151
|
Bussey SR, Dobrof J. Social work's opportunity and obligation to achieve population health equity. Soc Work Health Care 2024; 63:154-167. [PMID: 38185123 DOI: 10.1080/00981389.2024.2302620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
US healthcare remains a system in crisis, wherein spending outpaces other Western economies but health inequities match those of an emerging market economy. As a country founded in tenets of white supremacy, structural racism persists as evidenced by longstanding race-based disparities. Although the population health approach offers a potential framework for preventative and community-based health, without overt race-conscious design, race-based disparities will be replicated. This article outlines the current US context and healthcare policy changes that led to population health taking hold. It then articulates social work's pivotal role in population health by explicitly challenging colorblindness to reach race-based health equity. Opportunities for social work practice, leadership, and research are discussed.
Collapse
Affiliation(s)
- Sarah Ross Bussey
- Mount Sinai Health Partners, Mount Sinai Health System, New York, New York, USA
| | - Judith Dobrof
- Mount Sinai Health Partners, Mount Sinai Health System, New York, New York, USA
| |
Collapse
|
152
|
Cénat JM, Darius WP, Dalexis RD, Kogan CS, Guerrier M, Ndengeyingoma A. Perceived racial discrimination, internalized racism, social support, and self-esteem among Black individuals in Canada: A moderated mediation model. Cultur Divers Ethnic Minor Psychol 2024; 30:118-129. [PMID: 35420837 DOI: 10.1037/cdp0000542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Black Canadians report experiencing various forms of racial discrimination disproportionately. This study aimed to: (a) examine the association between everyday racial discrimination and self-esteem; (b) test the mediating role of internalized racism and social support in the association between racial discrimination and self-esteem, and (c) test the moderating role of gender and age in this same relationship. METHOD A total of 860 participants (76.60% female) aged 15-40 (Mage = 24.96, SD = 6.31) completed questionnaires assessing racial discrimination, self-esteem, internalized racism, and social support. Descriptive and moderated mediation analyses were performed. RESULTS A total of 65.33% of participants were categorized as endorsing low self-esteem, with no significant difference between males and females (66.67% and 62.20%, respectively; χ² = 1.56, p = .47). Participants aged 25-40 exhibited a higher prevalence of low self-esteem compared to those aged 15-24 (89.91% and 58.54%, respectively, χ² = 37.31, p < .001). The results showed a progressive increase in the prevalence of low self-esteem commensurate with increasing levels of reported racial discrimination. Internalized racism (β = -.09, SE = .01, p < .001) and social support (β = .10, SE = .01, p < .001) mediated the association between everyday racial discrimination and self-esteem; whereas gender moderated the latter association (β = .17, SE = .04, p < .001; being a woman). CONCLUSIONS Results indicate a strong association between racial discrimination and low self-esteem. These findings provide a better understanding of the mechanisms underlying the development of self-esteem problems among Black individuals in Canada. They also have important relevance for the development of educational and clinical programs for prevention and intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Jude Mary Cénat
- Vulnerability, Trauma Resilience and Culture Research Laboratory (V-TRaCLab), Interdisciplinary Centre for Black Health, School of Psychology, University of Ottawa
| | - Wina Paul Darius
- Vulnerability, Trauma Resilience and Culture Research Laboratory (V-TRaCLab), Interdisciplinary Centre for Black Health, School of Psychology, University of Ottawa
| | | | - Cary S Kogan
- Interdisciplinary Centre for Black Health, School of Psychology, University of Ottawa
| | - Mireille Guerrier
- Vulnerability, Trauma Resilience and Culture Research Laboratory (V-TRaCLab), Interdisciplinary Centre for Black Health, School of Psychology, University of Ottawa
| | | |
Collapse
|
153
|
Bell BV. "We'd really love to but we're really busy": Silence, precarity and resistance as structural barriers to anti- racism in nursing education. J Adv Nurs 2024; 80:214-225. [PMID: 37464570 DOI: 10.1111/jan.15795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/10/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
AIM To identify structural barriers to the uptake and practice of anti-racism in nursing education, specifically in the Canadian context. DESIGN A deconstructive, critical, qualitative inquiry informed by critical race theory, critical whiteness, feminism and post-colonialism. METHODS This study employed an anonymous online open-ended questionnaire and online focus groups with Canadian nurse educators from April to June 2021. The data were analysed through a contextualist thematic analysis that accounts for data as essential experience and also a product of discourse. RESULTS Structural barriers identified are organized into themes of: the academic environment; position and power; racism; program delivery; and Whiteness. Pervasive silence, especially white silence, can be interpreted in related contexts of precarity, self-interest and institutional violence. Overarching processes of precarity and resistance exert power over the environment of nursing education which act to destabilize, disrupt and discourage anti-racist efforts and education. CONCLUSION The sustainability of anti-racism should be a primary focus. This entails attending to structures in nursing and higher education that make nursing education precarious work, especially for educators racialized as Other in the white supremacist racial binary of White: non-White. Explicit and ongoing attention to conditions that silence is necessary for any progress to be made. Strategies of applying anti-racism need to be as complex as the barriers. IMPLICATIONS Many schools of nursing are engaged in attempts to include anti-racism as learning and environment. The structural barriers that interfere with effective integration of anti-racism as a lens for nursing education must be named and addressed so educators and schools can be successful. The implication of trying to incorporate anti-racism without addressing the barriers is a very superficial or pocketed application of anti-racism, and a continuation of the status quo that reproduces Whiteness and excludes and harms people racialized otherwise. IMPACT The study addressed both strategies and barriers to anti-racism in nursing education. This article addressed structural barriers in anti-racism in Canadian nursing education. The main findings are that processes of precarity specific to nursing education in institutions of higher learning, and resistance through Whiteness, decision-making hierarchy and regulatory structures interfere with the application of anti-racism. This research impacts nurse educators in all nursing schools and leaders in higher education. It also impacts all current and future nursing students as the recipients of the education we provide. REPORTING METHOD The paper adheres to COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
|
154
|
Anderson A, Onumah C. Does Racial Bias Play a Role in Internal Medicine Resident Knowledge Evaluations? Ann Intern Med 2024; 177:95-96. [PMID: 38145567 DOI: 10.7326/m23-3141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Affiliation(s)
- Andrea Anderson
- Department of Emergency Medicine, Division of Family Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Chavon Onumah
- Department of Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| |
Collapse
|
155
|
Hong JH, Talavera DC, Odafe MO, Barr CD, Walker RL. Does purpose in life or ethnic identity moderate the association for racial discrimination and suicide ideation in racial/ethnic minority emerging adults? Cultur Divers Ethnic Minor Psychol 2024; 30:1-10. [PMID: 30474989 DOI: 10.1037/cdp0000245] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To examine purpose in life (PIL) and ethnic identity (EI) as buffers to suicide ideation for Asian American, Hispanic, and Black emerging adults who perceive racial discrimination. METHOD Two-hundred eighty-nine undergraduate students enrolled at a large university in the southwestern region of the United States (40.8% Asian American, 32.5% Hispanic, 26.6% Black; 61.2% women; mean age = 20.47, SD = 1.83) reported on experiences of racial discrimination, PIL, EI, and suicidal thoughts. Covariates were intrinsic religiosity, gender, and age. RESULTS Regression analysis showed that EI was not a significant moderator for the association between perceived racial discrimination (PRD) and suicidal ideation (β = -.08, p = .13; 95% confidence interval (CI) [-.19, .03]). However, PIL was a significant moderator (β = -.11, p = .025; CI [-.20, -.01]). A hierarchical regression showed that PIL as a moderator explained additional variance (ΔR2 = 0.11, p < .001) in suicide ideation above and beyond EI. CONCLUSIONS These findings provide some insight into how life purpose might ameliorate the impact of social stressors above and beyond a positive cultural identity for young racial/ethnic minority adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Judy H Hong
- Department of Psychology, University of Houston
| | | | | | | | | |
Collapse
|
156
|
Waller BY, Giusto A, Tepper M, Legros NC, Sweetland AC, Taffy A, Wainberg ML. Should We Trust You? Strategies to Improve Access to Mental Healthcare to BIPOC Communities During the COVID-19 Pandemic. Community Ment Health J 2024; 60:82-86. [PMID: 37133709 PMCID: PMC10155669 DOI: 10.1007/s10597-023-01124-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/25/2023] [Indexed: 05/04/2023]
Abstract
Black, Indigenous, and People of Color (BIPOC) communities have weathered centuries of racism, causing transgenerational mental health consequences and hindering access to quality treatment. In this commentary, we describe the systemic challenges of engaging BIPOC to promote mental health equity during the COVID-19 pandemic. We then describe an initiative that illustrates these strategies, provide recommendations and further readings for academic institutions seeking to partner with community organizations to provide equitable mental health services to populations that have been traditionally overlooked.
