Week 4: Racism as a SDH

Question 1

What are the 3 ways of tracking bias in health care? Explain each

Answer 1

1. interpersonal interactions between a patient and provider: when making diagnosis and for helping with pain management
2. internal dynamic between organizations: communication between staff members, who is the leader based on assumptions we have about people
3. costs/waste: racial bias costs the health care system in the US $310 billion

Question 2

Relating to the bias involving interpersonal connections between the patient and provider, explain how bias is present in diagnosis and in pain management

Answer 2

diagnosis: the bias we have towards someone may influence the diagnosis that we provide. Also, this involves the patient’s trust of the provider and if we make diagnosis of people based on discriminatory or racial stereotypes

pain management: the assumptions we have about a specific marginalized group can affect the medication that a provider gives them. For example, POC are more likely to be given less of their required dosage due to the bias of the fact that POC struggle with addiction.

Question 3

T/F: Indigenous people suffer from disproportionately high rates of pre-existing health conditions, however this does not make them more vulnerable to communicable/chronic diseases.

Answer 3

F: this makes them more vulnerable to contracting a disease with underlying health conditions

Question 4

Covid-19 ___________ and __________ existing social and economic differences

Answer 4

discriminates, exacerbates

Question 5

The pandemic hit _______ groups harder and is exposing long standing ________ related to poverty and racism

Answer 5

marginalized, inequities

Question 6

1. In the Toronto report about the covid-19 cases for marginalized groups, which group had the highest case count? Which group had the lowest?
2. How does low income affect someone’s likelihood of contracting the virus

Answer 6

1. highest case count = POC, low income
   lowest case count = East Asian
2. Low income means that people can’t afford proper living conditions so they may be in overcrowding households. This increases their ability to contract the virus because they cannot social distance. They also may not be able to afford health care if they have any underlying health conditions which increases their risk of Covid

Question 7

What is an example of upstream systemic inequities?

Answer 7

The observed racial and ethnic disparities in Covid-19 cases

Question 8

Explain:

1. Upstream SDH
2. Midstream SDH
3. Downstream SDH

Answer 8

1. upstream = root causes of health disparities at the population level; racism, discrimination, social policies, poverty
2. Midstream = result of upstream determinants and mediate the effects of upstream SDH on down stream health outcomes; educational attainment, employment status, housing, living conditions, food security, access to masks during the pandemic
3. Downstream = health outcomes from upstream and midstream SDH; heart disease, obesity, cancer, Covid-19, death

Question 9

identify how the SDH types (upstream, midstream or downstream) are all involved in the situation below:

a) A big family of 10 living in poverty cannot afford to have a large house suitable for social distancing. Therefore, they are more likely to contract covid-19
b) Mary is a WOC and has contracted strep throat. However, when she goes to get her medication, the doctor gives her a lower dosage and his reasoning is that “POC have had situations of addiction in the past.” Therefore, it will take Mary longer to recover from the strep throat infection

Answer 9

a) Upstream: poverty, midstream: no social distancing, lack of income, lack of PPE, downstream: contract covid
b) upstream: racism, midstream: medical mistrust and access to high quality health care, downstream: her strep throat could get worse

Question 10

what are implicit biases?

Answer 10

unconscious stereotypes shaped by learned associations that inform understanding and decision making

Question 11

What are 3 paths to health equity?

Answer 11

1. More health disparity research by federal, state and local organizations.
2. racism must be declared a public health crisis
3. those affected by health disparities must be given a voice

Question 12

Define anti-oppressive framework

Answer 12

Anti-oppressive framework is not just about recognizing diversity in experiences within society. It is also about recognizing that the diversity in experiences within society are structurally determined and connected to the unequal distribution of power and stressors in society. It requires reflexivity

Question 13

1. what is reflexivity?
2. what does reflexivity help you to correct?
3. What relationship does it improve?

Answer 13

1. critical examination of how your social position and the norms and values that you have internalized through your life shape your experiences and what you notice or feel in the world.
2. helps you correct internalized bias
3. improves the patient-provider relationship

Question 14

What does the Canadian charter of rights and freedom say about this topic? (2)

Answer 14

• that every individual is equal under the law

- that every individual has the right to equal protection without discrimination based on race, gender, religion etc.

