HSCI 130: Racism, Discrimination & Ethnic Differences in Health Pt 1

HSCI 130 - Week 12: Racism, Discrimination & Ethnic Differences in Health

LEARNING OBJECTIVES

  • By the end of this week, students will be able to:

    • Distinguish between types of racism: Understanding the different forms racism can take.

    • Describe how racism and discrimination have been examined and measured in relation to health outcomes in North America: This includes the various methodologies used in studies and their findings.

    • Summarize some key evidence linking experiences of racism and discrimination to health outcomes: Identifying specific studies and their conclusions.

    • Explain how scientists have examined ethnic differences in health and health-related behavior: Analyzing research focusing on different ethnic groups.

    • Identify issues that merit further scientific exploration, particularly within the Canadian context: Highlighting gaps in existing research.

RACE, RACIALIZATION, AND RACISM

  • Race: Defined as a social construct that classifies humans into groups based on physical traits, ancestry, genetics, or social relations, as well as the interrelations between these groups.

  • Racialization: Refers to the processes by which people are systematically categorized and sorted into inferior social statuses according to perceived racial differences.

    • It is considered a precursor to racism.

  • Racism: The prejudicial treatment of groups and individuals based on subjective understandings of race.

WHY STUDY RACISM + PUBLIC HEALTH?

  • Purpose of studying injustice in health:

    • The goal is not solely to demonstrate that injustice is wrong; rather, it is to deepen understanding of how injustice shapes population health, consider whose benefit and whose expense it serves, contest narratives that normalize inequities, and produce evidence for accountability.

    • There is an emphasis on the ability of people to change unjust societal systems and structures to advocate for human rights, health equity, and ecological sustainability.

  • Quotation from Nancy Krieger, 2020:

    • “The reason to study how injustice harms health is…to generate evidence for accountability.”

ETHNICITY AND CULTURE

  • Ethnicity: A complex and multi-dimensional phenomenon encompassing culture, ethnoculture, ethnic ancestry/origin, ethnic identity, language, religion, and race or a combination thereof (Aspinall, 2001).

  • Culture: Defined as “the totality of the ideas, beliefs, values, knowledge, and way of life of a group of people who share certain historical, religious, racial, linguistic, ethnic, or social backgrounds” (Henry et al., 1995).

  • Ethnic groups can be seen as socially-based groupings existing within cultural frameworks.

ETHNIC DIFFERENCES IN HEALTH

  • Ethnic differences in health in Canada are complex and not easily summarized.

    • Limited research exists in this area except concerning Indigenous health.

    • Notably, some visible minorities and Indigenous Canadians earn less than their European-origin counterparts, and patterns of ethnic stratification have consequential health implications.

    • Socioeconomic inequality alone does not account for the ethnic differences observed in health.

AREAS COVERED IN TEXT CHAPTER 7

  1. Ethnic differences in perception and understanding of symptoms

  2. Ethnic differences in health-care behaviour

  3. Ethnic differences in the social determinants of health

  4. Indigenous peoples experience poorer health outcomes due to social exclusion and racism

  5. Health immigrant effect diminishes over time

1) ETHNIC DIFFERENCES IN THE PERCEPTION AND UNDERSTANDING OF SYMPTOMS

  • Emotional expression of symptoms, such as pain, is culturally patterned (Segall, 1988).

    • The way individuals conceptualize health and illness, including beliefs about the meaning and management of illness, reflects ethno-cultural influences.

    • The number of symptoms reported and the readiness of individuals to express pain vary significantly across different ethnic groups.

2) ETHNIC DIFFERENCES IN HEALTH-CARE BEHAVIOUR

  • Ethnicity significantly influences willingness to adopt the sick role, consult healthcare professionals, and utilize formal healthcare services.

    • Example: Asian immigrant women demonstrate lower levels of engagement with preventative screening for cervical cancer, even when controlling for variables like residency duration, demographic discrepancies, and socioeconomic status (Xiong et al., 2010).

    • Ethnicity interacts with other social factors, such as socioeconomic status, gender, and age, influencing individuals' health-seeking behaviour.