Collapse
Affiliation(s)
- Bernadine Y. Waller
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Miriam Tepper
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Naomi C. Legros
- Division of Environmental Pediatrics, NYU Langone Health, 403 E. 34Th Street, New York, NY 10016 USA
| | - Annika C. Sweetland
- Department of Psychiatry and Public Health, Columbia University Vagelos College of Physicians & Surgeons/New York State Psychiatric Institute, Columbia Mailman School of Public Health, New York, NY 10032 USA
| | - Amanda Taffy
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032 USA
| |
Collapse
|
157
|
Blatt LR, Sadler RC, Jones EJ, Miller P, Hunter-Rue DS, Votruba-Drzal E. Historical Structural Racism in the Built Environment and Contemporary Children's Opportunities. Pediatrics 2024; 153:e2023063230. [PMID: 38192230 DOI: 10.1542/peds.2023-063230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There are well-documented links between structural racism and inequities in children's opportunities. Yet, when it comes to understanding the role of the built environment, a disproportionate focus on redlining obscures other historical policies and practices such as blockbusting, freeway displacement, and urban renewal that may impact contemporary child development. We hypothesized that historical structural racism in Allegheny County, Pennsylvania's, built environment would be associated with fewer contemporary educational, socioeconomic, and health opportunities. We also hypothesized that these measures would explain more collective variance in children's opportunities than redlining alone. METHODS We used geospatial data from the US Census, Mapping Inequality Project, and other archival sources to construct historical measures of redlining, blockbusting, freeway displacement, and urban renewal in ArcGIS at the census tract level. These were linked with data from the Child Opportunity Index 2.0 to measure children's opportunities across domains of education, socioeconomic status, and health. We ran spatial regression analyses in Stata 18.0 to examine individual and collective associations between structural racism and children's opportunities. RESULTS Historical redlining, blockbusting, and urban renewal were largely associated with fewer contemporary educational, socioeconomic, and health opportunities, and explained up to 47.4% of the variance in children's opportunities. The measures collectively explained more variance in children's opportunities than redlining alone. CONCLUSIONS In support of our hypotheses, novel measures of structural racism were related to present-day differences in children's opportunities. Findings lay the groundwork for future research focused on repairing longstanding harm perpetuated by structural racism.
Collapse
|
158
|
Ghosh AK, Venkatraman S, Nanna MG, Safford MM, Colantonio LD, Brown TM, Pinheiro LC, Peterson ED, Navar AM, Sterling MR, Soroka O, Nahid M, Banerjee S, Goyal P. Risk Prediction for Atherosclerotic Cardiovascular Disease With and Without Race Stratification. JAMA Cardiol 2024; 9:55-62. [PMID: 38055247 PMCID: PMC10701663 DOI: 10.1001/jamacardio.2023.4520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/03/2023] [Indexed: 12/07/2023]
Abstract
Importance Use of race-specific risk prediction in clinical medicine is being questioned. Yet, the most commonly used prediction tool for atherosclerotic cardiovascular disease (ASCVD)-pooled cohort risk equations (PCEs)-uses race stratification. Objective To quantify the incremental value of race-specific PCEs and determine whether adding social determinants of health (SDOH) instead of race improves model performance. Design, Setting, and Participants Included in this analysis were participants from the biracial Reasons for Geographic and Racial Differences in Stroke (REGARDS) prospective cohort study. Participants were aged 45 to 79 years, without ASCVD, and with low-density lipoprotein cholesterol level of 70 to 189 mg/dL or non-high-density lipoprotein cholesterol level of 100 to 219 mg/dL at baseline during the period of 2003 to 2007. Participants were followed up to 10 years for incident ASCVD, including myocardial infarction, coronary heart disease death, and fatal and nonfatal stroke. Study data were analyzed from July 2022 to February 2023. Main outcome/measures Discrimination (C statistic, Net Reclassification Index [NRI]), and calibration (plots, Nam D'Agostino test statistic comparing observed to predicted events) were assessed for the original PCE, then for a set of best-fit, race-stratified equations including the same variables as in the PCE (model C), best-fit equations without race stratification (model D), and best-fit equations without race stratification but including SDOH as covariates (model E). Results This study included 11 638 participants (mean [SD] age, 61.8 [8.3] years; 6764 female [58.1%]) from the REGARDS cohort. Across all strata (Black female, Black male, White female, and White male participants), C statistics did not change substantively compared with model C (Black female, 0.71; 95% CI, 0.68-0.75; Black male, 0.68; 95% CI, 0.64-0.73; White female, 0.77; 95% CI, 0.74-0.81; White male, 0.68; 95% CI, 0.64-0.71), in model D (Black female, 0.71; 95% CI, 0.67-0.75; Black male, 0.68; 95% CI, 0.63-0.72; White female, 0.76; 95% CI, 0.73-0.80; White male, 0.68; 95% CI, 0.65-0.71), or in model E (Black female, 0.72; 95% CI, 0.68-0.76; Black male, 0.68; 95% CI, 0.64-0.72; White female, 0.77; 95% CI, 0.74-0.80; White male, 0.68; 95% CI, 0.65-0.71). Comparing model D with E using the NRI showed a net percentage decline in the correct assignment to higher risk for male but not female individuals. The Nam D'Agostino test was not significant for all race-sex strata in each model series, indicating good calibration in all groups. Conclusions Results of this cohort study suggest that PCE performed well overall but had poorer performance in both BM and WM participants compared with female participants regardless of race in the REGARDS cohort. Removal of race or the addition of SDOH did not improve model performance in any subgroup.
Collapse
Affiliation(s)
- Arnab K. Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| | - Sara Venkatraman
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
- Department of Statistics and Data Science, Cornell University, New York, New York
| | - Michael G. Nanna
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Monika M. Safford
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| | | | - Todd M. Brown
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Laura C. Pinheiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| | - Eric D. Peterson
- Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Ann Marie Navar
- Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Madeline R. Sterling
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| | - Orysya Soroka
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, New York
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York
| |
Collapse
|
159
|
Buckner JD, Zvolensky MJ, Scherzer CR. Alcohol and cannabis dual use among Black adults: Associations with alcohol use, use-related problems, and race-based discrimination. Am J Addict 2024; 33:65-70. [PMID: 37689991 PMCID: PMC10846665 DOI: 10.1111/ajad.13480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Black adults who drink alcohol appear at risk for poor alcohol-related outcomes, yet little research has examined whether cannabis use among those who consume alcohol (alcohol-cannabis dual use) is related to worse alcohol-related consequences, as observed in predominantly White samples. Further, it may be that experiencing more race-based discrimination may be related to using multiple substances to cope with such experiences; however, no known studies have examined the impact of race-based discrimination on alcohol-cannabis dual use. METHODS Participants were 270 Black undergraduates who endorsed past-month drinking, 112 of whom endorsed alcohol-cannabis dual use. RESULTS The dual use group reported heavier drinking, more drinking-related problems, and more race-based microaggressions (but not overt racism) than the alcohol-only group. CONCLUSIONS The use of cannabis among Black young adults who drink alcohol was related to heavier drinking and more alcohol-related problems. Further, experiencing more microaggressions may place these individuals at risk for using multiple substances, presumably to cope with these experiences. SCIENTIFIC SIGNIFICANCE Considering models suggesting that the dual use of cannabis may result in less alcohol use, the current study highlights that for Black adults who consume alcohol, cannabis dual use is related to heavier drinking and more alcohol-related problems, which can inform intervention and treatment efforts.
Collapse
Affiliation(s)
- Julia D. Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- HEALTH Institute, University of Houston, Houston, TX, United States
| | - Caroline R. Scherzer
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| |
Collapse
|
160
|
Aseffa F, Mehari L, Gure F, Ahmed S. Disrupting Racism in Ontario Midwifery. J Midwifery Womens Health 2024; 69:52-57. [PMID: 37394902 DOI: 10.1111/jmwh.13541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/01/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION There are a limited number of Canadian studies that explore the experiences of racism among health care providers who are Black, Indigenous, or people of color (BIPOC), and specifically within the context of midwifery in Ontario. More information is needed to better understand how to achieve racial equity and justice at all levels of the midwifery profession. METHODS Semistructured key informant interviews were conducted with racialized midwives in Ontario to understand how racism manifests in the midwifery profession and to conduct a needs assessment of interventions required. The researchers used thematic analysis to identify patterns and themes within the data and to develop a better understanding of participants' experiences and perspectives. RESULTS Ten racialized midwives participated in key informant interviews. The vast majority of participants reported experiences of racism in their work as a midwife, including being subject to or witnessing racism from clients and colleagues, tokenism, and exclusionary hiring practices. More than half of participants also emphasized their commitment to providing culturally concordant care for BIPOC clients. Participants relayed that access to BIPOC-centered gatherings, workshops, peer reviews, conferences, support groups, and mentorship opportunities constitute important supports for improving diversity and equity in midwifery. They also expressed a need for midwives and midwifery organizations to actively work to disrupt racism and the power structures in midwifery that enable racial inequity to proliferate. DISCUSSION The manifestations of racism in midwifery have negative impacts on the career trajectory, career satisfaction, interpersonal relationships, and well-being of BIPOC midwives. It is crucial to understand the role of racism in midwifery and make meaningful changes toward dismantling interpersonal and systemic racism in the profession. These progressive changes will serve to create a more diverse and equitable profession, where all midwives can belong and thrive.
Collapse
Affiliation(s)
- Feben Aseffa
- Health-Care Equity, Quality and Human Rights, Association of Ontario Midwives, Toronto, Ontario, Canada
| | - Lwam Mehari
- Health-Care Equity, Quality and Human Rights, Association of Ontario Midwives, Toronto, Ontario, Canada
| | - Faduma Gure
- Health-Care Equity, Quality and Human Rights, Association of Ontario Midwives, Toronto, Ontario, Canada
| | - Sumaya Ahmed
- Health-Care Equity, Quality and Human Rights, Association of Ontario Midwives, Toronto, Ontario, Canada
| |
Collapse
|
161
|
Ogunwole SM, Starks FD. Cultivating Critical Love to Improve Black Maternal Health Outcomes. AMA J Ethics 2024; 26:E72-83. [PMID: 38180861 DOI: 10.1001/amajethics.2024.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
Racism is responsible for the maldistribution of power in society and manifests as persistent disparities in maternal health among Black women in the United States. Testimonial injustice is an expression of prejudice that uses identity to undermine individuals' credibility as authoritative "knowers" of their own bodies, selves, and experiences. Among Black women, experiences of testimonial injustice in health care encounters are common and likely contribute to disparities in Black maternal health. To promote more equitable power distribution and prioritize testimonial justice in clinical encounters, this article proposes a conceptual framework for fostering critical-racial consciousness among health professions students and trainees. The goal is for critical-racial consciousness development and refinement to stimulate antiracist actions in medical decision making and, ultimately, lead to a more equitable health care system in which Black women can thrive.
