Week 7

Question 1

BLM movement

Answer 1

Can refer to any individual or group ascribing to the slogan, originally no formal organisation.
George Floyd’s death in 2020 led to 15-26 million people participating in BLM protests in
the USA, and related protests have been held in over 60 other countries, including the
Netherlands. Slogan intended to highlight inequality in media coverage as well as
accountability when black people are killed in the USA.

Question 2

Racism Affects Safety and Health

Answer 2

Safety: In the USA, 31% of people killed by police are black,
while only 13% of the population is black.
=> Discrimination as a source of stress and negative affect leads to poor health outcomes.
=> Exclusion and oppression compound psychological stress.
=> Patient communication is more complicated cross-culturally
=> Biases in health care systems/providers
=> Medical system set up for majority group patients

Question 3

Race

Answer 3

grouping of humans according to physical or social qualities -
a social construct.
* Complicated boundaries
* Not the same as the biological use of the word race: there is only one human race
* Often: race – physicial features; ethnicity – culture / geographic region

Question 4

Racism

Answer 4

a culturally socialized system in which some groups, usually minority
groups, are disadvantaged as compared to another, usually the majority group

Question 5

Prejudice

Answer 5

Culturally socialized bias based on group membership

Question 6

Discrimination

Answer 6

Differential treatment based on group membership

Question 7

Privlege

Answer 7

Benefits of being in the majority or more powerful group, irrespective of other disadvantages

Question 8

Minorities within a culture

Answer 8

Six potentially distinguishing variables:
1. Nationality and legality
2. Relative culture distance to majority culture
3. Relative language distance to majority language
4. Normality: how ‘strange’ is the minority culture perceived by the majority?
5. Reference group: how big is the minority group?
6. Social image: positive or negative attitudes of the majority group towards a minority
group

Question 9

Legality of racism and discrimination (USA)

Answer 9

Declaration of independence (1776) already says ‘all men are created equal’,
but slavery was not abolished until 1865, and segregation was lawful until 1965

Question 10

Legality of racism and discrimination (NL)

Answer 10

the first article in our constitution says discrimination
is unlawful, established in 1815, even though slavery in
the colonies was not abolished until 1863, with a 10-year
transition period in Surinam

Question 11

Legality of racism and discrimination (General)

Answer 11

Many countries still have laws giving people differing rights
* E.g. women, LGBTQ, refugees, Palestinians in Israel,
First Nations people in USA and Canada, etc
Hate speech and hate crimes are explicitly illegal in majority of developed
democracies
* Enforcement varies

Question 12

Institutional racism: Policy

Answer 12

Also called structural or systemic racism, term coined in the 60s
Policy that leads to discrimination in criminal justice,
employment, housing, health care, political power, education, etc
Current or previous laws and regulations
* Currently generally illegal, although examples still exist
* Policies that targeted specific groups disproportionally still support or maintain
segregation
Argued to be the biggest source of health disparaties

Question 13

Cultural racism: Prejudice

Answer 13

Culturally socialized ideas about specific groups
Attitudes, biases, prejudices: very often implicit!
- Stereotypes and xenophobia
Historically developed stereotypes, omnipresent in cultural messages
* Representation in popular media, use of language
Engrained in society, socialization starts at birth
* Including the idea that racism is ‘bad’, morally reprehensible. This complicates addressing the bias!
Arguably, not addressing/interrupting these biases sustains them
However, having biases does not equal acting on them

Question 14

Individual actions

Answer 14

Actions based on prejudice: most common understanding of racism
Treating people differently based on their (perceived) group membership
* Stereotyping
* Preferential treatment for majority group
* Exclusion of minority group
* Hate speech and hate crimes – no longer implicit

Question 15

Categorisation

Answer 15

We all live in a society that includes ideas about different groups – all members of a
cultural group are exposed/socialized into this
* Categorization is impossible to avoid, biases are acquired through exposure
* Biases can only be made explicit by active interference

Question 16

Intentions and effects

Answer 16

Intentions and effects have to be separated
* Acts of discrimination often happen without explicitly racist intentions, based on
socialized behavior
* Addressing discriminatory behavior leads to a sense of being morally attacked

Question 17

Cultures are resistant to change

Answer 17

• Whether cultural changes persist depends more on this initial state than on usefulness
• Minority group has no power other than public opinion

Question 18

Biases: Discrimination and othering

Answer 18

Consequences of socialized biases: discriminatory behavior
Majority of instances downplayed as jokes that don’t intend to be offensive
* ‘it wasn’t meant to be racist’
* ‘you just can’t take a joke’

