Social representations of health in non-hegemonic populations: an intersectional approach to the perceptions of migrant and Roma people in the Basque Country

Authors

DOI:

https://doi.org/10.22325/fes/res.2025.267

Keywords:

health inequalities, intersectionality, qualitative research, race, ethnicity

Abstract

Lay conceptions of health are social representations that develop within specific historical and cultural contexts and shape health behaviours. These conceptions are not socially homogeneous but are influenced by various positions of privilege and oppression. This study aimed to explore the diverse social representations of health and illness processes and their determinants, considering diversity in terms of migratory and ethnic backgrounds from an intersectional perspective. A qualitative study was conducted from a socioconstructivist approach, using discussion groups and triangular groups, with a total of 74 participants in the Basque Country (Spain) between October 2023 and May 2024. The findings reveal a continuum: on one end, multidimensional and non-binary conceptions of health that incorporate the social determinants of health model among individuals in positions of power; on the other, representations centred on the physical dimension and defined as the mere absence of disease, aligned with the biomedical model, among the most disadvantaged groups. These findings have important implications for the design of health promotion and prevention strategies, highlighting the need for an intersectional approach to health.

Author Biographies

Yolanda González-Rábago, University of the Basque Country

Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico – OPIK. Departamento de Sociología y Trabajo Social, Universidad del País Vasco/Euskal Herriko Unibertsitatea.

Iratxe López-López de Araya, University of the Basque Country

Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico – OPIK. Departamento de Sociología y Trabajo Social, Universidad del País Vasco/Euskal Herriko Unibertsitatea.

Celia Fernández-Carro, National University of Distance Education

Departamento de Sociología III, Facultad de Ciencias Políticas y Sociología, UNED, España.

Isabel Portillo, Department of Health

Servicio Vasco de Salud, Departamento de Salud, España. Instituto de Investigación Sanitaria IIS, Biobizkaia.

References

Abric, J. C. (2001). Las representaciones sociales: Aspectos teóricos. En Prácticas sociales y representaciones. Ediciones Coyoacán.

Alidu, L., y Grunfeld, E. A. (2017). Gender differences in beliefs about health: A comparative qualitative study with Ghanaian and Indian migrants living in the United Kingdom. BMC Psychology, 5(1), 1-8. https://doi.org/10.1186/s40359-017-0178-z

Artazcoz, L., Artieda, L., Borrell, C., Cortès, I., Benach, J., y García, V. (2004). Combining job and family demands and being healthy: What are the differences between men and women? European Journal of Public Health, 14(1), 43-48. https://doi.org/10.1093/eurpub/14.1.43

Backett, K., y Davison, C. (1992). Rational or reasonable? Perceptions of health at different stages of life. Health Education Journal, 51(2), 55-59. https://doi.org/10.1177/001789699205100202

Bauer, G. R. (2014) Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science Medicine, 110, 10-17. https://doi.org/10.1016/j.socscimed.2014.03.022

Baverstock, K. A., Gargya, D. M., Jackson, M., y Stupans, I. (2018). Identifying Future Health Professionals’ Understanding of the Determinants of Health. Journal of Nursing Education, 57(12), 756-759. https://doi.org/10.3928/01484834-20181119-10

Benazizi, I., Blasco-Blasco, M., Sanz-Valero, J., Koselka, E., Martínez-Martínez, J. M., y Ronda-Pérez, E. (2019). ¿Cómo es la alimentación de la población inmigrante residente en España? Resultados a partir de una revisión sistemática. Anales del Sistema Sanitario de Navarra, 42(1), 55-68. https://doi.org/10.23938/assn.0389

Berenguera, A., Fernández de Sanmamed, M., Pons, M., Pujol, E., Rodríguez, D., y Saura, S. (2014). Escuchar, observar y comprender: Recuperando la narrativa en las Ciencias de la Salud. Aportaciones de la investigación cualitativa. Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP J. Gol).