Collapse
Affiliation(s)
- S Michelle Ogunwole
- Assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore, Maryland
| | - Francheska D Starks
- Assistant professor in the Department of Theory and Practice in Teacher Education at the University of Tennessee in Knoxville
| |
Collapse
|
162
|
Norris DM, Primm A. Burnout and Moral Injury Among Black Psychiatrists and Other Black Mental Health Professionals. Psychiatr Serv 2024; 75:83-86. [PMID: 37287228 DOI: 10.1176/appi.ps.20220522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This column discusses burnout and moral injury among Black psychiatrists and other Black mental health professionals and highlights the contribution of racism to these outcomes. In the United States, the COVID-19 pandemic and racial turmoil have revealed stark inequities in health care and social justice, and demand for mental health services has increased. To meet the mental health needs of communities, racism must be recognized as a factor in burnout and moral injury. The authors offer preventive strategies to support the mental health, well-being, and longevity of Black mental health professionals.
Collapse
Affiliation(s)
- Donna M Norris
- Harvard Medical School, Boston (Norris); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore (Primm)
| | - Annelle Primm
- Harvard Medical School, Boston (Norris); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore (Primm)
| |
Collapse
|
163
|
Affiliation(s)
- Evan J White
- Laureate Institute for Brain Research, Tulsa, Oklahoma; University of Tulsa, Oxley College of Health & Natural Sciences, Tulsa, Oklahoma
| |
Collapse
|
164
|
Nield LS, Nease EK, Cottrell LE, Moffett KS, Saggio RB, Price SS. Increasing dental and medical students' understanding of race as a social construct. J Dent Educ 2024; 88:5-15. [PMID: 37740558 DOI: 10.1002/jdd.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To improve health equity, dental and medical students must have a firm grasp of the proper use of race as a social construct. The purpose of this study was to determine the degree to which an innovative learning event affected students' understanding of race as a social construct. It also sought to examine the effects that personally experienced and/or witnessed racism and previous education had on students' responses to the learning event. METHODS In 2022, all incoming first-year dental (N = 48) and medical (N = 114) students completed an online pre-matriculation assignment about the use of race in healthcare. Students initially completed an anonymous 14-item pre-survey and then read assigned publications, followed by answering questions about a real-life vignette concerning the topic of race as a social construct. Students finished the assignment by completing an anonymous seven-item post-survey. Data from the pre- and post-surveys were collected and analyzed to assess if differences existed among students and between the two surveys. RESULTS Dental and medical students were significantly more likely to endorse race as a social construct after the learning experience (p < 0.001). Students who had experienced discrimination or obtained training were more likely to define race as a social construct before and after the learning event. CONCLUSION Dental and medical schools can increase students' understanding of race as a social construct, rather than a biological construct, with educational interventions.
Collapse
Affiliation(s)
- Linda S Nield
- Departments of Medical Education and Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Emily K Nease
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Lesley E Cottrell
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
- Center for Excellence in Disabilities, Morgantown, West Virginia, USA
| | - Kathryn S Moffett
- Department of Pediatrics, Division of Pediatric Infectious Diseases, West Virginia University School of Medicine, Morgantown, West Virginia, USA
- Cystic Fibrosis Foundation and Therapeutics Development, Bethesda, Maryland, USA
| | - Renee B Saggio
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
- Division of Newborn Nursery, West Virginia University Medicine Children's Hospital, Morgantown, West Virginia, USA
| | - Shelia S Price
- Department of Diagnostic Sciences, West Virginia University School of Dentistry, Morgantown, West Virginia, USA
| |
Collapse
|
165
|
Fanny SA, Tam RP, Rule A, Barnes A, Haq H. Transforming Pediatric Global Health Education Through Antiracist and Anticolonial Principles. Pediatrics 2024; 153:e2023062612. [PMID: 38173415 DOI: 10.1542/peds.2023-062612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
| | | | - Amy Rule
- Emory School of Medicine, Atlanta, Georgia
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Adelaide Barnes
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Heather Haq
- Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, Texas
| |
Collapse
|
166
|
Shah-Altaf Z, Ranford D, Miu K, Hopkins C, Surda P. Exploring implicit bias among ENT surgeons: an analysis of the implicit association test. J Laryngol Otol 2024; 138:112-114. [PMID: 37017077 DOI: 10.1017/s0022215123000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE This study aimed to investigate the presence of implicit bias among ENT surgeons and explore the impact of the results of the Implicit Association Test on the surgeons' behaviour towards patients. METHOD Seven ENT surgeons who were not black, Asian or minority ethnic were asked to complete the Race Implicit Association Test. The surgeons also completed a survey about their perceptions of their implicit biases and the impact of the Race Implicit Association Test results on their behaviour towards patients. RESULTS The mean Race Implicit Association Test score for the ENT surgeons suggested a slight bias that favoured white over black people. Furthermore, 42 per cent of the surgeons thought that they had hidden or unconscious racial bias, 42 per cent said they would change their behaviour towards patients after receiving these results and 85 per cent thought that the Race Implicit Association Test was helpful for appraisal purposes. CONCLUSION The results suggest that ENT surgeons who are not black, Asian or minority ethnic may have implicit biases towards black patients. These findings highlight the need for interventions to reduce implicit bias among ENT surgeons and improve healthcare outcomes for marginalised populations.
Collapse
Affiliation(s)
- Z Shah-Altaf
- Department of Otolaryngology, Guy's and St Thomas' Hospital, London, UK
| | - D Ranford
- Department of Otolaryngology, Guy's and St Thomas' Hospital, London, UK
| | - K Miu
- Department of Otolaryngology, Guy's and St Thomas' Hospital, London, UK
| | - C Hopkins
- Department of Otolaryngology, Guy's and St Thomas' Hospital, London, UK
| | - P Surda
- Department of Otolaryngology, Guy's and St Thomas' Hospital, London, UK
| |
Collapse
|
167
|
Rollin FG, Beriwal S, Veira O, Alabi O. Racism, not race, impacts surgical outcomes. J Vasc Surg 2024; 79:183-184. [PMID: 37742730 DOI: 10.1016/j.jvs.2023.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Francois G Rollin
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Olivia Veira
- Emory University School of Medicine, Atlanta, GA
| | - Olamide Alabi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
168
|
Guglielminotti J, Samari G, Friedman AM, Landau R, Li G. State-Level Indicators of Structural Racism and Severe Adverse Maternal Outcomes During Childbirth. Matern Child Health J 2024; 28:165-176. [PMID: 37938439 DOI: 10.1007/s10995-023-03828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Structural racism (SR) is viewed as a root cause of racial and ethnic disparities in maternal health outcomes. However, evidence linking SR to increased odds of severe adverse maternal outcomes (SAMO) is scant. This study assessed the association between state-level indicators of SR and SAMO during childbirth. METHODS Data for non-Hispanic Black and non-Hispanic white women came from the US Natality file, 2017-2018. The exposures were state-level Black-to-white inequity ratios for lower education level, unemployment, and prison incarceration. The outcome was patient-level SAMO, including eclampsia, blood transfusion, hysterectomy, or intensive care unit admission. Adjusted odds ratios (aORs) of SAMO associated with each ratio were estimated using multilevel models adjusting for patient, hospital, and state characteristics. RESULTS A total of 4,804,488 birth certificates were analyzed, with 22.5% for Black women. SAMO incidence was 106.4 per 10,000 (95% CI 104.5, 108.4) for Black women, and 72.7 per 10,000 (95% CI 71.8, 73.6) for white women. Odds of SAMO increased 35% per 1-unit increase in the unemployment ratio for Black women (aOR 1.35; 95% CI 1.04, 1.73), and 16% for white women (aOR 1.16; 95% CI 1.01, 1.33). Odds of SAMO increased 6% per 1-unit increase in the incarceration ratio for Black women (aOR 1.06; 95% CI 1.03, 1.10), and 4% for white women (aOR 1.04; 95% CI 1.02, 1.06). No significant association was observed between SAMO and the lower education level ratio. CONCLUSIONS FOR PRACTICE State-level Black-to-white inequity ratios for unemployment and incarceration are associated with significantly increased odds of SAMO.
