaining an existing hierarchy • F: Failing to examine differences • D: Using double standards
Maintaining an existing hierarchy H - IS DOMINANCE OF ONE GROUP OVER THE OTHER IN ANY WAY JUSTIFIED OR MAINTAINED? Situate the problem within a human rights framework, in which equality is an underlying value. Point out the discrepancy between this value and the inequalities among groups of people that result from the hierarchy.
H 1 Denying hierarchy • Question: Is the existence of a hierarchy denied in spite of widespread evidence to the contrary? • Solution: The existence of a hierarchy is acknowledged; its validation is questioned and rejected.
H 2 Maintaining hierarchy • Question: Are practices or views that are based on a hierarchy presented as normal or unproblematic? • Solution: Expressions of hierarchies are questioned and problematized.
H 3 Dominant perspective • Question: Is the perspective or standpoint of the dominant group adopted? • Solution:The perspectives of non-dominant and dominant groups are respected and accepted.
H 4 Pathologization • Question:Is the non-dominant group pathologized when it differs from the norms derived from the dominant group? • Solution:Challenge the norm and address the reasons given for defining pathologizing the group.
H 5 Objectification • Question:Is stripping people of their intrinsic dignity and personhood presented as normal or unproblematic? • Solution:Recognize that every human being has intrinsic dignity and human rights that are inviolable and must be protected, and conduct the activity accordingly.
H 6 Victim-blaming • Question:Are victims of individual and/or structural violence blamed and held accountable? • Solution:Victims are not blamed; individual and/or structural violence is identified; and those responsible are held accountable.
H 7 Appropriation • Question:Is ownership claimed by the dominant group for entities that originate(d) in or belong to the non-dominant group? • Solution:Original ownership is acknowledged and respected.
Failing to examine differences F - IS MEMBERSHIP IN A NON-DOMINANT/ DOMINANT GROUP EXAMINED AS SOCIALLY RELEVANT? Establish the relevance of group membership within a given context. Once relevance is established, accommodate differences in ways that reduce the hierarchy.
F 1 Insensitivity to difference • Question:Has the relevance of membership in dominant/non-dominant group been ignored? • Solution:Relevance of dominant/non-dominant group membership must always be determined; group membership must be included as an analytical variable throughout the activity and only then can its relevance be assessed.
F 2 Decontextualization • Question:Has the different social reality of dominant/non-dominant groups explicitly been considered? • Solution:The context with respect to dominant/non-dominant group membership is explicitly examined and differences following from this are identified, analysed and taken into account.
F 3 Over-generalization or Universalization • Question: Is information derived from dominant groups generalised to non-dominant groups without examining if it is applicable to the non-dominant groups? • Solution: Information about the dominant group is acknowledged as such and efforts are made to obtain information about the non-dominant group or conclusions are limited to the dominant group.
F4 Assumed homogeneity • Question:Is the dominant or non-dominant group treated as a uniform group? • Solution:Differences within dominant and non-dominant groups are acknowledged and taken into account.
Using double standards D – ARE NON-DOMINANT AND DOMINANT GROUPS DEALT WITH DIFFERENTLY? Identify the double standard that leads to different treatment of members of dominant and non-dominant groups and how this maintains a hierarchy; then, devise means to provide the same treatment to both groups.
D 1 Overt double standard • Question: Are non-dominant and dominant groups treated differently? • Solution: Provide the same treatment to members of dominant and non-dominant groups whenever this increases equity.
D 2 Under-representation or exclusion • Question: Are non-dominant groups under-represented or excluded? • Solution:Non-dominant groups are included whenever relevant.
D 3 Exceptional under-representation or exclusion • Question:In contexts normally associated with non-dominant groups, but pertinent to all groups, is the dominant group under‑represented or excluded? • Solution: Dominant groups are appropriately represented in issues of relevance to them but that have been stereotyped as being important only for a non-dominant group.
D 4 Denying agency • Question: Is there a failure to consider non-dominant/dominant groups as both actors and acted upon? • Solution: Examine ways in which dominant and non-dominant groups are both acting as well as acted upon.
D 5 Treating dominant opinions as fact • Question: Are opinions expressed by a dominant group about a non-dominant group treated as fact? • Solution: Opinions expressed by dominant groups about non-dominant groups are treated as opinions, not fact.
D 6 Stereotyping • Question:Are stereotypes of non-dominant / dominant groups treated as essential aspects of group membership? • Solution:Treat stereotypes as stereotypes, not as truths.
D 7 Exaggerating differences • Question: Are overlapping traits treated as if they were characteristic of only non-dominant / dominant groups? • Solution: Document both the differences and the similarities between members of non-dominant and dominant groups.
D 8 Hidden double standard • Question: Are different criteria used to define comparable facts with the effect of hiding their comparability? • Solution: Ask whether there might be a hidden double standard by looking for non-obvious parallels. One way of achieving this is by asking what form the phenomenon identified within one group might take within another group.
Applying The BIAS FREE Framework Part 4
Costa Rica Case Study • Workshop held in 2001 with ca. 30 participants • Goal: To help the Hospital de las Mujeres Dr. Adolfo Carit Eva transform from a maternity hospital to a hospital for women • Learned of results in 2004
Costa Rica Case Study (cont.) • Workshop “unblocked” the process • Format was as important as content • New cooperative model was adopted • Workshop replicated for 250 persons • Flat, network-based management structure
Costa Rica Case Study (cont.) Outcomes: • Increased outreach • Increased access • Increased patient satisfaction • Increased staff satisfaction • Shorter waiting times • Lower hospital operating costs