Biţu, N., y Vincze, E. (2012). Personal encounters and parallel paths toward Romani feminism. Signs: Journal of Women in Culture and Society, 38(1), 44-46. https://doi.org/10.1086/665947

Bousmah, M.-Q., Combes, J.-B. S., y Abu-Zaineh, M. (2019). Health differentials between citizens and immigrants in Europe: A heterogeneous convergence. Health Policy, 123(2), 235-243. https://doi.org/10.1016/j.healthpol.2018.12.005

Bowleg, L. (2012). The problem with the phrase women and minorities: Intersectionality—an important theoretical framework for public health. American Journal of Public Health, 102(7), 1267-1273. https://doi.org/10.2105/AJPH.2012.300750

Braun, V., Clarke, V., Hayfield, N., y Terry, G. (2019). Thematic analysis. En P. Liamputtong (Ed.), Handbook of research methods in health social sciences. Springer Singapore. https://doi.org/10.1007/978-981-10-2779-6

Bronfenbrenner, U. (1994). Ecological models of human development. International encyclopedia of education, 3(2), 37-43.

Calnan, M., y Johnson, B. (1985). Health, health risks and inequalities: An exploratory study of women’s perceptions. Sociology of Health & Illness, 7(1), 55-75. https://doi.org/10.1111/1467-9566.ep10831360

Canguilhem, G. (1986). Lo normal y lo patológico. Siglo XXI Editores.

Conde, F. (2008). Los grupos triangulares como espacios transicionales para la producción discursiva: Un estudio sobre la vivienda en Huelva. En A. J. Gordo López & A. Serrano Pascual (Eds.), Estrategias y prácticas cualitativas de investigación social. Pearson Educación.

Conde, F., y Gabriel, C. (2002). La evolución de las representaciones sociales sobre la salud de las mujeres madrileñas, 1993-2000. Revista Española de Salud Pública, 76(5), 493-507.

Connell, R. W., y Messerschmidt, J. W. (2005). Hegemonic masculinity: Rethinking the concept. Gender & Society, 19(6), 829-859.

Couto, M. T., De Oliveira, E., Separavich, M. A. A., y Luiz, O. D. C. (2019). La perspectiva feminista de la interseccionalidad en el campo de la salud pública: Revisión narrativa de las producciones teórico-metodológicas. Salud Colectiva, 15, e1994. https://doi.org/10.18294/sc.2019.1994

Crenshaw, K. W. (1989). Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. University of Chicago Legal Forum, 1989(1), 139-167.

Crenshaw, K. W. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241-1299.

Departamento de Igualdad, Justicia y Políticas Sociales del Gobierno Vasco. (2022). Estrategia Vasca con el Pueblo Gitano: 2022-2026. https://www.euskadi.eus/contenidos/informacion/pueblo_gitano/es_7946/adjuntos/estrategia-gitana-Cast-web.pdf

Fernández-Feito, A., Pesquera-Cabezas, R., González-Cobo, C., y Prieto-Salceda, M. D. (2019). What do we know about the health of Spanish Roma people and what has been done to improve it? A scoping review. Ethnicity & Health, 24(2), 224-243. https://doi.org/10.1080/13557858.2017.1315373

Foucault, M. (2001). El nacimiento de la clínica: Una arqueología de la mirada médica (1953) (20a ed.). Siglo XXI Editores.

Fraser, N. (2015). Fortunas del feminismo: Del capitalismo gestionado por el Estado a la crisis neoliberal (C. Piña Aldao, Trad.). Traficantes de sueños.

Furnham, A. (1994). Explaining health and illness: Lay perceptions on current and future health, the causes of illness, and the nature of recovery. Social Science & Medicine, 39(5),715-725. https://doi.org/10.1016/0277-9536(94)90026-4

Gómez-Arias, R. D. (2018). ¿Qué se ha entendido por salud y enfermedad? Revista Facultad Nacional de Salud Pública, 36(Supl 1), 64-102.

González-Rábago, Y., La Parra-Casado, D., Jacques-Aviñó, C., Bee Nchama, M., y Manzano Lorenzo, J. (2024). Raza, salud y sistema sanitario: La necesidad de abordar el racismo institucional en España. Gaceta Sanitaria, 38, 102425. https://doi.org/10.1016/j.gaceta.2024.102425

Hawkes, S., y Buse, K. (2013). Gender and global health: Evidence, policy, and inconvenient truths. The Lancet, 381(9879), 1783-1787. https://doi.org/10.1016/S0140-6736(13)60253-6

Herrero-Arias, R., Parra-Casado, D. L., Ferrández-Ferrer, A., Sanchís-Ramón, M. J., y Ortiz-Barreda, G. (2023). Experiences and constructions of womanhood and motherhood among Spanish Roma women. European Journal of Women’s Studies, 30(2), 164-180. https://doi.org/10.1177/13505068211039950

