Racism, colonialism and the implications for nursing scholarship: A discussion paper

AIM

A critical discussion of the intersections between racism and colonialism as social determinants of health and explore how these discriminatory ideologies shape nursing inquiry.

DESIGN

Discussion paper.

DATA SOURCES

A review of pertinent discourse on racism and colonialism in nursing from 2000 to 2022.

IMPLICATIONS FOR NURSING

The failure to address health inequity plaguing racialized and marginalized populations locally and globally affects all groups, as illustrated in the COVID-19 pandemic. Racism and colonialism are inextricably linked, creating potent forces that influence nursing scholarship and adversely affect the health of a culturally and racially diverse society. Power differentials exist within and between countries creating structural challenges that lead to inequitable distribution of resources and othering. Nursing cannot be abstracted from the sociopolitical context in which it exists. There have been calls to address the social drivers that influence the health of the communities. More still needs to be done to support an antiracist agenda and decolonize nursing.

CONCLUSION

Nurses, as the largest healthcare workforce, can be critical in addressing health disparities. However, nurses have failed to eliminate racism within their ranks, and essentialism ideology has been normalized. A multidimensional approach that includes interventions aimed at nursing education, direct patient care, community health, nursing organizations and policy is needed to address problematic nursing discourse rooted in colonialism and racism ideologies. Since knowledge generated from scholarship informs nursing education, practice and policy, it is imperative to implement antiracist policies that eliminate racist assumptions and practices from nursing scholarship.

NO PATIENT OR PUBLIC CONTRIBUTION

The paper is a discursive paper using pertinent nursing literature.

IMPACT

For nursing to attain its potential as a leader in healthcare, standards of scientific vigour should be embedded within history, culture and politics. Recommendations are provided on possible strategies to identify, confront and abolish racism and colonialism in nursing scholarship.

Decolonisation initiatives at the Institute of Tropical Medicine, Antwerp, Belgium: ready for change?

In a global context, the pernicious effects of colonialism and coloniality are increasingly being recognised in many sectors. As a result, calls to reverse colonial aphasia and amnesia, and decolonise, are getting stronger. This raises a number of questions, particularly for entities that acted as agents of (previous) colonising countries and worked to further the progress of the colonial project: What does decolonisation mean for such historically colonial entities? How can they confront their (forgotten) arsonist past while addressing their current role in maintaining coloniality, at home and abroad? Given the embeddedness of many such entities in current global (power) structures of coloniality, do these entities really want change, and if so, how can such entities redefine their future to ensure that they are and remain 'decolonised'? We attempt to answer these questions, by reflecting on our efforts to think through and start the process of decolonisation at the Institute of Tropical Medicine (ITM) in Antwerp, Belgium. The overarching aim is to contribute to closing the gap in the literature when it comes to documenting practical efforts at decolonisation, particularly in contexts similar to ITM and to share our experience and engage with others who are undertaking or planning to undertake similar initiatives.

Beliefs around the causes of inequities and intergroup attitudes among health professional students before and after a course related to Indigenous Peoples and colonialism

BACKGROUND

Addressing the Truth and Reconciliation Calls to Action on including anti-racism and cultural competency education is acknowledged within many health professional programs. However, little is known about the effects of a course related to Indigenous Peoples and colonialism on learners' beliefs about the causes of inequities and intergroup attitudes.

METHODS

A total of 335 learners across three course cohorts (in 2019, 2020, 2022) of health professional programs (e.g., Dentistry/Dental Hygiene, Medicine, Nursing, and Pharmacy) at a Canadian university completed a survey prior to and 3 months following an educational intervention. The survey assessed gender, age, cultural identity, political ideology, and health professional program along with learners' causal beliefs, blaming attitudes, support for social action and perceived professional responsibility to address inequities. Pre-post changes were assessed using mixed measures (Cohort x Time of measurement) analyses of variance, and demographic predictors of change were determined using multiple regression analyses. Pearson correlations were conducted to assess the relationship between the main outcome variables.