Collapse
Affiliation(s)
- Jean Guglielminotti
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA.
| | - Goleen Samari
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Alexander M Friedman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, USA
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| |
Collapse
|
169
|
Fuller-Rowell TE, Nichols OI, El-Sheikh M, Burrow AL, Ong AD, Ryff CD. The pandemic and social experience: For whom did discrimination and social isolation increase? Cultur Divers Ethnic Minor Psychol 2024; 30:107-117. [PMID: 36095238 PMCID: PMC10008438 DOI: 10.1037/cdp0000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The objective of this study was to examine whether experiences of discrimination have increased during the pandemic, particularly among negatively stigmatized racial/ethnic groups, and whether such experiences have exacerbated feelings of social isolation. METHOD Discrimination and social isolation were assessed before and during the pandemic in a sample of 263 Black and White young adults attending a large, predominantly White 4-year research university in the Southeastern region of the United States (52% Black, 48% White, 53% female, mean age = 19.2). RESULTS Increases in discrimination were evident among Black but not White participants. Black participants also reported greater increases in social isolation than White participants, and changes in discrimination partially mediated the emergent racial disparity in social isolation. CONCLUSIONS Findings are consistent with theoretical perspectives on discrimination during times of stress and suggest the need for broader attention to the impact of the pandemic on unfair treatment of stigmatized groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Olivia I. Nichols
- Department of Human Development and Family Science, Auburn University, Auburn, AL
| | - Mona El-Sheikh
- Department of Human Development and Family Science, Auburn University, Auburn, AL
| | | | - Anthony D. Ong
- Department of Psychology, Cornell University, Ithaca, NY
| | - Carol D. Ryff
- Department of Psychology, University of Wisconsin—Madison, Madison, Wisconsin
| |
Collapse
|
170
|
Dai HD, Thiel G, Hafer D. Perceived racism and discrimination and youth substance use in the United States - Intersections with sex and ethnicity. Prev Med 2024; 178:107811. [PMID: 38081420 PMCID: PMC10928724 DOI: 10.1016/j.ypmed.2023.107811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES This study sought to examine associations between U.S. adolescents' perceived racism and discrimination (PRD) at school and current substance use. METHODS Data were drawn from the Adolescent Behaviors and Experiences Survey (ABES), a probability sample of U.S. high school students in 2021 (n = 7705). Multivariable regression models were conducted to examine associations of PRD with current (past 30-day) use of tobacco products, marijuana, alcohol, and prescription opioid misuse. Interaction effects of PRD and demographic factors were tested. RESULTS Among participants in the 2021 ABES, PRD was associated with higher odds of current use of tobacco (AOR = 1.3, p = 0.03), marijuana (AOR = 1.3, p = 0.03), alcohol (AOR = 1.2, p = 0.03), and misuse of prescription opioids (AOR = 1.6, p = 0.004). The effects of PRD on current tobacco and alcohol use differed by Hispanic and non-Hispanic adolescents (interaction effect = 0.007 and 0.01, respectively) with higher odds among Hispanic youth than among non-Hispanic counterparts. The associations of PRD and current tobacco use, marijuana use, alcohol use, and misuse of prescription opioids were moderated by sex with more pronounced effects on males than females. CONCLUSIONS Efforts to promote awareness and create support environments that value diversity and inclusivity at school are needed to mitigate adolescent exposure to racism and discrimination.
Collapse
Affiliation(s)
- Hongying Daisy Dai
- College of Public Health University of Nebraska Medical Center, Omaha, NE, United States.
| | - Grace Thiel
- College of Public Health University of Nebraska Medical Center, Omaha, NE, United States; College of Osteopathic Medicine, Kansas City University, Kansas City, MO, United States
| | - Dylan Hafer
- College of Public Health University of Nebraska Medical Center, Omaha, NE, United States; College of Osteopathic Medicine, Kansas City University, Kansas City, MO, United States
| |
Collapse
|
171
|
Turcotte PL, Holmes D. The shadow side of occupational therapy: Necropower, state racism and colonialism. Scand J Occup Ther 2024; 31:2264330. [PMID: 37783208 DOI: 10.1080/11038128.2023.2264330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND In the Global North, advances in occupational therapy benefitted unduly from the oppression, disablement and suffering of thousands of people in the South (and beyond). To prevent the recurrence of these injustices, history must be unveiled and occupational therapists urged to come to terms with their own involvement and responsibility. OBJECTIVE AND METHOD Utilising Achille Mbembe's concept of necropolitics, this academic essay blends select historical and philosophical perspectives to explore occupational therapy's concealed role in manifestations of institutionalised violence. RESULTS By examining its roles in World War II and France's colonisation of Algeria, we make visible the development of occupational therapy's distinct 'shadow side'. In Nazi Germany's Euthanasia Programme, it became a tool for identifying which lives were deemed 'worthy of living' and which were not, which indirectly contributed to the killing of 200,000 disabled persons. Under France's colonial medical system, occupational therapy imposed Western standards that alienated and completely depersonalised Algerian patients. CONCLUSION AND SIGNIFICANCE Entrenched in a (bio)economy that has endured beyond these events, occupational therapists must exercise vigilance, remaining mindful of the potential to unintentionally overlook individuals labelled as 'unproductive'. This requires confronting the profession's assumptions of inherent 'goodness' and acknowledging and addressing its shadow side.
Collapse
Affiliation(s)
- Pier-Luc Turcotte
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa
| | - Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa
- Faculty of Science, Technology and Medicine, University of Luxembourg, Luxembourg
| |
Collapse
|
172
|
Khan SS, Yancy CW. Race, Racism, and Risk-Implications of Social Determinants of Health in Cardiovascular Disease Prediction. JAMA Cardiol 2024; 9:63. [PMID: 38055236 DOI: 10.1001/jamacardio.2023.4529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Sadiya S Khan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Associate Editor, JAMA Cardiology
| | - Clyde W Yancy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| |
Collapse
|
173
|
Yeo AJ, Halpern LF, Flagg AM, Lin B. Discrimination and depressive symptoms among Black and Asian American college students: Shared and group-specific processes of self-concept. Cultur Divers Ethnic Minor Psychol 2024; 30:83-94. [PMID: 35511523 DOI: 10.1037/cdp0000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Black and Asian American emerging adults are at higher risk of experiencing racial/ethnic discrimination and related distress. Racial/ethnic discrimination may increase vulnerability for depressive symptoms by diminishing individuals' positive self-concept. While low global self-esteem has been noted as a crucial process linking discrimination and depressive symptoms, it is unclear if it plays a unique role beyond other relevant aspects of one's self-concept: racial/ethnic private regard and centrality. Moreover, although different racial/ethnic groups are known to experience discrimination in distinctive ways, little is known about how relative processes of self-esteem and racial/ethnic identity may differ across these groups. We investigated the generalizability and specificity of discrimination to distress linkages across Asian and Black Americans. METHOD Undergraduate Black (N = 109) and Asian American (N = 90) students self-reported racial/ethnic discrimination, depressive symptoms, and self-concept. RESULTS Global self-esteem indirectly linked the association between discrimination and depressive symptoms among Black Americans beyond the effects of racial/ethnic identity. Only among Black Americans, discrimination was associated with lower private regard. CONCLUSIONS Finding highlight group-specific processes underlying Black and Asian Americans' experiences of discrimination and depressive symptoms. Findings also demonstrate shared processes of discrimination-depressive symptoms linkage across groups and underscore the need to address the pervasive issues of racism and discrimination. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Anna J Yeo
- Department of Psychology, University at Albany, State University at New York
| | | | - Amanda M Flagg
- Department of Psychology, University at Albany, State University at New York
| | - Betty Lin
- Department of Psychology, University at Albany, State University at New York
| |
Collapse
|
174
|
Kim Y, Beale AM, Rasmussen HF, Kazmierski KFM, Margolin G. Anti-Black violence, discrimination, and sleep difficulties amongst racially diverse Americans: The aftermath of the murder of George Floyd. Soc Sci Med 2024; 340:116410. [PMID: 38016308 DOI: 10.1016/j.socscimed.2023.116410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/06/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
RATIONALE Following the murders of George Floyd and other Black Americans during the summer of 2020, there was unprecedented exposure to media-disseminated depictions of anti-Black violence. Little is known about the impact of this widespread form of vicarious racism that was pervasive during that historic time. OBJECTIVE The present study applies the concept of vicarious racism to study this secondary exposure to anti-Black violence. We investigated negative impacts of anti-Black violence (NIAV) and personal experiences with discrimination in association with sleep difficulties, a critical intermediary health process. METHODS Racially diverse Americans (N = 487) were recruited to participate in a cross-sectional study using an online survey given between December 11, 2020 and February 11, 2021. RESULTS Black participants endorsed greater NIAV than Asian, Latinx, and White participants. Moreover, Black, Asian, and Latinx participants reported greater direct discrimination than White participants. NIAV and direct discrimination were each associated with more sleep difficulties. Although associations between NIAV and sleep difficulties did not vary by race, race moderated the association between direct discrimination and sleep difficulties. In addition, direct discrimination moderated the association between NIAV and sleep difficulties in an unanticipated direction: the link between NIAV and sleep difficulties was weaker for those experiencing more direct discrimination. CONCLUSION Findings suggest that anti-Black violence and police brutality not only impact direct victims but have widespread vicarious impacts on racially diverse Americans, and highlight that vicarious anti-Black racism and discrimination are important issues of public health.
Collapse
Affiliation(s)
- Yehsong Kim
- University of Southern California, 3620 South McClintock Ave, SGM 501, Los Angeles, CA, 90089, USA.
| | - Alexis M Beale
- University of Southern California, 3620 South McClintock Ave, SGM 501, Los Angeles, CA, 90089, USA.
| | - Hannah F Rasmussen
- University of Southern California, 3620 South McClintock Ave, SGM 501, Los Angeles, CA, 90089, USA.
| | - Kelly F M Kazmierski
- University of California, Irvine, 4201 Social & Behavioral Sciences Gateway, University of California Irvine, Irvine, CA, 92697, USA.
| | - Gayla Margolin
- University of Southern California, 3620 South McClintock Ave, SGM 501, Los Angeles, CA, 90089, USA.
| |
Collapse
|
175
|
Yang L, Kandasamy K, Na L, Zhang W, Wang P. Perceived and Experienced Anti-Chinese Discrimination and Its Associated Psychological Impacts Among Chinese Canadians During the Wave 2 of the COVID-19 Pandemic. PSYCHOL HEALTH MED 2024; 29:108-125. [PMID: 36336783 DOI: 10.1080/13548506.2022.2142947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
The current study examined the sociodemographic factors associated with perceived and experienced anti-Chinese discrimination and discrimination as a predictor of psychological distress and loneliness among Chinese Canadians. A cross-sectional online survey was conducted in early 2021 with a sample of 899 Chinese Canadians (i.e., immigrants, citizens, visitors, and international students) during the Wave 2 of the COVID-19 pandemic. Overall, anti-Chinese discrimination was generally associated with younger age and poor financial or health status. Christianity/Catholicism believers were less likely to report perceived discrimination, whereas being married/partnered and living with family reduced the incidences of experienced discrimination. Most importantly, hierarchical linear regression models showed that both perceived and experienced discrimination predicted higher psychological distress (βs = 4.90-7.57, ps ≤ .001) and loneliness (βs = .89-1.73, ps ≤ .003), before and after controlling for all related sociodemographic covariates. Additionally, older age, higher education, better financial or health status could all buffer psychological distress, whereas living with family or in a house and better financial or health status could mitigate feeling of loneliness. The results suggested that discrimination has a robust detrimental impact on mental health conditions among Chinese Canadians.