Question 15

1. What is racism?

2. Is racism a SDH? Why or why not?

Answer 15

1. racism is historically and context specific systems that operate to enforce unequal distribution of power and privilege in society
2. racism is a SDH because it acts as a mechanism through which a person has access to other resources. It is socially determined and affects someone’s health access and care

Question 16

Fill in the blanks about discrimination:

1. Discrimination adversely affect populations ______ and _________
2. Discrimination is often ________. This means it is expected and can people can someone justify their discrimination because they believe it is logical
3. Discriminatory acts reinforce the ______ of more privileged groups

Answer 16

1. directly and indirectly
2. normalized
3. power

Question 17

Explain the difference between structural vs individual discrimination. Give an example

Answer 17

structural = macro-level conditions that limit resources, opportunities and the wellbeing of less privileged groups. ex: Institutions creating a policy where you have to pay to get tested for covid 19 limits those who cannot afford it

individual = negative interactions with another person based on an individuals characteristics. ex: being denied medication due to their race

Question 18

structural discrimination is _______, ________ and __________

Answer 18

institutionalized, widespread and normalized

Question 19

health equity cannot be achieved unless we analyze the ______ types of SDH

Answer 19

upstream

Question 20

Fill in the blanks about stats:

1. 80% of those who self identify as belonging to a visible minority group have experienced _____
2. In Quebec, thyroid screening was conducted __x more likely for white people than for POC
3. ___ in ____ women in Canada experienced racism in healthcare
4. in Canada ___ of people living in poverty identify with a racial group
5. Sometimes there are (reduced/increased) health care use responses due to the fear of being discriminated against and not being treated fairly

Answer 20

1. discrimination
2. 3x
3. 1 in 5
4. 60%
5. reduced

Question 21

Define each type of racism:

1. Systemic
2. Institutional
3. interpersonal
4. internalized

Answer 21

1. racial inequalities maintained by society
2. discriminatory policies within organizations
3. biases between individuals through words and action
4. race based beliefs in individuals themselves

Question 22

What are direct impacts of racism on health?

Answer 22

• being denied care = increases chances of developing diseases
• not seeking care due to fear = increases chanced of developing diseases
• mental health decreases

Question 23

What are indirect impacts of racism?

Answer 23

higher poverty levels = poorer health outcomes

Question 24

1. every income bracket in Canada harbours slightly _____ health outcomes than the one below it
2. ___ in ___ racialized families live in poverty as opposed to ___ in ___ non-racialized families

Answer 24

1. better

2. 1 in 5, 1 in 20

Question 25

How does racism operate as a psychosocial stressor?

Answer 25

This means that someone anticipates the stress of being discriminated against. They may worry about being denied healthcare treatment so they will not seek it. They may also fear for their families health and have stress about that

Question 26

what is intersectionality. Give an example. how does it relate to SDH?

Answer 26

intersectionality is the idea that people simultaneously face bias at multiple identity levels. ex: being a WOC or being a LGTBQ+ POC

it relates to SDH because these intersectional biases can influence the amount of access that people have to SDH. Being discriminated against intersectionally deepens health inequalities

Question 27

governmental policy can ____ the experiences and needs of marginalized groups

Answer 27

ignore

Question 28

___% of canadian households have been affected by reduced capacity to work. ___% of LGTBQ+ households in Canada are affected

Answer 28

40%, 50%

Question 29

Explain how each factor can make a person more susceptible to covid-19:

1. structural and social inequalities based on racial identities
2. precarious work environments
3. essential service occupations
4. sex and gender
5. indigenous populations
6. requiring assistance
7. homelessness
8. incarcerated populations

Answer 29

1. poor access to healthcare, being denied treatment, lower socioeconomic status means less protection against the virus
2. less secure employment, vulnerable financial situations means that it is harder to afford health services
3. front-line workers, food, heathcare, water, transportation, safety industries
4. women are overrepresented in front-line work and precarious work
5. housing shortage, no indoor plumbing so people rely on communal washrooms, overcrowding
6. for daily needs and also for understanding the effects and risks of the virus
7. overcrowding, closure of public spaces
8. overcrowding, lack of PPE, systemic racism

Question 30

why is covid-19 described as a “she”-session

Answer 30

because employment was disproportionately affecting female workers

Question 31

Indigenous health stats:
1. __ in ___ first nations will get diabetes compared to ___ in ____ non-first nations

2. indigenous people face ___% higher prevalence of heart disease than non-indigenous
3. indigenous patients are __x more likely to develop chronic kidney failure
4. the condition of indigenous people’s health is a reflection of _______ and lack of access to proper _____

Answer 31

1. 8 in 10, 5 in 10
2. 50%
3. 2x
4. racism, SDH

Question 32

Identify the TRUE statement about having a career in health:

a) structural and political change is necessary and we do not need to question our own personal bias
b) scientific fact can invalidate patient experiences
c) theory does not always translate into practice

Answer 32

c)

Question 33

explain equity vs. equality. Explain a health care situation and how equity vs equality would play out to resolve the issue