3) ETHNIC DIFFERENCES IN THE SOCIAL DETERMINANTS OF HEALTH

  • Ethnic stratification: Describes the unequal distribution of wealth, power, and privilege based on ethnic group membership.

    • John Porter documented a social hierarchy concerning occupations, income, and prestige based on ethnic group classification.

    • Veenstra (2009) examined the effects of racialization on health, revealing high risks of diabetes and poor self-rated health among Indigenous or minority populations.

DIFFERENCES IN LOG WEEKLY EARNINGS - MEN (Canada, 2015)

  • Chart depicting disparities in log weekly earnings between men in visible minority categories and White men.

    • Significant differences (p < 0.05) reported for various visible minority categories compared to the reference category.

    • Sample included individuals aged 25 to 44 who were born in Canada and had at least one week of paid employment with a minimum earning threshold in 2015.

DIFFERENCES IN LOG WEEKLY EARNINGS - WOMEN (Canada, 2015)

  • Chart illustrating the differences in log weekly earnings between women in designated visible minority categories and White women.

    • Similar to men's earnings, significant differences (p < 0.05) noted across multiple visible minority categories.

    • Sample parameters mirrored those of the women's earnings analysis.

EXPLANATIONS OF ETHNIC DIFFERENCES IN HEALTH AND ILLNESS

A. Biomedical model: Focuses on differences in biophysical traits.
B. Cultural behavioral perspective: Posits that culture shapes behaviors, influencing health outcomes.
C. Socioeconomic perspective: Attributes differences to variations in social class.

RACE & HEALTH

  • Although race is a scientifically discredited concept, its social construction has significant implications for individuals' lives and health.

    • Racialization affects biochemical, neurophysiological, and cellular aspects of health, linking racism and discrimination to health disparities.

  • Race is recognized as a social construct that profoundly impacts lives, bodies, and health.

A) BIOLOGICAL DETERMINIST EXPLANATIONS

  • Studies attempting to frame race as a strictly biological variable tend to overlook social influences on health.

    • Example: Neel’s (1962) hypothesis concerning a “thrifty gene” explaining high diabetes prevalence among Aboriginal populations is mentioned as an unproven assumption.

    • Williams and Sterthal (2010) warn that a biological view of race can reinforce norms of racial inferiority and support the status quo.

B) CULTURAL BEHAVIOURAL EXPLANATIONS

  • Culture plays a crucial role in shaping health perceptions and treatment behaviors (Segall, 1988).

    • Cultural differences contribute to variations in health outcomes across cultural groups, such as emphasized unhealthy lifestyles in Indigenous populations in Canada.

C) SOCIOECONOMIC EXPLANATIONS

  • Socioeconomic status mediates ethnicity-health relationships and affects various determinants of health, including:

    • Access to healthcare

    • Physical environment

    • Chronic stress (Prus and Lin, 2005).

SOCIOECONOMIC EXPLANATIONS (CONT'D)

  • Individuals belonging to socially excluded minority groups typically experience lower socioeconomic status, resulting in:

    • Reduced access to healthcare services

    • Poorer living and working conditions

    • Insufficient material resources for optimal health (Wu and Schimmele, 2005).

4) INDIGENOUS PEOPLES HAVE POORER HEALTH OUTCOMES DUE TO SOCIAL EXCLUSION AND RACISM

  • Historical social exclusion of Indigenous peoples in Canada has negatively impacted the health of First Nations, Métis, and Inuit populations.

    • Social exclusion: Defined as the systematic exclusion of a group from the economic, political, and social resources of society (Galabuzi, 2009).

    • Racism is a significant element of social exclusion affecting the health of Indigenous Canadians (Reading, 2013).

INDIGENOUS PEOPLES HAVE POORER HEALTH OUTCOMES (CONT'D)

  • Life expectancy figures show that registered First Nations and Inuit individuals exhibit a lifespan that is 5 to 14 years shorter than that of non-Aboriginal Canadians (Statistics Canada, 2008a).

