Race, Racism, and Social Determinants of Health Slides

What are the social determinants of health?

• Economic stability

• Where you live/ safety

• Education level

• Food

• Having support systems and a community

• Healthcare system (access and quality)

How is spending money on healthcare related to years lived?

• More money spent on healthcare usually = longer years lived

In one sentence what are social determinants of health?

• Social factors that are not directly related to the healthcare or public health that play a role in average lifespan, infant mortality rate, maternal mortality rate, etc.

What are some social factors at play in healthcare?

• Culturally sensitive care

• Someone at the hospital speaking your language

• Can you find the health institute online easily and be drawn to it?

• Amenities supporting patients and visitors

What are the 8 Americas that Murray and Colleagues looked at?

A public health study that divided USA population into 8 different groups based on race, geography, and socioeconomic factors. These groups showed the big differences in life expectancy and health due to different social and economic conditions.

Who is the best well-off in the 8 Americas?

Asian-American women —> live about 91 years

How long do Native American men in South Dakota live?

About 58 years old.

Why is it that people living in cities live longer than those in rural areas?

• In rural areas there isn’t as much access to healthcare.

• Socializing is essential for health —> religion is really good at this

Why is America 1 (Asian-Americans) so healthy?

• High high school completion rate

• Good income

Why is America 8 (high-risk Black Americans” so unhealthy?

• Lower income

• Lower high school completion rates

• Larger homocide death probability

What are some other cultural variables that play a role in health?

Cultural-specific diet and exercise regimes.

Who lives longer generally, men or women?

• With the exception of Greece, women tend to live longer than men.

Where are all the countries with life expectancy below 65?

• They are all in Africa with the exception of Haiti

How long do women in Hong Kong live vs men in Africa?

• Women in Hong Kong live to about 88

• Men is Africa live to about 52

Who has the highest life expectancy in Canada?

Richmond BC —> about 84 years

In Canada, who lives longer, the ones in cities or rural areas?

• People living in cities

Who lives longer generally, immigrant populations or Native American populations?

Immigrant populations

How does employment affect life expectancy?

Areas with low employment rates have lower life expectancy.

What health factors tie to lower life expectancy?

Places with low life expectancy usually also have higher substance abuse rates, worse mental health, and higher infant/maternal morality rates.

Why do women tend to live longer than men?

This is such a popular trend among different populations that it seems to track biological differences.

Does race affect health? For instance, being genetically sub-saharan African.

Through genetic analysis it has been shown that being genetically Sub-Saharan African does not cause poor health outcomes; the differences are due to environment and socioeconomic factors, not genetics.

In terms of where they live, why do Native communities tend to have poorer health?

• They usually live in remote areas in the North

• Rural areas don’t have as much access to healthcare and we have to ship nurses, doctors, dentists, etc. in.

What did Weijer and Skelton say about Indigenous people being marginalized?

• Indigenous people are historically marginalized group —> in aspects other than just healthcare, law and education as well.

• They are also colonized and have to live with laws that go against their traditional ways of life and healthcare.

What do we mean when we say there are 2 Canadas?

• There is Settler Canada which is doing very well.

• There is Indiginous Canada which has the same healthcare opportunities as a 3rd world country.

Why social determinants do Indigenous people lack?

• Access to healthy food (and affordable)

• Good education

• Social supports

• Some communities don’t even have access to healthy water (have been told to evacuate)

What did Crenshaw say?

• Black women were denied rights that were granted to black men and white women.

What was the GM situation that Crenshaw talks about?

• There was a case in court where the hiring and firing practices of the company GM were questioned.

• It was ruled that the company’s hiring and firing practices were not sexist as they hired and retained white women and also not racist as they hired and retained black men.

• The court knew that GM would not hire black women up until recently, but said that the black women had to either appeal as women or black they could not do both.

What is intersectionality?

The idea that people’s identities like race, gender, and class add up and you cannot look at them one at a time.

People experience oppression and privilege in combined and overlapping ways not just in one way or another.