Question 18

Biases: Discrimination and othering

Answer 18

Consequences of socialized biases: discriminatory behavior
Majority of instances downplayed as jokes that don’t intend to be offensive
* ‘it wasn’t meant to be racist’
* ‘you just can’t take a joke’

Question 19

Othering

Answer 19

magnifying boundaries between groups, attributing negative characteristics that separates you from them

Question 20

Micro aggression

Answer 20

• “brief commonplace daily verbal, behavioral, or environmental indignities, whether
  intentional or unintentional, that communicate hostile, derogatory, or negative racial
  slights and insults toward people of color” Sue, 2007
• Often hard to recognize for majority group members
• Experience of discrimination cannot be inferred!

Question 21

Everyday racism

Answer 21

Important source of stress, worry, frustration, anger
* Regular experiences, however small, increase stress and vigilance
* Related to poor physical health outcomes
* Inversely related to positive healthcare experiences

Question 22

Intersectionality

Answer 22

multiple group memberships give compound effects
* i.e. being female and non-white

Question 23

Racism in the Netherlands

Answer 23

A 2020 report from the Dutch policy research (SCP, n=8536) indicates
27% of people in the Netherlands experience discrimination
* Gender, sexual orientation, skin color, culture, religion, etc
* Most discriminated groups are people with Turkish or
Moroccan background

Question 24

Increasing discrimination in schools (NL)

Answer 24

* 7% of mentioned incidents refer to sexually inappropriate behavior, 8% refer to violence or threats of violence * 2-3% of all students stopped their studies due to discrimination

Question 25

Discrimination at work (NL)

Answer 25

Discrimination at work * 5% of all job seekers experience discrimination * 7% of people with jobs feel less safe at work due to discrimination

Question 26

Stereotypes and predjudice can lead to....

Answer 26

subtle discrimination, especially crucial in acculturation progress, disadvantaged groups, or for bicultural individuals

Question 27

Discrimination can affect acculturation process in two ways:

Answer 27

1. Identity denial—questioning someone’s cultural identity because he or she does not match the prototype of the culture 2. Stereotype threat—anxieties about one’s group’s negative stereotypes lead one to confirm those stereotypes

Question 28

Identity Denial

Answer 28

Exclusion can be subtle.. or blatant * Questioning language abilities * Questioning cultural knowledge * Typical example of micro-aggression! Triggers sense of not belonging * Eliciting behavior ‘proving’ membership * Negatively affects mental health

Question 29

People deal with negative stereotypes by:

Answer 29

* Disidentifying with the stereotyped domain (e.g., “I don’t care about school.”) * Avoiding reminders of the stereotype (e.g., “I’m going to drop out of school.”) Clear demonstration of socialized nature of these negative stereotypes! Holding negative stereotypes about your own group is inherently stressful and harmful to mental health * Extra affirmations may help Stereotype threat occurs in a variety of contexts

Question 30

Stereotype threat

Answer 30

Priming for race induces existing socialized prejudice

Question 31

Potential psychological consequences of being a member of a minority group:

Answer 31

* Homesickness – tends to start after 2-3 years and recurs even after long periods of time * Frustration – difficulty in dealing with environment, discrimination * Isolation * Cultural solitude – lack of understanding * Decreased self-esteem – perceived as foolish or childish * Paranoia – feeling different from everyone else * Anger * Depression * Feelings of failure and/or success – minor successes can be perceived as very significant, also by other group members

Question 32

Minority cultures and health

Answer 32

Health effects of discrimination as a stressor, leading to deterioration in physical and mental health * Revisit various previous lectures, also Williams et al 2019 Discrimination in health care settings * Generally based on implicit cultural biases * Lead to reduced seeking of health care in minority groups

Question 33

Differences in medical care

Answer 33

Western medicine largely based on white males, leading to lack of knowledge on any differences with other groups * Recently more attention for heart function in women * Availability of services differs * i.e. stem cell donors, fertility treatments, funeral homes, etc

Question 34

Health effects of discrimination and othering

Answer 34

Discrimination has a range of negative effects on (mental) health, including High blood pressure Heart problems Low birth weight Depression Somatization Risky behaviors such as smoking and alcohol use

Question 35

Dermatology training (study)

Answer 35

medical textbooks found only 4.5% of images to show dark skin. A more recent study on dermatology textbooks found a range of 4-18% dark skin images, but mostly represented infectious diseases such as syphillis, and very little mention of diseases with a racial disposition to be more commonly found in darker skin. For Covid-19-related skin rashes, 2 out of 400 images on the British Association of Dematologists’ website featured dark skin, a review on scientific articles (with 130 images) included no images of dark skin. * Much higher incidence of Covid-19 in Black people in UK and USA