Hjelm, K., Bard, K., y Apelqvist, J. (2018). A qualitative study of developing beliefs about health, illness and healthcare in migrant African women with gestational diabetes living in Sweden. BMC Women’s Health, 18(34), 1-14. https://doi.org/10.1186/s12905-018-0518-z

Jobanputra, R., y Furnham, A. F. (2005). British Gujarati Indian Immigrants’ and British Caucasians’ Beliefs about Health and Illness. International Journal of Social Psychiatry, 51(4), 350-364. https://doi.org/10.1177/0020764005060851

Jodelet, D. (1986). La representación social: fenómenos, concepto y teoría. En S. Moscovici (Ed.), Psicología social II: Pensamiento y vida social. (469-494) Paidós.

Kostelanetz, S., Pettapiece-Phillips, M., Weems, J., Spalding, T., Roumie, C., Wilkins, C. H., y Kripalani, S. (2022). Health Care Professionals’ Perspectives on Universal Screening of Social Determinants of Health: A Mixed-Methods Study. Population Health Management, 25(3), 367-374. https://doi.org/10.1089/pop.2021.0176

La Parra-Casado, D., Arza-Porras, J., y Estévez, J. F. (2020). Health indicators of the National Roma Integration Strategy in Spain in the years 2006 and 2014. European Journal of Public Health, 30(5), 906-910. https://doi.org/10.1093/eurpub/ckaa063

La Parra-Casado, D., Solheim, E. F., y Estévez, J. F. (2021). Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys. Scandinavian Journal of Public Health, 51(3), 347-354. https://doi.org/10.1177/14034948211056210

Lugones, M. (2010). Toward a Decolonial Feminism. Hypatia, 25(4), 742-759. https://doi.org/10.1111/j.1527-2001.2010.01137.x

Malmusi, D., y Ortiz-Barreda, G. (2014). Desigualdades sociales en salud en poblaciones inmigradas en España: Revisión de la literatura. Revista Española de Salud Pública, 88, 687-701. https://dx.doi.org/10.4321/S1135-57272014000600003

Martín Criado, E., y Moreno Pestaña, J. L. (Eds.). (2005). Conflictos sobre lo sano: Un estudio sociológico de la alimentación en las clases populares en Andalucía. Junta de Andalucía, Dirección General de Salud Pública y Participación.

Menéndez, E. L. (2020). Modelo médico hegemónico: tendencias posibles y tendencias más o menos imaginarias. Salud colectiva, 16, e2615. https://doi.org/10.18294/sc.2020.2615

Moscovici, S. (2001). Social representations: Essays in social psychology. New York University Press.

Nielsen, S. S., y Krasnik, A. (2010). Poorer self-perceived health among migrants and ethnic minorities versus the majority population in Europe: A systematic review. International Journal of Public Health, 55(5), 357-371. https://doi.org/10.1007/s00038-010-0145-4

Olišarová, V., Tóthová, V., Bártlová, S., Dolák, F., Kajanová, A., Nováková, D., Prokešová, R., y Šedová, L. (2018). Cultural features influencing eating, overweight, and obesity in the Roma people of South Bohemia. Nutrients, 10(7), 838-848. https://doi.org/10.3390/nu10070838

Parsons, T. (1984). El sistema social [1951]. Alianza Universidad.

Peersman, W., Cambier, D., De Maeseneer, J., y Willems, S. (2012). Gender, educational

and age differences in meanings that underlie global self-rated health. International Journal of Public Health, 57(3), 513-523. https://doi.org/10.1007/s00038-011-0320-2

Pfeffer, N., y Moynihan, C. (1996). Ethnicity and health beliefs with respect to cancer: A critical review of methodology. British Journal of Cancer. Supplement, 29, 66-72.

Ravenell, J. E., Johnson Jr, W. E., y Whitaker, E. E. (2006). African-American men’s perceptions of health: A focus group study. Journal of the National Medical Association, 98(4), 544-550.