What do Bourassa et al say about why Indigenous women have poorer health?

• Forced sterilization of indigenous women (forced to go through medical procedures and not be able to have children).

• Distrust of the healthcare system due to past discrimination.

• Lower income and educational/job opportunities

• Exposure to violence

• Higher rates of being imprisoned (incarcerated)

What happened to Joyce Echaquan?

She went to a hospital in Quebec and the nurses just mocked her and laughed at her until she died.

What is othering?

Sorting of people into hierarchical categories

What was the Indian Act?

A document that stated who counts as First Nation.

How did the Indian Act negatively affect Indigenous women?

• They can lose their status more easily than men.

• Indigenous women were put under a government system that was very different from their traditional ways of self-governing.

• This government system usually exclude women from leadership roles, unlike Indigenous government systems were women were included.

What did Howard McGary say?

American healthcare institutions have a history of ignoring Black patients —> distrust

What was John Rawls’s theory?

His theory says people have a “sense of the good”, which shapes their interests and to pursue those interests they need to have basic things called “primary goods”.

What are John Rawls’s primary goods?

Essentials like food, housing, education, and healthcare.

What is the reason people of colour tend to have worse health?

• Have lower incomes

• Less education

• Live in more dangerous neighbourhoods

• Not enough mental health support and not good access to food

Are sexism, racism, and colonialism for the past only?

No —> Covid-19 cases were 2.5X higher in Black, Hispanic, and Native American populations than in white populations

Why were COVID cases so much higher in POC?

• Less likely to be able to works from home —> can’t socially distance

• More likely to work in customer service roles and take public transport

• More living with extended family —> young infect the old

Why don’t doctors know how to look for certain symptoms in Black patients?

• Most of the medical research is done on white people

• For instance, melanoma ( a type of skin cancer) is more common in Black communities since doctors just don’t know that it looks like on Black skin.

What was the Tuskegee Syphilis Experiment?

• Study run by the U.S Public Health Service in the 1930s-1970s

• The test subjects were poor Black men and they were told they were being treated for “bad blood” (term used to refer to many diseases included syphilis)

• Men were told they were getting the best treatment possible when it fact they were given placebos: lies.

• After penicillin became a cure in the 1940s the men were not allowed to be treated with it.

• The goal of the study was to see the natural progression of untreated syphilis in black men.

McGary and Rawls on Distributive Justice

• How we distribute social goods

What does John Rawl consider primary goods?

Housing, healthcare, good food.

• We can assume everyone wants primary goods regardless of their personal beliefs or goals.

What is Rawl’s maximin principal?

Distribute goods in a way that the worst-off group are as well-off as possible. Improve the situation of those who have the least, even if others are better off.

What is Rawl’s idea of Veil of Ignorance?

Imagine you don’t know anything about yourself —> your race, gender, wealth, social status (veil of ignorance)

From that position create fair principles that you’d be okay to live with no matter where you end up in society.

Who was Peter Buxton?

• He was a whistleblower (an employee who exposes activity in an organization) who told his superiors in the U.S Public Health Service about the Tuskegee study but was ignored.

Who was Bill Jenkins

He also worked at USPHS and helped Buxton put an end to the Tuskegee study

What 2 principals does Rawls say we should choose?

1. Principle of liberty: Everyone should have basic freedom to live how they want (pursuing their conception of the good), as long as they don’t stop everyone else from doing the same

2. Principle of (in)equality: Some inequalities (like higher pay for doctors) are okay if they help the least advantaged people and if everyone has an equal chance to get those positions (so not blocked by race, gender, class).

What does McGary say about mistrust?

He says that mistrust is a social justice issue rather than a failure of POC to take up opportunities provided by healthcare.

This mistrust is a rational response to past mistreatments like the Tuskegee experiment.

The state must be involved to build and support anti-racism initiatives that go beyond just healthcare.

What led to research ethics being formalized and unethical research being banned?

The Tuskegee syphilis study.