Question 36

Covid-19 disparities

Answer 36

In the USA, twice as many Black people die from Covid-19 as white people, Native Americans even more * Mostly argued to be related to higher preexisting health conditions, lower access to health care facilities, higher population density of living spaces, public transport use * All related to systemic segregation and marginalization

Question 37

Covid-19 disparities adjusting for age

Answer 37

* Populations of color tend to be younger, so death tolls also refer to younger people * After controlling for age, Native American groups are even more disproportionally affected, together with Pacific Islanders, LatinX and Black people

Question 37

Covid-19 disparities adjusting for age

Answer 37

* Populations of color tend to be younger, so death tolls also refer to younger people * After controlling for age, Native American groups are even more disproportionally affected, together with Pacific Islanders, LatinX and Black people

Question 38

Covid-19 disparities in brazil

Answer 38

3.2 the Pardo ethnicity is the second most important risk factor for death after age, and before pre-existing health conditions. * Pardo and Black (Preto) people suffered substantially more than White (Branco), Indigenous (Indígeno), and East Asian (Amarelo) ethnicities. * Mostly argued to be related lower access to health care facilities, lower SES, potential differences in susceptibility. * Authors state this is likely an underestimation of the disparity.

Question 39

Covid-19 disparities in NL

Answer 39

it is less pronounced, but migrant groups show larger infection rates (2-4 times as high) and higher mortality rates (1.5x higher) * In line with same factors creating health differences in the US (but not SES) * Indications of more stigma about infections Migrant workers often live in extremely impoverished conditions * Often provided by employer or job agency, creating dependence

Question 40

Influence SES of minority groups

Answer 40

Minority groups generally have a lower social-economic status than the majority group

Question 41

Negative Health effects of low SES

Answer 41

-Two theories/mechanisms: social causation (poverty leads to health differences) and health selective theory (health supports upward social mobility) * Global phenomenon * Effects on physical as well as psychological health, lifestyle is a mediator (Wang & Geng, 2019) * With wealth disparities increasing, so do health disparities * Harder-to-reach group for health behavior interventions

Question 42

Negative health effects of discrimination and othering

Answer 42

Negative health effects of discrimination and othering are additional! * Many studies on health disparities control for income

Question 43

Acculturation strategies: Affected by discrimination

Answer 43

Integration, marginalization, serperation, assimilation Consider: similar processes my happen for cultural identities of minority and majority groups (i.e. without actual migration)

Question 44

Pitfalls of Acculturation

Answer 44

Downwards assimilation and immigrant paradox

Question 45

Downward assimilaiton

Answer 45

Entering a culture as a minority, low SES, crime stigma Acculturating may not always be beneficial—not all cultural habits are inherently good.

Question 46

Immigrant paradox

Answer 46

Children of immigrants may experience more negative outcomes than their parents. * First generation vs second generation: different drives * Length of stay in United States predicts a higher obesity rate. * Vietnamese immigrants who were less integrated into New Orleans achieved more in school and were more upwardly mobile. * The more Latino immigrants acculturated to mainstream culture, the worse they performed in school.

Question 47

Clinical implications of racism

Answer 47

Culture-sensitive clinicians recognize impact of racism Explore your own biases Refrain from inferring feelings about race for others Anticipate possible conflicts related to socializing into a system as a minority group member with negative stereotypes Increased education on (mental) health in specific groups Better training leads to better diagnoses & treatment * Benefits in health as well as cost More awareness of biases as well as more empathy

Question 48

What can be done against racism

Answer 48

Education: increase knowlegde Learn about socialized biases * Move away from moral judgement making it difficult to address biased behavior * Take responsibility for your own education rather than expecting this from others Include more perspectives * Diverse voices in academia, cultural messages, politics etc can make implicit biases explicit * Experiences of discrimination cannot be inferred Interventions: interrupting historically-based inequalities Diversity trainings fostering awareness Working to reduce inequality

Question 49

Further considerations of multicultural societies

Answer 49

Research on this topic is developing, as well as what we know about how to intervene * Most research from USA * Diversity of voices especially relevant The group with the least power has no way to make changes * Responsibility of majority group members, whether it refers to policy changes, diversifying the discourse, or calling out biases Changing the use of language can help * i.e. considering racism as a socialized system instead of an act by a bad person Salad bowl vs melting pot model: how much diversity is accepted? Changing socialized biases is hard work! * Needs sustained attention