Collapse
Affiliation(s)
- Lixia Yang
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Kesaan Kandasamy
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Ling Na
- Department of Population Health, University of Toledo, Toledo, OH, United States
| | - Weiguo Zhang
- Department of Sociology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Peizhong Wang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
176
|
Etienne S, Lewis LS. Racial implicit bias: Perspectives of nursing students. J Prof Nurs 2024; 50:95-103. [PMID: 38369378 DOI: 10.1016/j.profnurs.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Racial implicit bias contributes to healthcare disparities. While research has been conducted on other health professionals, there is a lack of evidence about nursing students' experiences with racial implicit bias. PURPOSE This study described the perspectives of pre-licensure nursing students regarding racial implicit bias (RIB) and its impact on patient care. METHOD A qualitative descriptive methodology utilizing focus groups was used to describe the students' perspectives. RESULTS Data analysis revealed three main themes: RIB may not be on purpose, but wrong is wrong; Bad nurse versus good nurse; and This is not okay. CONCLUSION As RIB continues to contribute to health care disparities, this study reveals the need for it to be addressed in nursing education, while students prepare to be front line health care professionals.
Collapse
Affiliation(s)
- Shirley Etienne
- Department of Nursing, Elon University, Gerlad Francis Center, 762 East Haggard Avenue, Elon, NC 27244, United States of America.
| | - Lisa Scandale Lewis
- Duke School of Nursing, 307 Trent Drive, Pearson Building, Room 3061, DUMC Box 3322, Durham, NC 27710, United States of America.
| |
Collapse
|
177
|
Jones SH, Unsworth A. Two Islamophobias? Racism and religion as distinct but mutually supportive dimensions of anti-Muslim prejudice. Br J Sociol 2024; 75:5-22. [PMID: 37712210 DOI: 10.1111/1468-4446.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/06/2023] [Accepted: 08/11/2023] [Indexed: 09/16/2023]
Abstract
Debates about Islamophobia have been blighted by the question of whether the prejudice can be defined as a form of racism or as hostility to religion (or a combination of the two). This paper sheds light on this debate by presenting the findings of a new nationally representative survey, focused on the UK, that contrasts perceptions of Muslims not only with perceptions of other ethnic and religious minorities but also with perceptions of Islam as a religious tradition. We find that prejudice against Muslims is higher than for any other group examined other than Travellers. We also find contrasting demographic drivers of prejudice towards Muslims and towards Islam. Across most prejudice measures we analyse, intolerant views are generally significantly associated with being male, voting Conservative and being older, although not with Anglican identity. We find, however, that class effects vary depending on the question's focus. Anti-immigration sentiment - including support for a 'Muslim ban' - is significantly correlated with being working-class. However, prejudice towards Islam as a body of teachings (tested using a question measuring perceptions of religious literalism) is significantly correlated with being middle-class, as is negative sentiment towards Travellers. Using these findings, the paper makes an argument for supplementing recent scholarship on the associations between racism and Islamophobia with analyses focusing on misperceptions of belief.
Collapse
Affiliation(s)
- Stephen H Jones
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Amy Unsworth
- Faculty of Maths and Physical Sciences, University College London, London, UK
| |
Collapse
|
178
|
Addala A, Mungmode A, Ospelt E, Sanchez JE, Malik F, Demeterco-Berggren C, Butler A, Edwards C, Manukyan M, Ochoa-Maya M, Zupa M, Ebekozien O. Current Practices in Operationalizing and Addressing Racial Equity in the Provision of Type 1 Diabetes Care: Insights from the Type 1 Diabetes Exchange Quality Improvement Collaborative Health Equity Advancement Lab. Endocr Pract 2024; 30:41-48. [PMID: 37806550 DOI: 10.1016/j.eprac.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Medical racism contributes to adverse health outcomes. Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in T1D care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity. METHODS The annual T1DX-QI survey was administered to participating clinics in fall 2022 and had a 93% response rate. There were 50 responses (pediatric: 66% and adult: 34%). Questions, in part, evaluated clinical resources and racial equity. Response data were aggregated, summarized, and stratified by pediatric/adult institutions. RESULTS Only 21% pediatric and 35% adult institutions felt that all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, equity offices/committees, patient resources, and hiring practices. Patient resources included interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Most institutions have offered antiracism training in the last year (pediatric: 85% and adult: 72%) and annually (pediatric: 64% and adult: 56%). Pediatric teams felt that their antiracism training was effective more often (pediatric: 60% and adult: 45%) and more commonly, they were provided resources (pediatric: 67% and adult: 47%) to help address inequities. CONCLUSION Despite increased antiracism training, insufficient institutional support and perceived subeffective training still represent obstacles, especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities.
Collapse
Affiliation(s)
- Ananta Addala
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford School of Medicine, California.
| | | | | | - Janine E Sanchez
- Division of Pediatric Endocrinology, University of Miami, Florida
| | - Faisal Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Carla Demeterco-Berggren
- Division of Pediatric Endocrinology, University of California, San Diego, Rady Children's Hospital, San Diego, California
| | - Ashley Butler
- Division of Pediatric Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | | | - Makaila Manukyan
- Office of Equity, Vitality, and Inclusion, Boston Medical Center, Boston, Massachusetts
| | | | - Margaret Zupa
- Divison of Endocrinology, University of Pittsburgh Medical Center, Pittsburgh
| | - Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts; Deartment of Population Health, University of Mississippi School of Population Health, Mississippi
| |
Collapse
|
179
|
Chiraroekmongkon S. The Invisibility Cloak: Narrative From an Asian American Woman Physician-in-Training. Psychiatr Serv 2024; 75:92-93. [PMID: 38161316 DOI: 10.1176/appi.ps.23074022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
|
180
|
Mbise A, Hodge-Growden C, Agnew Bemben T, Shimizu R. Addressing barriers to health care among Black Alaskans: contributions by social work research to an agenda of health equity. Soc Work Health Care 2024; 63:4-18. [PMID: 37952194 DOI: 10.1080/00981389.2023.2278800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/31/2023] [Indexed: 11/14/2023]
Abstract
Black Alaskans face serious barriers to health care. This paper reports on qualitative results of a health needs assessment to understand the health challenges facing Black Alaskans. Utilizing exploratory thematic analysis, the findings indicate that Black Alaskans experience barriers such as high cost of care, underinsurance, lack of information and education, a shortage of BIPOC health providers, stigma, negative perceptions by health-care providers, and racism both in the community and in the health-care system. The paper concludes by discussing emerging health equity initiatives to advance responsive care for Black Alaskans.
Collapse
Affiliation(s)
- Amana Mbise
- School of Social Work, University of Alaska Anchorage, Anchorage, Alaska, USA
| | | | | | - Rei Shimizu
- School of Social Work, University of Alaska Anchorage, Anchorage, Alaska, USA
| |
Collapse
|
181
|
Abstract
This article addresses a paradox between self-perceptions of psychology as a liberal, progressive, antiracist discipline and profession and the persistent criticisms of racism and calls for decolonization. It builds on the criticisms of epistemic exclusion and White centering, arguing that White supremacy is maintained by "conversational silencing" in which the focus on doing good psychology systematically draws attention away from the realities of racism and the operation of power. The process is illustrated by investigations of disciplinary discourse around non-Western, educated, industrialized, rich, and democratic psychology and on stereotyping, racism, and prejudice reduction, which constitute the vanguard of liberal scholarship in the discipline. This progressive scholarship nurtures "White ignorance," an absence of belief about systemic racism that psychology plays a part in upholding.
Collapse
|
182
|
Figueroa CA, Manalo-Pedro E, Pola S, Darwish S, Sachdeva P, Guerrero C, von Vacano C, Jha M, De Maio F, Kennedy CJ. The stories about racism and health: the development of a framework for racism narratives in medical literature using a computational grounded theory approach. Int J Equity Health 2023; 22:265. [PMID: 38129909 PMCID: PMC10734166 DOI: 10.1186/s12939-023-02077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION The scientific study of racism as a root cause of health inequities has been hampered by the policies and practices of medical journals. Monitoring the discourse around racism and health inequities (i.e., racism narratives) in scientific publications is a critical aspect of understanding, confronting, and ultimately dismantling racism in medicine. A conceptual framework and multi-level construct is needed to evaluate the changes in the prevalence and composition of racism over time and across journals. OBJECTIVE To develop a framework for classifying racism narratives in scientific medical journals. METHODS We constructed an initial set of racism narratives based on an exploratory literature search. Using a computational grounded theory approach, we analyzed a targeted sample of 31 articles in four top medical journals which mentioned the word 'racism'. We compiled and evaluated 80 excerpts of text that illustrate racism narratives. Two coders grouped and ordered the excerpts, iteratively revising and refining racism narratives. RESULTS We developed a qualitative framework of racism narratives, ordered on an anti-racism spectrum from impeding anti-racism to strong anti-racism, consisting of 4 broad categories and 12 granular modalities for classifying racism narratives. The broad narratives were "dismissal," "person-level," "societal," and "actionable." Granular modalities further specified how race-related health differences were related to racism (e.g., natural, aberrant, or structurally modifiable). We curated a "reference set" of example sentences to empirically ground each label. CONCLUSION We demonstrated racism narratives of dismissal, person-level, societal, and actionable explanations within influential medical articles. Our framework can help clinicians, researchers, and educators gain insight into which narratives have been used to describe the causes of racial and ethnic health inequities, and to evaluate medical literature more critically. This work is a first step towards monitoring racism narratives over time, which can more clearly expose the limits of how the medical community has come to understand the root causes of health inequities. This is a fundamental aspect of medicine's long-term trajectory towards racial justice and health equity.