  • Indigenous populations experience higher incidences of:

    • Non-infectious diseases (e.g., cancer, heart disease) and infectious diseases (e.g., tuberculosis, AIDS).

LEADING CAUSES OF DEATH IN FIRST NATIONS (1999) AND IN CANADA (1998)

  • Comparative data on causes of death between First Nations and overall Canadian populations, reflecting higher mortality rates among Indigenous people in categories such as:

    • Endocrine and immune diseases

    • Digestive diseases

    • Respiratory diseases (including cancer)

    • Injuries and poisoning

    • Circulatory diseases.

INDIGENOUS PEOPLES HAVE POORER HEALTH OUTCOMES (CONT'D)

  • Health disparities among Aboriginal communities have roots in colonization.

    • “Four centuries of colonization—being subjugated, stripped of land, religion, culture, language, and autonomy—have adversely affected the physical, mental, emotional, spiritual, and cultural health of Aboriginal communities.” (Shah, 2004)

INTERGENERATIONAL TRAUMA AND POORER HEALTH OUTCOMES

  • Rates of violence, abuse, substance dependence, and suicide are significantly elevated in Indigenous communities, largely due to intergenerational trauma from the residential school system (Frideres, 2011).

    • Intergenerational trauma: Refers to the negative emotional effects sustained from an initial traumatic experience throughout generations.

    • Over half of the approximately 70,000 to 80,000 Indigenous individuals who attended residential schools report adverse health consequences (Health Canada, 2014a).

INDIGENOUS PEOPLES IN CANADA - CIHR PRIORITY AREAS

  • Priority areas for Indigenous health research as identified by the Canadian Institutes of Health Research (CIHR):

    1. Suicide prevention

    2. Diabetes & Obesity

    3. Tuberculosis

    4. Oral Health

DISPROPORTIONATE POVERTY IN CHILDREN IN CANADA

  • Child poverty rates highlight significant disparities:

    • For example, Indigenous children experience markedly higher poverty rates compared to non-Indigenous children across various provinces.

RACISM AND HEALTH IN THE SCIENTIFIC LITERATURE

  • Extensive research indicates racial discrepancies in health outcomes in the US, drawing increased focus on the relationship between racism and health disparities.

RACISM AND INDIGENOUS PEOPLES’ HEALTH OUTCOMES

  • Indigenous individuals often confront systemic racism in interactions with mainstream healthcare, leading to compromised care quality and adverse health effects.

    • Case example: Brian Sinclair, who passed away from a treatable condition after prolonged neglect in an emergency room setting.

RACISM AND INDIGENOUS PEOPLES’ HEALTH OUTCOMES (CONT'D)

  • Recognition of the racially stratified nature of Canadian society has prompted policy advancements aimed at preventing discrimination based on race within healthcare.

ADDRESSING RACISM WITHIN THE CANADIAN HEALTH CARE SYSTEM

  • Traditional healthcare models have revolved around homogeneous patient populations, a notion that is now outdated given Canada’s diversity.

  • The Intercultural Care Model acknowledges the distinct cultural backgrounds of patients.

    • Expectations for healthcare professionals include demonstrating cultural sensitivity, exercising cultural competency, and implementing cultural safety.

CULTURAL COMPETENCE, SENSITIVITY, AND SAFETY

  • Cultural competence: Defined as “a set of congruent behaviors, attitudes, and policies facilitating effective cross-cultural work.”

  • Cultural sensitivity: Involves understanding the emotional depth of one's own culture and its perception by others.

  • Cultural safety: Analyzes power imbalances, discrimination, and colonial relationships in health care contexts.

ADDRESSING RACISM WITHIN THE CANADIAN HEALTH CARE SYSTEM (CONT'D)

  • Intersectionality theory is vital for understanding Indigenous health inequities.

  • There is a need for enhanced research involving Indigenous people to:

    • Investigate social inequalities responsible for health disparities.

    • Develop health policies recognizing Indigenous individuals as integral actors in addressing these issues.

    • Allan and Smylie’s (2015) study utilized a mixed-methods approach guided by Indigenous Elders, integrating their narratives into the research process.