RESULTS

Only one cohort of learners reported change following the intervention, indicating greater awareness of the effects of historical aspects of colonialism on Indigenous Peoples inequities, but unexpectedly, expressed stronger blaming attitudes and less support for government social action and policy at the end of the course. When controlling for demographic variables, the strongest predictors of blaming attitudes towards Indigenous Peoples and lower support for government action were gender and health professional program. There was a negative correlation between historical factors and blaming attitudes suggesting that learners who were less willing to recognize the role of historical factors on health inequities were more likely to express blaming attitudes. Further, stronger support for government action or policies to address such inequities was associated with greater recognition of the causal effects of historical factors, and learners were less likely to express blaming attitudes.

CONCLUSION

The findings with respect to blaming attitudes and lower support for government social action and policies suggested that educational interventions can have unexpected negative effects. As such, implementation of content to address the Truth and Reconciliation Commissions Calls to Action should be accompanied by rigorous research and evaluation that explore how attitudes are transformed across the health professional education journey to monitor intended and unintended effects.

From 'making up' professionals to epistemic colonialism: Digital health platforms in the Global South

Platforms have been studied in terms of their impact on knowledge production and generation of social value. Little however is known about the significance of the knowledge they transfer to the recipient communities-often in faraway countries of the Global South-or its potential perceived colonizing effects. Our study explores the question around digital epistemic colonialism in the context of health platforms involved in knowledge transfer. Using a Foucauldian lens, we study digital colonialism as a phenomenon that emerges from platforms' underpinning power/knowledge relations. Drawing upon a longitudinal study of MedicineAfrica-a nonprofit platform intended to offer clinical education to healthcare workers and medical students in Somaliland-we discuss interview findings from two phases: (a) with Somaliland-based medical students who studied MedicineAfrica as part of their medical studies, and (b) with medical professionals who attended a MedicineAfrica Continuing Professional Development (CPD) course on Covid-19 treatment/prevention. Our study shows how the platform 'makes up' healthcare professionals by offering opportunities for learning and skill development whilst instilling work values and ethos resembling Western medical identities. The platform was also perceived to produce subtle colonizing effects as its content embodies knowledge that (a) presupposes medical infrastructures that are absent in the recipient country; (b) is presented in English instead of participants' mother tongue; and (c) neglects the idiosyncrasies of the local context. The platform sets its tutees in a colonial condition in which they cannot fully practice what they learn; they cannot entirely engage with the subject they learn, taught as it is in a different language, and they do not necessarily learn about the medical conditions and the patients they encounter. This alienation from their local context, embraced by the platform's underpinning power/knowledge relations, is at the heart of digital epistemic colonialism and comes together with the social value the platform generates.

Indigenous Knowledge and the Microbiome-Bridging the Disconnect between Colonized Places, Peoples, and the Unseen Influences That Shape Our Health and Well-Being

Indigenous Peoples have a rich and long-standing connection with the environments that they descend from-a connection that has informed a deep and multifaceted understanding of the relationship between human well-being and the environment. Through cultural narratives and practices, much of this knowledge has endured despite the ongoing effects that colonization has had on many Indigenous peoples across the world. These narratives and practices, based on observation, experimentation, and practical application over many generations, have the potential to make compelling contributions to our understanding of the environmental microbiome and its relationship to health. Furthermore, the inclusion of Indigenous perspectives regarding the microbiome opens pathways to those who rarely engage with the field and its learnings. Within the scientific community, Indigenous perspectives have not always been acknowledged as valid contributions and are often seen as myth or lacking rigor. Thus, this paper aims to explore an Indigenous perspective of the microbiome as an unseen influence on health and well-being by framing the importance of the natural environment, Indigenous knowledge and leadership, and future research directions that can contribute to this domain. Although the Indigenous perspective in this article reflects the experiences, worldviews, and knowledge of two New Zealand Māori authors, it is hoped that the concepts discussed can relate to Indigenous peoples, and non-Indigenous advocates, globally.

Papal Doctrines' Deep Trauma Legacies in Minoritized Communities

Understanding papal documents from the 15th century and the nature and scope of their authority is important when working with Black, Indigenous, and people of color communities influenced by forces and structures of colonialism. Intergenerational trauma has deep roots, which require clinicians to understand historical and cultural context when working with vulnerable patients-in particular, young victims of child abuse and neglect.