Collapse
Affiliation(s)
- Caroline A Figueroa
- University of California Berkeley, Berkeley, USA.
- Department of Technology, Policy, and Management, Delft University of Technology, Policy & Management Room B3.230, Building 31, Jaffalaan 5, Delft, 2628 BX, the Netherlands.
| | - Erin Manalo-Pedro
- University of California Berkeley, Berkeley, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | - Swetha Pola
- University of California Berkeley, Berkeley, USA
| | - Sajia Darwish
- University of California Berkeley, Berkeley, USA
- School of Public Health, University of California Berkeley, Berkeley, USA
| | | | | | | | | | - Fernando De Maio
- American Medical Association, Chicago, USA
- Department of Sociology, DePaul University, Chicago, USA
| | - Chris J Kennedy
- University of California Berkeley, Berkeley, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, USA
| |
Collapse
|
183
|
Javadi D, Murchland AR, Rushovich T, Wright E, Shchetinina A, Siefkas AC, Todd KP, Gitelman J, Hall E, Wynne JO, Zewge-Abubaker N, Krieger N. Systematic review of how racialized health inequities are addressed in Epidemiologic Reviews articles (1979-2021): a critical conceptual and empirical content analysis and recommendations for best practices. Epidemiol Rev 2023; 45:1-14. [PMID: 37386694 DOI: 10.1093/epirev/mxad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 04/25/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Abstract
Critical analysis of the determinants of current and changing racialized health inequities, including the central role of racism, is an urgent priority for epidemiology, for both original research studies and epidemiologic review articles. Motivating our systematic overview review of Epidemiologic Reviews articles is the critical role of epidemiologic reviews in shaping discourse, research priorities, and policy relevant to the social patterning of population health. Our approach was first to document the number of articles published in Epidemiologic Reviews (1979-2021; n = 685) that either: (1) focused the review on racism and health, racial discrimination and health, or racialized health inequities (n = 27; 4%); (2) mentioned racialized groups but did not focus on racism or racialized health inequities (n = 399; 59%); or (3) included no mention of racialized groups or racialized health inequities (n = 250; 37%). We then conducted a critical content analysis of the 27 review articles that focused on racialized health inequities and assessed key characteristics, including (1) concepts, terms, and metrics used regarding racism and racialized groups (notably only 26% addressed the use or nonuse of measures explicitly linked to racism; 15% provided explicit definitions of racialized groups); (2) theories of disease distribution guiding (explicitly or implicitly) the review's approach; (3) interpretation of findings; and (4) recommendations offered. Guided by our results, we offer recommendations for best practices for epidemiologic review articles for addressing how epidemiologic research does or does not address ubiquitous racialized health inequities.
Collapse
Affiliation(s)
- Dena Javadi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Audrey R Murchland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Tamara Rushovich
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Emily Wright
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Anna Shchetinina
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Anna C Siefkas
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Kieran P Todd
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Julian Gitelman
- Postgraduate Medical Education, University of Toronto, Toronto, Ontario M5R 0A3, Canada
| | - Enjoli Hall
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Jhordan O Wynne
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| | - Nishan Zewge-Abubaker
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
| |
Collapse
|
184
|
Wizentier MM, Stephenson BJK, Goodman MS. The measurement of racism in health inequities research. Epidemiol Rev 2023; 45:32-43. [PMID: 37147182 DOI: 10.1093/epirev/mxad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023] Open
Abstract
There is limited literature on the measures and metrics used to examine racism in the health inequities literature. Health inequities research is continuously evolving, with the number of publications increasing over time. However, there is limited knowledge on the best measures and methods to examine the impact of different levels of racism (institutionalized, personally mediated, and internalized) on health inequities. Advanced statistical methods have the potential to be used in new ways to examine the relationship between racism and health inequities. In this review, we conduct a descriptive examination of the measurement of racism in the health inequities epidemiologic literature. We examine the study design, methods used for analysis, types of measures used (e.g., composite, absolute, relative), number of measures used, phase of research (detect, understand, solutions), viewpoint (oppressor, oppressed), and components of structural racism measures (historical context, geographical context, multifaceted nature). We discuss methods (e.g., Peters-Belson, latent class analysis, difference in differences) that have demonstrated potential for future work. The articles reviewed were limited to the detect (25%) and understand (75%) phases, with no studies in the solutions phase. Although the majority (56%) of studies had cross-sectional designs, many authors pointed to the need for longitudinal and multilevel data for further exploration. We examined study design features as mutually exclusive elements. However, racism is a multifaceted system and the measurement of racism in many studies does not fit into a single category. As the literature grows, the significance of methodological and measurement triangulation to assess racism should be investigated.
Collapse
Affiliation(s)
- Marina Mautner Wizentier
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
| | - Briana Joy K Stephenson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Melody S Goodman
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
| |
Collapse
|
185
|
Tomdi L. Gender, race and class at work: enlisting African health labour into the Gold Coast Medical Service, 1860-1957. Med Humanit 2023; 49:623-630. [PMID: 37068946 DOI: 10.1136/medhum-2022-012468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 06/19/2023]
Abstract
From the mid-nineteenth century, the people of the Gold Coast formed an essential component of the missionary and early colonial medical services (CMS). The labour of the people was mainly confined to the category of medical auxiliaries. Enlisting these African auxiliaries into the medical service took place within gendered, racial and class boundaries. Yet, the historiography of the Gold Coast does not overtly address the interplay of gender, race and class in connection with the work of African health auxiliaries. This article examines the intersection of race, gender and class in the employment and training of African health labour in the Gold Coast. It argues that European and African gendered ideologies, racial discrimination and class difference influenced the recruitment of Africans into early colonial and missionary medical services. This article is largely based on qualitative research and critical reading and re-reading of textual records. The records include colonial medical reports obtained from the digital archives of the Wellcome Library in London, Manhyia Archives of Ghana, and Public Records and Archives Administration Department in Kumase of Ghana. Books and dissertations were critically re-examined for fragmented details about these auxiliary workers. This article reveals that men dominated the categories of African health labour, that is doctors, orderlies, dispensers, nurses and midwives until the 1940s when more women began to enter the CMS. The relationship between African and European medical staff, and colonial administrators within the Gold Coast Medical Department from the 1890s shows the existence of racial discrimination largely based on physical appearance and intellectualism. Recruiting Africans into the CMS was necessary to augment insufficient European staffing across many occupations, but not to the same rank and class. This research identifies the pathways into the formalised health professions in Ghana within the context of colonial and missionary medicine.
Collapse
Affiliation(s)
- Lucky Tomdi
- Department of History, University of New Brunswick, Fredericton, New Brunswick, Canada
| |
Collapse
|
186
|
Bressan P. Racism is not about "race". Sci Rep 2023; 13:22339. [PMID: 38102138 PMCID: PMC10724130 DOI: 10.1038/s41598-023-47653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023] Open
Abstract
Unfamiliar individuals are viewed with suspicion across the entire animal kingdom. This makes evolutionary sense, as outsiders may carry unfamiliar pathogens against which one has not yet developed immune defenses. In humans, the unfamiliar-pathogens idea has been dismissed on the grounds that people do not shun microbe-sharing contact with ethnic outgroups (other "races") more than they do with ingroups. Reanalyzing the same public data on which such claims are based-6500 participants from China, India, USA, and UK-here I show that (1) people do behave as though the parasites of unfamiliar individuals were more dangerous, and (2) strangers' ethnicity matters when, and only when, it is a proxy for unfamiliarity. This implies that racism could be tamed by acquainting our children with fellow humans of all shapes and colors, so that everyone in the world looks like family.
Collapse
Affiliation(s)
- Paola Bressan
- Dipartimento di Psicologia Generale, University of Padova, 35131, Padua, Italy.
| |
Collapse
|
187
|
Aponte J, Roldós MI. National Institutes of Health R-series Grants portfolio of racism and healthcare, 2017-2022. BMC Public Health 2023; 23:2511. [PMID: 38098011 PMCID: PMC10722752 DOI: 10.1186/s12889-023-17407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Any form of racism in healthcare is an unacceptable barrier to receiving equitable and quality care, further contributing to health disparities among populations. For these reasons, it is critical to have a better understanding on the amount of research and scientific advances of funded projects aimed at racism in healthcare. An examination of the distribution of R-series funded research by the National Institutes of Health (NIH) on racism in healthcare during a 5-year fiscal year (FY) period (2017-2022) was conducted by the study team. METHODS This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools: Expenditures and Results) for research project grants awarded on racism and healthcare during the FYs of 2017 to 2022. The number of R-series NIH funded projects on racism in healthcare were examined, including the abstract and public health relevance statement, number of publications, spending category, fiscal start and end dates, total amount of funding each year, funding agency/center(s), and type of funding opportunity announcements. Descriptive statistics were performed on the data by the research team. RESULTS There were a total of 93 R-series grants funded during the FYs of 2017 to 2022. Most of the grants were R01s (77.4%); focused primarily on racism at the system-wide level (68.8%), and on patients (64.5%); the largest racial and ethnic minority group reported were African/American/Black (20.4%); and close to 40% did not report race or ethnicity. None of the grants focused in internalized racism, which is at the individual -level. From the FYs of 2017 to 2022, 0.07% of all NIH research funding was awarded to racism in healthcare. CONCLUSION The findings of this study showed the need for continued funding and of the need of more research on racism in healthcare, that potentially can reduce health disparities and inequities.
