PPN 302 Week 4: Race, Health, and Structural injustice

Overlapping intersections

what happens when someone experiences multiple forms of discrimination/ oppression at the same time?

Key takeaways (How racism makes us sick) David R. William

• Racism health toll is stark: blacks live shorter than whites at all education levels, driven by systemic discrimination

• Discrimination, both major and minor, elevates risk for diseases from hypertension to heart disease, affecting health profoundly

• Racisms’ profound impact on health is not just about income or education; it’s a rigged system disadvantaging racial groups

Findings (How racism makes us sick) David R.William

• There is a large gap in the life expectancy between black and white people who have dropped out, or had post secondary education. 

• Higher levels of discrimination are associated with an elevated risk of a broad range of diseases from blood pressure, to abdominal obesity, breast cancer, heart disease, and premature mortality

• Residential segregation creates the base for inequities

What ways can this be fixed (How racism makes us sick) David R.William

• Providing high quality healthcare from age 1-5 

• Providing high quality overall

• Providing health assessment upon orientation and providing tools as needed to the students. And annual health transcript to monitor progress 

• Devine solution: found a way to attack hidden bias 

Racism and Canadian society

• Canada convinces itself and world that colonization hasn’t shaped society 

• Denial is a part of systemic discrimination 

• Systemic racism normalizes racism 

• Myths that we are so different for US which is not true 

• After civil war black people went back to US after slavery due to it being worse in Canada

• Black and indigenous people make up 40% of incarcerated population but only make up 10% of general population 

• Nearly half of the cases of people who have died since the 2000s due to police brutality were mentally distressed 

Why discuss racism in community health nursing?

• Racism is fundamental cause of racial disparities, health inequity, and differential illness outcomes 

• Health promotion requires a critical understanding of issues of race, class, gender sexuality and their intersecting impacts on power, privilege, equity, and diverse groups’ 

• Experiences with health and illness 

• Nurses have an ethical responsibility to care for diverse individuals, groups, and communities

Race defined

• The socially constructed classification of human beings based on skin colour/physical attributes, historical and geographic context 

• Determined socially and psychologically, rather than biologically 

• Often the basis upon which groups are formed, agency is attained, social roles are assigned, and status is conferred

Racism defined

• An “ideology of inferiority” used to justify discrimination 

• A comprehensive system of discrimination, restructuring opportunities, and assigning value (a systematic/systemic process) 

• The protection of privilege (privilege of status, opportunity and traditions)

Levels of Racism

• individual/interpersonal

• Institutionalized 

• Systemic 

• Internalized 

Individual/interpersonal racism (levels of racism)

Negative attitudes and behaviours that individuals hold regarding other of different race

Examples of Individual/interpersonal racism (levels of racism)

Microaggressions, passive aggression, exclusion, bias, stereotyping, prejudice

Institutionalized racism (levels of racism)

• Policies, rules, and regulations of an organization or institution that systematically reflect and produce differential treatment of racialized groups 

• Sometimes referred to as systemic racism

Examples of Institutionalized racism (levels of racism)

Underrepresentation, bias in hiring and promotion, education policies, victim service policies

Systemic racism (levels of racism)

• The way in which rooted inequities in society operate to justify differential access of goods, services, opportunities, & recognition of racialized groups 

• Sometimes referred to as structural racism

Examples of Systemic racism (levels of racism)

Police brutality/state violence, surveillance, overrepresentation in criminal justice system

Internalized racism (levels of racism

Acceptance of negative messages about racialized groups’ own abilities and intrinsic worth

Examples of Internalized racism (levels of racism

Self doubt, fear, low aspiration

Historical context of racism

Colonization & slavery → replicate in intergenerational cycles of poverty and trauma → marginalization & Systemic oppression

Colonization (Historical context of racism) 

• Indian act

• Residential schools 

• Sixties scoop 

• Broken family bonds

Slavery (Historical contexts of racism)

• Control 

• Entrapment 

• Brutality 

• Dehumanization 

Manifestations of racism

• Privilege vs oppression 

• Bias, prejudice, microaggressions, exclusionary practices, discrimination, underrepresentation, unfair hiring and promotion practice, police brutality/state violence, surveillance → hypervigilance, self-doubt, fear 

Health Impacts of Racism

• Health inequities

• Psychological impacts

• Illness

• Maternal-Child health

• Family health

Health inequities (Health Impacts of Racism)

• Sustained high levels of poverty 

• Poor access to education

Psychological (Health Impacts of Racism)

