Faculty member’s research on women’s health care access published in national journal

A Roanoke College professor’s research examining how state-level barriers negatively impact women seeking health care was recently published in the flagship journal of the American Public Health Association. 

The research report, titled “State-Level Sexism and Women’s Health Care Access in the United States: Differences by Race/Ethnicity, 2014–2019,” was co-authored by Dr. Kristen Schorpp Rapp, assistant professor of sociology and public health at Roanoke, and published in the October 2021 issue of the American Journal of Public Health.   

Rapp’s research, conducted in collaboration with Dr. Vanessa Volpe, assistant professor of psychology at North Carolina State University, utilized administrative data collected from the national Consumer Survey of Health Care Access (2014-2019). Research determined that state-level factors — including gender inequities in pay, women’s underrepresentation in state legislature, and lack of paid family/medical leave policy — disproportionately prevent many women, particularly non-Hispanic Black and Hispanic/Latina women, from receiving appropriate and affordable health care. The research focused primarily on physical health care implications rather than mental health care implications.    

Rapp says it is not enough to research health care barriers in regard to gender, race, ethnicity, or economic class independently, which has been the traditional process for this kind of research. Rather, research now requires analysis on how health care roadblocks impact individuals who intersect among multiple demographic groups.  

“In order to truly address the gaps that we see in health care and health, we need to better understand the role of social inequities in creating them, like gender gaps in employment and pay, representation of women — especially women of color — in our government, and policies that restrict reproductive rights of women,” Rapp says. “All of these things cumulatively matter for health and health care.”  

The research concluded that cost primarily played a significant role in health care disparities for women of color, disparities that far outnumbered what other women face when seeking medical care. Rapp’s research, which also explores gender disparities in health care, determined that women in states with more indicators of state-level sexism — such as high gender gaps in pay, low representation of women in state government, and limited access to providers offering reproductive care — had far more barriers than men in accessing appropriate care.    

Throughout recent years, various research studies have been published about disparities in health care for Black and Hispanic/Latina women. However, Rapp says she intended to bring to light the gender and race intersections at play in the health care field, something often overlooked by analysts.    

“This is the first research that documents the disproportionate impact that these state-level policies and practices have on women of color,” says Rapp. “When we think of women’s health, we often fail to consider how gender might interact with race and ethnicity to impact health in unique ways for certain groups.”   

Along with publishing her findings in the American Journal of Public Health, this research, which Rapp has conducted over several years, is also published in the Journal of Health and Social Behavior and the American Journal of Preventive Medicine, accomplishments she says are still “settling in.”  

“I am thrilled that our work is published in a major public health outlet,” Rapp says. “I really did not expect that at the beginning of this research, but then to have three publications within a year is beyond exciting. Working at a smaller, liberal arts college and getting published by [the American Journal of Public Health] isn’t quite as common since larger research universities have all kinds of resources, but it’s very exciting for myself, my collaborators, and Roanoke College.”  

Rapp is especially proud of this work, as she hopes the findings will help lawmakers develop woman-minded policy changes that are more consistent from state to state, a major factor contributing to limited health care access for women of color.   

One way Rapp hopes to indirectly influence those policy changes is by incorporating this research into her classroom. Rapp says that her instruction “heavily focuses” on examining health care disparities based on race, gender and class, among other factors, to open her students’ minds to thinking about health care beyond an individualist perspective.  

“It’s important to see that research has an impact on the ways we think about societal problems and their solutions,” says Rapp. “We aren’t going to solve the world’s problems with research alone, but research is an important and necessary part of the conversation. It allows us to develop evidence-based approaches to address health inequities and bring about social justice. I try to bring those practices into the classroom as often as possible.”  

Rapp’s students seem to be listening. Roanoke College graduates Tabitha L. Hale ’20 and Dominique F. Quartararo ’20, co-authors of the Journal of Health and Social Behavior article, played key roles in developing the analysis for the published work. 

“I had mentioned this work in class, and both expressed interest in being a part of the research,” Rapp says. “We all worked really well together, and I truly enjoyed having them be a part of the process because they brought enthusiasm and new ideas into the research process.”  

As a continuation of this research, Rapp has enlisted the help of current Roanoke College students to analyze how state policy contexts shape the physical and mental health of populations with various intersecting social identities. The “fundamental questions we are asking are guided by student interest,” Rapp says.  

“Much of what I do in the classroom is teaching through research,” she says. “It is such a good way to apply what we learn in the classroom to real-world social problems. It’s really been through my teaching that I have further developed my personal research focus.”  

Rapp, a Roanoke College faculty member since 2017, earned a B.A. in biology from Rutgers University. She then earned an M.A. and a Ph.D. in sociology at the University of North Carolina at Chapel Hill, focusing her academic research on ways social, economic, and political contexts relate to health and health care disparities.