Rodríguez-Álvarez, E., González-Rábago, Y., Bacigalupe, A., Martín, U., y Lanborena Elordui, N. (2014). Inmigración y salud: Desigualdades entre la población autóctona e inmigrante en el País Vasco. Gaceta Sanitaria, 28(4), 274-280. https://doi.org/10.1016/j.gaceta.2014.01.008

Rodríguez-Álvarez, E., González-Rábago, Y., Borrell, L. N., y Lanborena, N. (2017). Perceived discrimination and self-rated health in the immigrant population of the Basque Country, Spain. Gaceta Sanitaria, 31(5), 390-395. https://doi.org/10.1016/j.gaceta.2016.12.014

Ruiz Ruiz, J. (2012). El grupo triangular: Reflexiones metodológicas en torno a dos experiencias de investigación. Empiria: Revista de Metodología de Ciencias Sociales, (24), 141-162. https://doi.org/10.5944/empiria.24.2012.846

Sanders Thompson, V., Talley, M., Caito, N., y Kreuter, M. (2009). African American men’s perceptions of factors influencing health-information seeking. American Journal of Men's Health, 3(1), 6-15. https://doi.org/10.1177/1557988307304630

Satia-About, J. (2003). Dietary acculturation: Definition, process, assessment, and implications. International Journal of Human Ecology, 4(1), 71-86.

Sanz Remacha, M. (2021). Promoción de la actividad física y los hábitos saludables en familias de poblaciones desfavorecidas [Tesis doctoral, Universidad de Zaragoza]. Universidad de Zaragoza.

Shahin, W., Stupans, I., y Kennedy, G. (2021). Health beliefs and chronic illnesses of refugees: A systematic review. Ethnicity & Health, 26(5), 756-768. https://doi.org/10.1080/13557858.2018.1557118

Shershneva Zastavnaia, J. (Ed.) (2024). Dos décadas de reflexión sobre migración y asilo en Euskadi. Servicio Editorial de la Universidad del País Vasco.

Simon, J. G., De Boer, J. B., Joung, I. M. A., Bosma, H., y Mackenbach, J. P. (2005). How is your health in general? A qualitative study on self-assessed health. European Journal of Public Health, 15(2), 200-208. https://doi.org/10.1093/eurpub/cki102

Stronks, K., Hoeymans, N., Haverkamp, B., den Hertog, F. R. J., van Bon-Martens, M. J. H., Galenkamp, H., Verweij, M., y van Oers, H. A. M. (2018). Do conceptualisations of health differ across social strata? A concept mapping study among lay people. BMJ Open, 8(4), e020210. https://doi.org/10.1136/bmjopen-2017-020210

Subedi, R., Kaphle, S., Adhikari, M., Dhakal, Y., Khadka, M., Duwadi, S., Tamang, S., y Shakya, S. (2022). First call, home: Perception and practice around health among South Asian migrants in Melbourne, Australia. Australian Journal of Primary Health, 28(1), 40-48. https://doi.org/10.1071/PY21036

Torres López, T. M., Munguía Cortés, J. A., Pozos Radillo, B. E., y Aguilera Velasco, M. de los Á. (2010). Representaciones sociales sobre la salud y la enfermedad de la población adulta de Guadalajara, México. Atención Primaria, 42(3), 154-161. https://doi.org/10.1016/j.aprim.2009.07.002

van Dalen, H., Williams, A., y Gudex, C. (1994). Lay people's evaluations of health: Are there variations between different subgroups? Journal of Epidemiology and Community Health, 48(3), 248-253. https://doi.org/10.1136/jech.48.3.248

Vélez-Agosto, N. M., Soto-Crespo, J. G., Vizcarrondo-Oppenheimer, M., Vega-Molina, S., y García Coll, C. (2017). Bronfenbrenner’s bioecological theory revision: Moving culture from the macro into the micro. Perspectives on psychological science, 12(5), 900-910. https://doi.org/10.1177/1745691617704397

Zwi, K. J., Woodland, L., Kalowski, J., y Parmeter, J. (2017). The impact of health perceptions and beliefs on access to care for migrants and refugees. Journal of Cultural Diversity, 24(3), 63-72.

Published

2025-05-05

How to Cite

González-Rábago, Y., López-López de Araya, I., Fernández-Carro, C., & Portillo, I. (2025). Social representations of health in non-hegemonic populations: an intersectional approach to the perceptions of migrant and Roma people in the Basque Country. Spanish Journal of Sociology, 34(2), a267. https://doi.org/10.22325/fes/res.2025.267

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