Collapse
Affiliation(s)
- Judith Aponte
- Hunter College School of Nursing| City University of New York - CUNY, CUNY Institute of Health Equity, New York, USA.
| | - Maria Isabel Roldós
- Department of Health Equity, Administration, and Technology, School of Health Sciences, Human Services and Nursing (HS2N) | Lehman College | City University of New York - CUNY, CUNY Institute for Health Equity, New York, USA
| |
Collapse
|
188
|
Meudec M, Affun-Adegbulu C, Cosaert T. Review of health research and data on/with racially minoritised groups: Implications for addressing racism and racial disparities in public health practice and policies in Europe: a study protocol. F1000Res 2023; 12:57. [PMID: 38434645 PMCID: PMC10904934 DOI: 10.12688/f1000research.128331.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 03/05/2024] Open
Abstract
Historically, across Europe, data and research on/with racially minoritised groups have not been collected or carried out in a sufficient, adequate, or appropriate manner. Yet, to understand emerging and existing health disparities among such groups, researchers and policymakers must obtain and use data to build evidence that informs decision-making and action on key structural and social determinants of health. This systematic search and review aims to contribute to closing this gap and promote a race-conscious approach to health research, strengthening the utilisation and deployment of data and research on/with racially minoritised groups in Europe. Its ultimate goal is to improve equality and equity in health*. Concretely, the study will do so by reviewing and critically analysing the usage of the concepts of race, ethnicity, and their related euphemisms and proxies in health-related research. It will examine the collection, use, and deployment of data and research on/with racially minoritised groups in this area. The study will focus on Belgium, France, and the Netherlands, three countries with graphical proximity and several similarities, one of which is the limited attention that is given to racism and racial inequalities in health in research and policy. This choice is also justified by practical knowledge of the context and languages. The results of the review will be used to develop guidance on how to use and deploy data and research on/with racially minoritised groups. The review is part of a larger project which aims to promote race-conscious research and data. The project does this by a three-pronged approach which: 1) highlights the need for a race-conscious approach when collecting and using data, carrying out research on/with racially minoritised groups; 2) builds expertise for their effective use and deployment, and; 3) creates a knowledge network and community of practice for public health researchers working in Europe.
Collapse
Affiliation(s)
- Marie Meudec
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Clara Affun-Adegbulu
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Theo Cosaert
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| |
Collapse
|
189
|
Yehuda R, Hankerson SH. Learning From Racial Disparities in COVID-19-Related Stress. Am J Psychiatry 2023; 180:865-867. [PMID: 38037400 DOI: 10.1176/appi.ajp.20230782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx, N.Y. (Yehuda, Hankerson); Center for Psychedelic Psychotherapy and Trauma Research (Yehuda), Department of Psychiatry (Yehuda, Hankerson), and Institute of Health Equity Research, Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York
| | - Sidney H Hankerson
- James J. Peters Veterans Affairs Medical Center, Bronx, N.Y. (Yehuda, Hankerson); Center for Psychedelic Psychotherapy and Trauma Research (Yehuda), Department of Psychiatry (Yehuda, Hankerson), and Institute of Health Equity Research, Department of Population Health Sciences and Policy (Hankerson), Icahn School of Medicine at Mount Sinai, New York
| |
Collapse
|
190
|
Curtis MG, Whalen CC, Pjesivac I, Kogan SM. Contextual Pathways Linking Cumulative Experiences of Racial Discrimination to Black American Men's COVID Vaccine Hesitancy. J Racial Ethn Health Disparities 2023; 10:2944-2956. [PMID: 36445684 PMCID: PMC9707415 DOI: 10.1007/s40615-022-01471-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has revealed and widened racialized health disparities, underscoring the impact of structural inequities and racial discrimination on COVID-19 vaccination uptake. A sizable proportion of Black American men report that they either do not plan to or are unsure about becoming vaccinated against COVID-19. The present study investigated hypotheses regarding the mechanisms by which experiences of racial discrimination are associated with Black American men's COVID-19 vaccine hesitancy. Hypotheses were tested using structural equation modeling with 4 waves of data from 242 Black American men (aged ~ 27) living in resource-poor communities in the rural South. Study findings revealed that racial discrimination was indirectly associated with COVID-19 vaccine hesitancy via increased endorsement of COVID-19 conspiratorial beliefs. Findings also demonstrated that increased levels of ethnic identity strengthen the association between experiences of racial discrimination and COVID-19 conspiratorial beliefs. In contrast, increased levels of social support weakened the association between cumulative experiences of racial discrimination and COVID conspiratorial beliefs. Taken together, these results suggest that racial discrimination may promote conspiratorial beliefs which undermine Black American men's willingness to be vaccinated. Future interventions aimed towards promoting vaccine uptake among Black American men may benefit from the inclusion of targeted efforts to rebuild cultural trust and increase social support.
Collapse
Affiliation(s)
- Michael G Curtis
- Department of Human Development and Family Science, University of Georgia, 1095 College Station Road, Athens, Georgia, 30602-4527, USA.
| | | | - Ivanka Pjesivac
- Grady College of Journalism & Mass Communication, University of Georgia, Athens, Georgia, USA
| | - Steven M Kogan
- Department of Human Development and Family Science, University of Georgia, 1095 College Station Road, Athens, Georgia, 30602-4527, USA
| |
Collapse
|
191
|
Liu LS, Jia X, Zhu A, Ran GJ, Siegert R, French N, Johnston D. Stigmatising and Racialising COVID-19: Asian People's Experience in New Zealand. J Racial Ethn Health Disparities 2023; 10:2704-2717. [PMID: 36369460 PMCID: PMC9651882 DOI: 10.1007/s40615-022-01448-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/24/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
The Asian community - the second largest non-European ethnic community in New Zealand - plays an important role in combatting the COVID-19 pandemic, evidenced by their active advocation for border control and mass masking. Despite the long history of racial discrimination against the Asian population, the Asian community has experienced certain degrees of racial discrimination associated with the stigmatisation as the cause of the COVID-19 outbreak in New Zealand. Based on data from a quantitative online survey with 402 valid responses within the Asian communities across New Zealand and the in-depth interviews with 19 Asian people in Auckland, New Zealand, this paper will illustrate Asian people's experience of racial discrimination and stigmatisation during the pandemic in the country. The survey shows that since the outbreak of COVID-19, under a quarter of the participants reported experiencing discrimination, and a third reported knowing an immediate contact who had experienced discrimination. However, when looking beyond their immediate social circle, an even higher proportion reported noticing racism and stigmatisation through the traditional or social media due to COVID-19. Major variations of the degree of racial discrimination experienced are determined by three demographic variables: ethnicity, age, and region. The in-depth interviews largely echoed the survey findings and highlighted a strong correlation between the perceived racial discrimination among the local Asian community and the stigmatisation associated with COVID-19. These findings are important for improving the way we manage future pandemics and other disasters within the context of the UN Sendai Framework for Disaster Risk Reduction.
Collapse
Affiliation(s)
- Liangni Sally Liu
- School of Humanities, Media and Creative Communication, Massey University, Auckland, New Zealand.
| | - Xiaoyun Jia
- Institute of Governance & School of Politics and Public Administration, Shangdong University, Qingdao, China
- School of Mathematical and Computational Sciences, Massey University, Auckland, New Zealand
| | - Andrew Zhu
- Trace Research Ltd, Auckland, New Zealand
| | - Guanyu Jason Ran
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Richard Siegert
- Department of Psychology & Neuroscience, School of Clinical Sciences, University of Technology, Auckland, New Zealand
| | - Nigel French
- Infectious Diseases Research Centre, Hopkirk Research Institute, Massey University, Palmerston North, New Zealand
| | - David Johnston
- Joint Centre for Disaster Research, Massey University, Wellington, New Zealand.
| |
Collapse
|
192
|
Reis E. Envisioning African Intersex: Challenging Colonial and Racist Legacies in South African Medicine, by Amanda Lock Swarr. Durham, NC: Duke University Press, 2023. J Med Humanit 2023; 44:581-583. [PMID: 37058188 DOI: 10.1007/s10912-023-09794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Elizabeth Reis
- Macaulay Honors College at the City University of New York, New York, NY, USA.
| |
Collapse
|
193
|
Elias A, Ben J. Pandemic Racism: Lessons on the Nature, Structures, and Trajectories of Racism During COVID-19. J Bioeth Inq 2023; 20:617-623. [PMID: 37917295 PMCID: PMC10942924 DOI: 10.1007/s11673-023-10312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
The COVID-19 pandemic has been one of the most acute global crises in recent history, which profoundly impacted the world across many dimensions. During this period, racism manifested in ways specifically related to the pandemic, including xenophobic sentiments, racial attacks, discriminatory policies, and disparate outcomes across racial/ethnic groups. This paper examines some of the pressing questions about pandemic racism and inequity. We review what research has revealed about the nature and manifestations of racism, the entrenchment of structural racism, and trajectories of racism during COVID-19.