On the Cover: Speculations with Vaginal Specula

Close analysis of an image coupled with documents and material culture draws attention to complex connections between political ideas and material realities. Zoltan Kluger's 1940 photograph of a woman manufacturing cow vaginal specula was framed by the campaign for Zionist settlement. The essay explains how relationships between people, animals, and technologies were formed and displayed in the context of settler colonialism in Palestine.

The Camera and the Railway: Framing the Portuguese Empire and Technological Landscapes in Angola and Mozambique, 1880s-1910s

Starting in the 1880s, Portugal invested in constructing railways in its African colonies, Angola and Mozambique. The aim was both to solidify Portuguese presence in territories disputed by other imperial nations and to facilitate exploration of the resources that imperial policymakers assumed existed in the colonial hinterland. To promote the perception that Portugal was an imperial nation, hundreds of photographs recorded the construction, inauguration, and operation of these new railways. Using a semiotics approach, this article analyzes photographs from various sources in Portugal to show how they helped create a novel technological landscape, underscoring the domestication of the territory and the civilization of its inhabitants by European rule, thus promoting it as a land of opportunity for European settlers. This focus adds to the debate claiming that photography was a crucial tool of empire serving European colonialism and imperialism in Africa.

A Historian of Technology Watches "The King, His Kitchen, and Other Stories"

Public representation of Indian cuisine is important for historians of technology. It shows how progress, modernity, and innovation pervade the general public's understanding of South Asian food history. Based on a popular documentary series, this review shows that technology is an elusive category when discussing food in relation to colonialism, religion, and national identity. Analyzing various dimensions of culinary history gives us an opportunity to rethink research and teaching methodologies by foregrounding indigenous technologies and the role of nonelite actors in shaping technological history and practices.

Recent insights into the mental health needs of two-spirit people

This paper provides a review of issues impacting the mental health of two-spirit people. Research has documented high rates of poverty, disparities in rates of harassment and violence, PTSD, anxiety, depression, suicidality, and substance use. Most research has focused on mental health disparities, often framing two-spirit people as affected by intersecting oppressions (i.e., racism or colonialism intersecting with homophobia or transphobia). Most research to date has been qualitative or has drawn on small convenience samples, limiting the generalizability of findings. Large-scale quantitative data is needed to advance understanding of how mental health disparities emerge and how protective factors, such as cultural engagement, improve well-being.

Combatting neo-Colonialism in Health Research: What can Aboriginal Health Research Ethics and Global Health Research Ethics Teach Each Other?

The ethics of research involving Aboriginal populations and low and middle-income country populations each developed out of a long history of exploitative research projects and partnerships. Commonalities and differences between the two fields have not yet been examined. This study undertook two independent literature searches for Aboriginal health research ethics and global health research ethics. Content analysis identified shared and differently emphasised ethical principles and concepts between the two fields. Shared ethical concepts like "benefit" and "capacity development" have been developed to guide collaborations in both Aboriginal health research and global health research. However, Aboriginal health research ethics gives much greater prominence to ethical principles that assist in decolonising research practice such as "self-determination", "community-control", and "community ownership". The paper argues that global health research ethics would benefit from giving greater emphasis to these principles to guide research practice, while justice as approached in global health research ethics may inform Aboriginal health research practice. With increasing attention being drawn to the need to decolonise global health research, the lessons Aboriginal health research ethics can offer may be especially timely.

Invited Commentary on "Combatting neo-Colonialism in Health Research: What can Aboriginal Health Research Ethics and Global Health Research Ethics Teach Each Other?"

Bridget Pratt and Adrian Harper ( 2021) conducted a comparison of articles identified through six electronic literature searches. Their aim was to "identify ethics literature… that discussed combatting neo-colonial models of research". They used manifest content analysis to compare the conceptual content of articles from the fields of global health (GH) and Australian Aboriginal health (AH). This innovative application of a literature review approach from literary and media studies, to health sciences in which literature reviews have traditionally focused on synthesizing evidence about intervention effectiveness, should be commended. It has potential to advance theoretical understandings of ethics in health research. However, I argue here that Pratt and Harper's (2021) search strategy has several weaknesses, which suggests that their results must be interpreted with caution.