• Intergenerational trauma 

• Increased suicide rates 

• Increased substance misuse/abuse 

• Racial identity- paranoia/fear/low self-esteem 

Illness (Health Impacts of Racism)

• Increased chronic diseases 

• Increased obesity rates

Maternal-child health (Health Impacts of Racism)

• Increased infant mortality in indigenous community

• SGA/preterm babies among black women

Family health (Health Impacts of Racism)

• Loss of black and indigenous parents to violence and incarceration 

• Child welfare apprehension- broken family ties 

Racialized immigrant experience includes 

• Migrant workers 

• Refugee health

• Deskilling immigrants

• Healthy immigrant effects

Migrant workers (racialized immigrant experience)

• Unique barriers to accessing health care

• Disproportionately affected by COVID-19

Refugee health (racialized immigrant experience)

• Traumatic experiences 

• Institutional discrimination 

• Lack of culturally safe care/ services

Deskilling immigrants (racialized immigrant experience)

• Education qualifications not recognized in Canada 

• Reduces initial employment opportunities 

Healthy immigrant effects (racialized immigrant experience)

• Recent migrants have substantially better health when compared to native-born people

• Decline of health among immigrants with additional years living in the new country 

A Critical health approach to Racism

• Racism identified as a public health emergency 

• Building HP strategies to address racism in public health frameworks - what would this look like? 

• Critical health promotion actions - rooted in social justice approaches and guided by critical race theory, critical anti-colonical theories, equity and intersectionality lens 

• Addressing key determinants of health to support resilience and resistance against racism 

• Current municipal and provincial anti-racism strategies- are they working 

Decolonizing Nursing

• Nursing education is built to maintain and perpetuate whiteness 

• Blacks, racialized and indigenous peoples’ contribution unacknowledged and erased 

• Nursing is a caring profession. Does this mean nurses cannot be racist? - no 

• The conundrum of balancing the act of honoring community voices to address “equity gap” and confronting own ideologies of racism 

• Ethics in nursing practice: values, morals, norms, moral principles, & traditions that support social justice & equity 

Questions the status quo (Decolonizing nursing) 

• move beyond the "concepts of culture” 

• Whose voices are heard? 

• Whose voices are silenced or absent? 

• What are the implications of not listening to or ignoring individuals and groups 

A Commitment to Anti-racism

• What does it mean to be anti-racist? 

• Acknowledge that systemic oppression exists & creates inequities across groups 

• Acknowledge that we all have a responsibility to understand our own role in creating disparity, & to identify and address issues of inequity 

• Critically look at who we are, our positionality, out biases and assumptions 

• Reflect. See. Think. Do

Reflect (A commitment to Anti-Racism)

why am I thinking this way?

See (A commitment to Anti-Racism)

what does privilege, and oppression look like?

Think (A commitment to Anti-Racism)

what are the root causes?

Do (A commitment to Anti-Racism)

How can I take action?

The cycle of oppression

• Seeing 

• Understanding and mapping 

• Confronting oppression, racism: acting for change 

Seeing (the cycle of oppression) 

• What does the cycle of oppression “look like” in our nursing practice, education, research, policy-making, leadership, everyday life? (e.g racism, heterosexism, classism etc) 

• What does privilege “look like”? (e.g white, settler, heterosexual, social class) 

• What do oppression and privilege “look like” in nursing practice, education, research, policy-making, leadership, and in our everyday lives?

Understanding and mapping (the cycle of oppression)

• Once we “see” oppression and privilege in our practice, education, research, policy-making, leadership, everyday life, we ask: where are its root causes 

• In other words: what is the path or map from everyday acts of prejudice, colonialism, racism, heterosexism, and other isms is the societal supports or structures that create and sustain colonialism, racism, heterosexism, classim…? 

Confronting oppression, racism: acting for change (The cycle of oppression)

• Once we engage in understanding and mapping oppression and privilege, we continually ask ourselves: how can I take action to confront my participation in oppression, my privileges? How can I act for decolonization, reconciliation? How can I act for social change? How can I engage in lifelong allyship? 

Towards critical social justice

• Need a moral commitment to critical justice in nursing practice to tackle systemic injustice and oppressive social and political processes that sustain health inequity

• Critical social justice go to the root of societal power hierarchies, interrupt practices of oppression and structural violence that cause human suffering- Peel back the layers of the onion” 

• Liberation from oppressive structures is a necessary part of marginalised groups’ pursuit and attainment of health equity 

• “Critical social justice" is a natural extension of nursing ethics” 

• Moving beyond the Eurocentric biomedical perspective