Collapse
Affiliation(s)
- A Elias
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, 221 Burwood HWY, Burwood, Victoria, 3125, Australia.
| | - J Ben
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, 221 Burwood HWY, Burwood, Victoria, 3125, Australia
| |
Collapse
|
194
|
Caffrey A, Botticello J, Quarshie PE, Ali L, Watts P, Cathala X, Ferrante J. Student nurses' experiences of discrimination and racism on work placements: What can higher education institutions do? Nurse Educ Today 2023; 131:105980. [PMID: 37857100 DOI: 10.1016/j.nedt.2023.105980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/31/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND There is persistent interpersonal, institutional and structural racism within the health sector and higher education. Such anti-Black and anti-Brown racisms are experienced by nursing students, nursing apprentices and fully qualified nurses. This discrimination intersects with other characteristics, namely gender and student status, which can make the nursing profession an unsafe environment for many. OBJECTIVES To understand student nurses' experiences of racism and intersecting oppressions, at university and on work placement. DESIGN A qualitative descriptive study with individual interviews and focus groups. SETTINGS A widening participation higher education institution in London, UK. PARTICIPANTS Twenty-four student nurses and nurse apprentices studying on an adult nursing programme. METHODS Students were recruited through purposive sampling. In-depth data relating to student nurses' perspectives and experiences were gathered through two focus groups and three individual interviews conducted by student nurse peers. Interviews were transcribed verbatim and open coding was used to analyse transcripts using comparison and thematic analysis. RESULTS Three key themes arose: safety and support in the university space; hierarchical treatment in work placements due to intersecting race and 'student' identities, and; direct racism by patients and staff in work placements. CONCLUSIONS Student nurses expressed their vulnerability to discrimination and racism whilst on placement in the National Health Service. More opportunities within university curricula are needed for student nurses to learn about, reflect on, and gain support for managing experiences of discrimination in the health system.
Collapse
Affiliation(s)
- Anna Caffrey
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom..
| | - Julie Botticello
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
| | - Philomena Esinam Quarshie
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
| | - Luul Ali
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
| | - Paul Watts
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
| | - Xabi Cathala
- City, University of London, Northampton Square, London EC1V 0HB, University of London
| | - Joshua Ferrante
- University of East London, School of Health Sport and Bioscience, University Way, E16 2RD London, United Kingdom
| |
Collapse
|
195
|
Jindal M, Chaiyachati KH, Fung V, Manson SM, Mortensen K. Eliminating health care inequities through strengthening access to care. Health Serv Res 2023; 58 Suppl 3:300-310. [PMID: 38015865 PMCID: PMC10684044 DOI: 10.1111/1475-6773.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To provide a research agenda and recommendations to address inequities in access to health care. DATA SOURCES AND STUDY SETTING The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. STUDY DESIGN Multi-stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. DATA COLLECTION/EXTRACTION METHODS Through a stakeholder-engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. PRINCIPAL FINDINGS The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti-racist practices (e.g., co-production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. CONCLUSIONS AHRQ is well-positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations.
Collapse
Affiliation(s)
- Monique Jindal
- Department of Academic Internal MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Krisda H. Chaiyachati
- Verily, Inc.South San FranciscoCaliforniaUSA
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Mongan InstituteMassachusetts General HospitalBostonMassachusettsUSA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Karoline Mortensen
- Department of Health Management and PolicyMiami Herbert Business SchoolCoral GablesFloridaUSA
| |
Collapse
|
196
|
Lynn TM, D’urzo KA, Vaughan-Ogunlusi O, Wiesendanger K, Colbert-Kaip S, Capcara A, Chen S, Sreenan S, Brennan MP. The impact of a student-led anti- racism programme on medical students' perceptions and awareness of racial bias in medicine and confidence to advocate against racism. Med Educ Online 2023; 28:2176802. [PMID: 36787247 PMCID: PMC9930825 DOI: 10.1080/10872981.2023.2176802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/30/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Systemic racism impacts personal and community health; however, education regarding its role in perpetuating healthcare inequity remains limited in medical curricula. This study implemented and evaluated the impact of a student-led anti-racism programme on medical students' perceptions of racial bias in medicine, awareness of, and confidence to advocate against racism in medicine. METHOD A total of 543 early stage medical students were invited to participate in the programme. Participants were assigned readings and videos exploring racial injustice in medicine and attended a virtual small-group discussion facilitated by faculty and students. Online surveys were used to collect pre- and post-programme data using Likert scales for response items. Open-ended questions were independently reviewed by three authors using reflexive thematic analysis. RESULTS Sixty-three early-stage medical students enrolled in the programme, of which 42 completed the pre-programme survey. There was a 76% (n = 32) response rate for the post-programme survey. The majority of students (60%, n = 25) had no previous education about racism in medicine. From pre- to post-programme, there was a significant change in students' perceived definition of race from genetic, biological, geographical, and cultural factors to socio-political factors (P < 0.0001). Significant increases in almost all factors assessing student awareness of racism and confidence to advocate against racism were observed. Student-identified barriers to discussing racism included lack of education and lived experience, fear of starting conflict and offending others. All survey respondents would recommend this programme to peers and 69% (n = 32) engaged in further topical self-directed education. CONCLUSION This simple and reproducible programme improved awareness and confidence to advocate against racism in medicine and resulted in a change in opinion regarding race-based medical practice. These findings are in line with best practice towards addressing racial bias in medicine, decolonizing medical curricula and strengthening anti-racism teaching of future physicians.
Collapse
Affiliation(s)
- Thérése M. Lynn
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Katrina A. D’urzo
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Kathryn Wiesendanger
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Colbert-Kaip
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Austin Capcara
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Chen
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Seamus Sreenan
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Endocrinology, Connolly Hospital, Dublin, Ireland
| | - Marian P. Brennan
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Pharmacy and Biomedical Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
197
|
Shen E, Zhong J, Benhayoun A, Choi EY, Zou L, Yuen EY. Navigating Intersectional Identities: Clinical Considerations for Working With LGBTQ Asian American Youth. J Am Acad Child Adolesc Psychiatry 2023; 62:1297-1300. [PMID: 37088451 DOI: 10.1016/j.jaac.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/24/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
LGBTQ Asian American youth face unique challenges related to their marginalized identities. It is well documented that Asian Americans who need mental health treatment access care at lower rates than White populations.1 Although Asian cultural values are often cited as reasons for decreased help-seeking behavior, research suggests structural barriers including cost, lack of culturally tailored services, and lack of knowledge of available resources as greater contributors to these disparities.1 Asian Americans have also been subject to the "model minority" myth, the stereotype that the community is universally high achieving, rule following, and well adjusted. This false narrative contributes to negative mental health outcomes driven by racial discrimination and homogenizing the Asian American experience. This masks the diversity in mental health needs among Asian Americans. In addition, LGBTQ Asian Americans experience microaggressions, the perception of being "not queer enough," and racism from LGBTQ spaces that often primarily cater to a White population.2.
Collapse
Affiliation(s)
- Elaine Shen
- Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Julia Zhong
- Yale School of Medicine, New Haven, Connecticut; Yale Child Study Center, New Haven, Connecticut
| | | | | | - Lei Zou
- Yale School of Medicine, New Haven, Connecticut
| | - Eunice Y Yuen
- Yale School of Medicine, New Haven, Connecticut; Yale Child Study Center, New Haven, Connecticut.
| |
Collapse
|
198
|
Kalofonos I. Meaning in Psychosis: A Veteran's Critique of the Traumas of Racism, Sexual Violence, and Intersectional Oppression. Cult Med Psychiatry 2023; 47:1090-1112. [PMID: 37138030 PMCID: PMC10654173 DOI: 10.1007/s11013-023-09824-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/05/2023]
Abstract
This clinical case study presents the case of a Latina Veteran experiencing psychosis and draws on eclectic theoretical sources, including user/survivor scholarship, phenomenology, meaning-oriented cultural psychiatry & critical medical anthropology, and Frantz Fanon's insight on 'sociogeny,' to emphasize the importance of attending to the meaning within psychosis and to ground that meaning in a person's subjective-lived experience and social world. The process of exploring the meaning and critical significance of the narratives of people experiencing psychosis is important for developing empathy and connection, the fundamental prerequisite for developing trust and therapeutic rapport. It also helps us to recognize some of the relevant aspects of a person's lived experiences. To be understood, this Veteran's narratives must be contextualized in her past and ongoing life experience of racism, social hierarchy, and violence. Engaging in this way with her narratives pushes us towards a social etiology that conceptualizes psychosis as a complex response to life experience, and in her case, a critical embodiment of intersectional oppression.
Collapse
Affiliation(s)
- Ippolytos Kalofonos
- HSR&D Center for the Study of Helathcare Innovation, Implementation & Policy (CSHIIP) & Mental Illness Research Education & Clinical Center (MIRECC) Health Services Unit, Greater Los Angeles VA Health System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA.
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.
- UCLA International Institute, 11248 Bunche Hall, Los Angeles, CA, 90095, USA.
- UCLA Department of Anthropology, 375 Portola Plaza, Los Angeles, CA, 90095, USA.
| |
Collapse
|
199
|
Kemp D, Black CG, Isom J. Racism, Psychosis, and Ethnicities of Black Americans. Psychiatr Serv 2023; 74:1217. [PMID: 38037389 DOI: 10.1176/appi.ps.23074021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Dwight Kemp
- Extended Care Unit, Kings County Hospital, New York City (Kemp); Department of Psychiatry, Yale University, New Haven (Black, Isom)
| | - Carmen G Black
- Extended Care Unit, Kings County Hospital, New York City (Kemp); Department of Psychiatry, Yale University, New Haven (Black, Isom)
| | - Jessica Isom
- Extended Care Unit, Kings County Hospital, New York City (Kemp); Department of Psychiatry, Yale University, New Haven (Black, Isom)
| |
Collapse
|
200
|
Onaga L. Jeannie N. Shinozuka, Biotic Borders: Transpacific Plant and Insect Migration and the Rise of Anti-Asian Racism in America, 1890-1950, Chicago: University of Chicago Press, 2022, 296 pp. J Hist Biol 2023; 56:755-757. [PMID: 38051437 PMCID: PMC10806067 DOI: 10.1007/s10739-023-09759-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Lisa Onaga
- Max Planck Institute for the History of Science, Berlin, Germany.
| |
Collapse
|