Racism and Health Flashcards
what is race?
race refers to the superficial physical characteristics such as skin colour, facial features, hair texture etc.
what is ethnicity?
ethnicity involves cultural characteristics such as language, beliefs, clothing, dietary practices etc.
what is discrimination?
unfair treatment based on belonging to (or being perceived as belonging to) a particular social group
what are some characteristics that can be discriminatory
- racial/ethnic group
- immigration status
- religion
- gender and sexual orientation
- social class
- disability
what is racism?
an organized system that ranks population groups and allocates resources preferentially based on race
*throughout history, belief in biological differences among races has been used to justify mistreatment
who is affected most by systemic racism?
- Blacks/ African Americans
- Latinos
- Indigenous
systemic racism puts them at economic and health disadvantage within society
what are the stats about race and hate crimes?
the motivation behind most hate crimes is hatred towards a particular race or ethnicity!!
what races/ethnicity experience the most discrimination?
highest = black, indigenous, south asian, chinese
lowest = white!!
4 types of racism
1) interpersonal
2) internalized
3) cultural
4) systemic and structural
what is interpersonal racism?
- occurs when a person’s conscious or subconscious racial bias influences their interactions and perceptions of other people
- most overt forms = micro-aggressions, violence, slurs
what is internalized racism?
- when a person believes and accepts negative messages about their own, and other’s, cultures and races, believing inferiority to others
what is cultural racism?
- societal beliefs, norms, and values that perpetuate the idea that one cultural group is superior/inferior to others
what is systemic/ structural racism?
refers to race-based inequities embedded within systems, laws, institutions and policies (written and unwritten) as a result of ongoing and historical injustice
–> structural focuses on just the structure (policies, laws)
–> systemic focuses more on the entire systems and their structure (all encompassing)
how can racism be understood as an iceberg?
- overt forms of racism, such as racial hate crimes, represent only the “tip of the iceberg”
–> ex: hate crimes - structural and institutional racism represent its base and cannot be easily observed
–> ex: residential segregation
examples of systemic and structural racism
- obstacles to home ownership
- residential racial segregation
- red-lining
- racial policing and sentencing practices
- environmental injustice
- unequal access to quality education
- Japanese internment camps
- Indigenous residential schools
what are causal pathways?
a series of sequential steps on how racism products disparities in health
what are the steps to how racism damages health?
these are listed from upstream to downstream! (left to right)
1) systemic racism
2) differential access to resources and opportunities
3) health harming (or lack of health promoting) behaviours or experiences
4) biological mechanisms
5) worse health outcomes among people of colour
what are the 4 major causal pathways that racism can harm health
1) putting people of colour at socioeconomic disadvantage
2) exposing people of colour to health-harming conditions and limiting their access to health-promoting resources and opportunities
3) exposing people of colour of all socioeconimc levels to racism-based chronic stress
4) disenfranchising and disempowering poeple of colour
what is causal pathway #1?
racial discriminatory barriers to economic resources and opportunities are a major pathway that racism impacts health
- racism makes it difficult for certain racial/ethnic groups to accumulate wealth
- economic disadvantage leads to poor living conditions, access to nutritious foods, education and health care
- ultimately leads to racial or ethnic disparities in health
what is causal pathway #2?
racism can harm health by increasing exposure to health-harming conditions and limiting access to health-promoting resources and opportunities
- racism leads to disproportionate exposure to environmental health hazards
- racial bias in policing, sentencing, and incarceration leading to abuse, violence
- racial residential segregation deprives people of health-promoting conditions (education, green space)
- racism leads to inequitable access to and quality of healthcare
what is causal pathway #3?
racism can lead to poorer health outcomes among people of colour due to chronic stress
- chronic stress lead to systemic inflammation and immune system dysregulation
- racism-related stress can lead to chronic disease like heart disease, diabetes, preterm birth
- compounded stressors (finances, segregation, policies) exacerbates stress
- stress can be passed on and inherited through future generations (adverse childhood experiences)
2 ways stress can lead to poor health
1) triggers physiological mechanisms that damage health (DIRECT)
2) increasing likelihood of health harming behaviours (INDIRECT)
what are the physiological mechanisms leading to poor health?
- the body’s response to stress begins in the brain
- it is triggers by acute and chronic stressors
- cortisol, a mediator of the stress response is released (can be protective or damaging dependent on the context and duration of the stressor)
- chronic stress and release of cortisol is damaging to bodily systems such inflammation and immune system dysregulation
what are the health behaviours leading to poor health?
attempts to cope with stressors can lead to unhealthy behaviours:
- eating unhealthy foods
- excessive alcohol intake
- inadequate physical activity
- smoking and drug abuse
who are most at risk for adopting poor coping mechanisms?
- racially segregated communities are disproportionately targeted with advertising that promote drugs, alcohol and tabbaco
–> these neighbourhoods also lack resources that encourage healthier coping mechanisms (parks, recreations centres, green space) - children who experience stress more frequently are more likely to adopt (and less like to discontinue) risky health behaviours
what is causal pathway #4?
racism can damage health by disenfranchising and disempowering people of colour
- voter suppression and gerrymandering are policies that impact health indirectly by depriving people of the ability to influence policies that affect them
what is social exclusion?
the process in which individuals are blocked from (or denied full access to) various rights, opportunities and resources
what are the effects of social exclusion?
1) places targeted individuals at social disadvantage by excluding them from benefits typically associated with being involved in society
2) awareness of social exclusion leads to psychological distress and prolonged stress (inflammation and immune dysregulation)
what is implicit bias?
- implicit bias refers to the attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner
–> even when healthcare providers intend to offer equal care, biases can lead to disparities in treatment and outcomes
what are the effects of implicit bias?
- disparities in access to healthcare services
- differences in diagnostic accuracy and treatment options
- lower trust in healthcare options among racial minorities
what were the results of the study that looked at racial bias in pain assessment?
- a substantial amount of white laypeople and medical students/residents hold false beliefs about differences between blacks and whites
- these beliefs predict racial bias in pain perception and treatment recommendation accuracy
- as a result, this shapes the way they perceive and treat black people
–> study found that racial minorities receive less effective pain management and preventative care compared to white people
what are some examples of implicit bias in healthcare
1) clinical decision making
- bias in prescribing medication
- differences in medicla recommendations based on rcae
2) patient-provider interaction
- variations in how providers communicate with patients
- non-verbal cues and body language that may affect patient comfort
what are common implicit stereotypes about racial minorities?
- African Americans are less likely to comply with medical advice
- hispanic patients have lower pain thresholds
- asian patients are perceived as more knowledgable about medicine
what is the impact of implicit stereotypes?
these biases about racial minorities influence clinical decisions, often leading to unequal treatment and poorer health outcomes
what did the study on “differences in care team responses through a portal” look at?
- examined the differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups
- looked at rates which medical advice requests were responded to by car e teams and the type of health professionals that responded
what were the results of the study “differences in care team responses through a portal”?
- showed that the likelihood of receiving any response was similar regardless of race
- rather, it was the type of health care professional responding that differed
- patients who belong to racialized groups were less likely to receive a response from a physician and more likely to hear back from a nurse!
–> black, hispanic and asian patients were less likely to receive a response from a physician
–> IMPLICIT BIAS (most doctors don’t know they had biases and many doctors were racialized themself)
what are some strategies to address racism?
focus on UPSTREAM interventions
- enact and enforce anti-discrimination laws and policies
- eliminate laws and practices enabling systemic racism
- advocacy and education
- reducing or repairing damages caused by racism
