White by default: conceptual and methodological limits of binary white logic in global health equity research

This article examines the conceptual and methodological limitations of how the category “White” is interpreted and used in health equity research. I argue that such studies often rely on a binary White logic – a framework that organises ethnoracial comparisons around a dichotomy between people racialised as White and Non-White Others. Within this logic, the White category is treated as a homogeneous reference group that reliably signals uniform protection from racism and access to White privilege. This assumption operates both statistically and epistemically, with profound implications for how health disparities are measured and understood. Although this framework reflects broad ethnoracial dynamics rooted in White supremacism, it has serious shortcomings. One relevant but underexplored consequence is that it tends to biologise and essentialise Whiteness. It also obscures complex, context-specific processes of racialisation and marginalises groups that do not fit prevailing classificatory practices. I demonstrate that the uncritical use of the White category – as a default homogenous comparator category – in global health equity research reproduces epistemic injustice and misrepresents complex dynamics of racialisation, thereby concealing medically relevant experiences of representatives of such groups. I focus on people racialised as Eastern Europeans, whose ambiguous positioning within global ethnoracial hierarchies – often termed Off-White – renders them largely invisible in scholarship, despite evidence of racism affecting their health. To produce more accurate and socially responsible science, I call for a shift away from binary White logic towards more thoughtful, precise, and contextually appropriate uses of ethnoracial categories – and other proxies for racism – in research on racism and health.