A systematic review of trauma intervention adaptations for indigenous caregivers and children: Insights and implications for reciprocal collaboration

OBJECTIVE

Indigenous peoples are at elevated risk of exposure to trauma and related mental and physical health difficulties that are rooted in the ongoing experience of settler-colonialism. Historical and current trauma exposure feed intergenerational cycles that compromise the healthy development of Indigenous children.

METHOD

We conducted a systematic review of trauma-focused, caregiver-child interventions adapted for Indigenous communities.

RESULTS

We identified 13 articles each reporting a unique intervention. Six were implemented among American Indians, five among Indigenous Australians, one among First Nations and Metis peoples, and one among Māori peoples. Eight of the interventions used surface-structure cultural adaptations (i.e., replacing images or examples for greater cultural relevance), one used deep-structure cultural adaptations (i.e., replacing curriculum for greater cultural relevance), and four were culturally grounded interventions (i.e., developed by the Indigenous community in partnership with researchers).

CONCLUSIONS

The overall limited number of trauma-focused, caregiver-child interventions for Indigenous communities, and especially those representing reciprocal collaboration between researchers and the communities with whom they engage, is notable. We argue that such collaboration is critical to healing Indigenous traumatization from colonization and provide recommendations for future trauma intervention science. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Colonial Research on Public Hygiene and its Postcolonial Legacy: Focusing on Hygiene Laboratory in Colonial Korea

Previous studies on the history of Korean public health have shown that the public hygiene system in Korea under Japan's colonial rule relied heavily on the sanitary police, whose lack of expertise in hygiene reinforced the coercion and violence of the colonial public hygiene system. This view, however, has overlooked the existence and function of scientific knowledge, which underpinned the formulation and implementation of public hygiene policies. This paper explores the knowledge production in public hygiene by research institutes of Japan's colonial government in Korea, drawing on the Hygiene Laboratory as a case. The Hygiene Laboratory chiefly played three roles: first, providing advice on the sanitary police's crackdowns; second, quality inspection of food, beverage, and pharmaceuticals, and authorizing their production and distribution; third, investigating health resources such as conventional food ingredients, medicinal herbs, and drinking water to support the wartime public health policy of the colonial government in Korea. The third function in particular continued after the reorganization of the Hygiene Laboratory as the National Chemistry Laboratory in the postcolonial period. By tracing the Hygiene Laboratory's research activities, this paper highlights the complicated cooperation between expertise, practices, and institutions in the field of sanitation control in colonial Korea.

Digital Colonialism and the Fourth Industrial Revolution - Preventing Exploitative Bio-economies

As the traditional use of non-human genetic resources in research and development is increasingly ceded to computerised research activities, current frameworks for access and benefit-sharing face an impending identity crisis. The absence of international consensus on the regulation of digital sequence information presents a critical point of social division between the Global North and Global South, whereby a culture of "open data" promises immeasurable opportunity in high-income nations and threatens a wave of digital bio-piracy for vulnerable communities. This article critically evaluates these problems and considers solutions which draw on Indigenous Data Sovereignty principles. To do so, it uses the recent experience in Queensland to explore how the law might reconcile and balance these competing interests. Insofar as Queensland is one of the most mega biodiverse regions on earth, boasts a globally competitive life sciences sector, and has a vibrant and longstanding Indigenous population, it offers a unique case study.

Making the road caminando de otra manera: Co-constructing decolonial community psychologies from the Global South

Current discussion on coloniality dismantles structures embedded in neoliberal capitalism that maintain and perpetuate social pathologies. Theories and praxes emerging from Abya Yala (North, Central, and South America) provide academic and nonacademic contributions to co-construct community psychologies de otra manera (otherwise). These accountable ways of knowing and acting in cultural context and local place, become ways of making counterculture to inform decolonial community psychologies. The epistemologies of the Global South have produced invaluable teachings for transformative revisions of community psychology within frameworks that go beyond liberation and toward decoloniality. Activist women and decolonial feminists from the Global South, contest patriarchal rationality and universalism and co-construct new ways of being, thinking-feeling, sentipensar, and acting. Decolonial paradigms weave networks of solidarity with communities in their struggles to sustain Indigenous cosmovisions, delinking from western-centric ideologies that are not anthropocentric and promote sustainability, epistemic and ecological justice, and Sumak Kawsay/Buen Vivir (wellbeing) that includes the rights of the Earth. This paper deepens into decolonial community psychologies from Abya Yala that are making the road caminando (walking) de otra manera by applying methodologies of affective conviviality with communities, sentipensando, and co-authoring collective stories that weave pluriversal solidary networks within ecologies of praxes into colorful tapestries of liberation. These are the proposed coordinates to sketch pathways toward decoloniality.

