By Derek T. Dangerfield II, PhD
Public health is very good at studying what goes wrong. We measure disease, identify risk factors, document disparities, and determine which populations experience the greatest burden of illness. This work is essential. But increasingly, researchers and community members are challenging the deficit models that have traditionally informed research and interventions involving high-need populations.
The critique is familiar: when populations enter the scientific literature primarily because they experience elevated rates of disease, poverty, violence, or other adverse outcomes, they can gradually become defined by those outcomes.
There is now considerable discussion about moving toward strengths-based approaches, with growing attention to resilience, thriving, community assets, and well-being.
But do we actually know how to move beyond deficit models toward these approaches?
I found myself returning to this question while editing my new volume, Life Course Perspectives on Black Sexual Minority Men’s Health and Quality of Life.
For more than three decades, research involving Black gay, bisexual, and other sexual minority men has been heavily informed by HIV. That research has been essential and lifesaving. But in developing this volume, I thought about what becomes visible when a specific disease is no longer the primary premise for studying a population.
That turned out to be a more complicated intellectual (and spiritual) journey than simply adding chapters on “resilience” or “quality of life” to the book. Adding a measure of resilience to a study focused on disease does not necessarily transform a deficit model. Nor does changing our language from “risk” to “strengths” if our theories, methods, and attitudes towards a population remain fundamentally unchanged.
I think this question requires us to think differently about resilience, which has become central to many strengths-based approaches. Resilience cannot simply become another expectation placed on individuals experiencing structural inequality. In fact, I sometimes wonder whether our emphasis on “building resilience” sets the bar too low. Resilience often becomes visible because people have encountered something they were required to withstand or overcome.
Certainly, understanding what enables people to adapt to adversity matters. But an equally important population health question is how we create conditions in which people are less frequently required to be resilient in the first place. Moving beyond deficit models requires changing what we consider worthy of scientific exploration.
Our edited volume represents one attempt to do that through the lives of Black sexual minority men. Across its chapters, contributors examine development, relationships, community, adversity, resilience, aging, health, and quality of life across the life course as necessary parts of understanding whole lives, rather than understanding this population primarily through an HIV prevention lens.
The implications, however, extend well beyond this population.
Perhaps the goal should not simply be to understand how people remain resilient in the face of adversity, but to build a population health science concerned with creating conditions in which fewer people are required to be resilient in the first place.