From rhetorical "inclusion" toward decolonial futures: Building communities of resistance against structural violence

In this paper, we name and uplift the ways in which Miya community workers are building communities of resistance as ways to address the manifold colonial, structural (including state-sponsored), and epistemic violence in their lives. These active spaces of refusal and resistance constitute the grounds of our theorizing. Centering this theory in the flesh, we offer critical implications for decolonial liberatory praxis, specifically community-engaged praxis in solidarity with people's struggles. In doing so, we speak to questions such as: What are the range of ways in which Global South communities are coming together to tackle various forms of political, social, epistemic, and racial injustice? What are ways of doing, being, and knowing that are produced at the borders and liminal zones? What are the varied ways in which people understand and name solidarities, alliances, and relationalities in pursuit of justice? We engage with these questions from our radically rooted places in Miya people's struggles via storytelling that not only confronts the historical and ongoing oppression, but also upholds desire-Interweaving and honoring rage, grief, pain, creativity, love, and communality.

Dissident women's letter writing as decolonial plurilogues of relational solidarities for epistemic justice

Braiding our words, "dissi-dance," and desires, this article engages how various social actors, and communities-which we are a part of and belong to-challenge structural violence, oppression, inequity, and social, racial, and epistemic injustice. We thread these reflections through our written words, in subversive letters which we offer in the form of a written relational conversation among us: a plurilogue that emerges in response to our specific locations, commitments, and refusals, as well as dissents. Our stories and process of dissent within the various locations, relationships, and contexts that we occupy served as the yarn and needle to thread our stories, posed questions and reflections. Braiding, threading and weaving together, we animate deep decolonial inquiries within ourselves, and our different cultural contexts and countries. Refusing individualism-the illusions of objectivity as distance, the academic as expert, and the exile of affect and emotion on academic pages-we choose to occupy academic writing and ask: What if academic writing were stitched with blood and laughter, relationships and insights, rage and incites? What if, at the nexus of critical psychology and decolonizing feminism, we grew an "embodied praxis?" Unlike academic writing, traditionally designed to camouflage affect, connection, relationality and subjectivity, these letters are unapologetically saturated in care and wisdom toward a narrative-based embodied practice: decolonial plurilogues of relational solidarities for epistemic justice. Our plurilogue of dissent offers a view to advance community research and action with goals of liberation, decoloniality, and community wellness.

The Case for Decolonising the Dental Curricula in the UK

Students across disciplines in UK universities are demanding decolonisation of their education. These demands aim to resist the white European colonial endeavour that create racist inequalities. To address racial inequalities, the dental discipline has predominantly focused on diversity rather than decolonisation. By using two inter-related referents of decolonisation to dental caries and cosmetic dentistry, this article demonstrates the epistemic violence exerted through the objective hierarchised knowledge practices in dentistry. First, by starting from the position of racisms, empire and slavery, the enduring colonial patterns of power and hierarchies come into view. We see how knowledge production in dentistry has neglected the interconnected histories of colonialism, racial capitalism and patriarchy that continue to shape oral health inequalities and work towards promoting white supremacist beauty ideals. Moreover, the interconnected character of inequalities - race, class and gender - begin to emerge. Second, by proceeding from the place of colonialism, the limits of dental knowledge and the violence embedded in knowledge practices emerge. This highlights the need for new ways of knowing. To decolonise is to confront and weaken the dental discipline's entanglement with the enduring colonial patterns of power and hierarchies that are complicit in maintaining inequalities. Diversity without decolonisation will simply subsume marginalised voices into the existing hierarchised knowledge paradigm and continue to reproduce a hierarchised, unequal world. I argue that if dental schools want to address racial and intersectional inequalities, they need new transformative ways of learning and knowing to equip students to work towards social justice in the outside world.