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Jenkins AIC, Surachman A, Armendariz M. Where I'm Livin' and How I'm Feelin': Associations among community stress, gender, and mental-emotional health among Black Americans. Soc Sci Med 2024; 348:116763. [PMID: 38552549 DOI: 10.1016/j.socscimed.2024.116763] [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: 03/10/2023] [Revised: 01/12/2024] [Accepted: 03/05/2024] [Indexed: 04/29/2024]
Abstract
RATIONALE Structural racism is a primary avenue for the perpetuation of racial health disparities. For Black Americans, both historically and contemporarily, the neighborhood context serves as one of the most striking examples of structural racism, with stressful neighborhood contexts contributing to the well-documented inequalities in psychological functioning among this population. OBJECTIVE Thus, in this study, we adapted an intersectional-ecological framework to investigate the links between community stress and multiple dimensions of mental-emotional health for Black men and women. METHODS Drawing on cross-sectional data from 842 Black Americans from the Milwaukee area, we tested both objective (Area Deprivation Index; ADI) and subjective (perceived neighborhood disadvantage; PND) indicators of community stress as simultaneous predictors of negative and positive affect and the odds of psychological disorder (depression, anxiety) in multilevel models, examining gender differences in these linkages. RESULTS Results showed greater objective community stress was related to lower levels of negative affect for both men and women and lower odds of psychological disorder for women specifically. Greater subjective community stress was related to higher levels of negative affect and lower levels of positive affect for both men and women and to higher odds of psychological disorder for women specifically. CONCLUSIONS Findings highlight the complex intersectional nature of the links between community stress and Black Americans' mental-emotional health. Specifically, findings demonstrate the pernicious psychological effects of perceived community stress and allude to Black Americans', particularly women's, active resistance and resilience to objective disadvantage, potentially through investing in social relationships in their neighborhoods.
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Affiliation(s)
- August I C Jenkins
- Department of Human Development and Family Studies, University of Illinois-Urbana Champaign, Urbana, IL, USA.
| | - Agus Surachman
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Marina Armendariz
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
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2
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Mays EJ, Diggs S, Vesoulis ZA, Warner B. The Effects of Health Disparities on Neonatal Outcomes. Crit Care Nurs Clin North Am 2024; 36:11-22. [PMID: 38296368 DOI: 10.1016/j.cnc.2023.08.006] [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: 02/15/2024]
Abstract
The history of racism in the United States was established with slavery, and the carry-over effect continues to impact health care through structural and institutional racism. Racial segregation and redlining have impacted access to quality health care, thereby impacting prematurity and infant mortality rates. Health disparities also impact neonatal morbidities such as intraventricular hemorrhage and necrotizing enterocolitis and the family care experience including the establishment of breastfeeding and health care provider interactions.
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Affiliation(s)
- Erin J Mays
- St. Louis Children's Hospital NICU, 1 Childrens Place, St Louis, MO 63110, USA.
| | - Stephanie Diggs
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
| | - Zachary A Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
| | - Barbara Warner
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Childrens Place, #8116-NWT 8, St Louis, MO 63110, USA
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3
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Elman C, Cunningham SA, Howard VJ, Judd SE, Bennett AM, Dupre ME. Birth in the U.S. Plantation South and Racial Differences in all-cause mortality in later life. Soc Sci Med 2023; 335:116213. [PMID: 37717468 DOI: 10.1016/j.socscimed.2023.116213] [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: 02/04/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
The American South has been characterized as a Stroke Belt due to high cardiovascular mortality. We examine whether mortality rates and race differences in rates reflect birthplace exposure to Jim Crow-era inequalities associated with the Plantation South. The plantation mode of agricultural production was widespread through the 1950s when older adults of today, if exposed, were children. We use proportional hazards models to estimate all-cause mortality in Non-Hispanic Black and White birth cohorts (1920-1954) in a sample (N = 21,941) drawn from REasons for Geographic and Racial Differences in Stroke (REGARDS), a national study designed to investigate Stroke Belt risk. We link REGARDS data to two U.S. Plantation Censuses (1916, 1948) to develop county-level measures that capture the geographic overlap between the Stroke Belt, two subregions of the Plantation South, and a non-Plantation South subregion. Additionally, we examine the life course timing of geographic exposure: at birth, adulthood (survey enrollment baseline), neither, or both portions of life. We find mortality hazard rates higher for Black compared to White participants, regardless of birthplace, and for the southern-born compared to those not southern-born, regardless of race. Race-specific models adjusting for adult Stroke Belt residence find birthplace-mortality associations fully attenuated among White-except in one of two Plantation South subregions-but not among Black participants. Mortality hazard rates are highest among Black and White participants born in this one Plantation South subregion. The Black-White mortality differential is largest in this birthplace subregion as well. In this subregion, the legacy of pre-Civil War plantation production under enslavement was followed by high-productivity plantation farming under the southern Sharecropping System.
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Affiliation(s)
- Cheryl Elman
- Social Science Research Institute, Duke University, Durham, NC, 27708, USA.
| | | | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama-Birmingham, USA.
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Aleena M Bennett
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA; Department of Sociology, Duke University, Durham, NC 27710, USA.
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Needham BL, Ali T, Allgood KL, Ro A, Hirschtick JL, Fleischer NL. Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01381-9. [PMID: 35994173 PMCID: PMC9395863 DOI: 10.1007/s40615-022-01381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.
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Affiliation(s)
- Belinda L Needham
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Talha Ali
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kristi L Allgood
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California-Irvine Program in Public Health, Irvine, CA, USA
| | - Jana L Hirschtick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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5
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Michaels EK, Canchola AJ, Beyer KMM, Zhou Y, Shariff-Marco S, Gomez SL. Home mortgage discrimination and incidence of triple-negative and Luminal A breast cancer among non-Hispanic Black and non-Hispanic White females in California, 2006-2015. Cancer Causes Control 2022; 33:727-735. [PMID: 35113296 PMCID: PMC9010391 DOI: 10.1007/s10552-022-01557-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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022]
Abstract
Purpose In the United States, Black females are burdened by more aggressive subtypes and increased mortality from breast cancer compared to non-Hispanic (NH) White females. Institutional racism may contribute to these inequities. We aimed to characterize the association between home mortgage discrimination, a novel measure of institutional racism, and incidence of Luminal A and triple-negative breast cancer (TNBC) subtypes among NH Black and NH White females in California metropolitan areas. Methods We merged data from the California Cancer Registry on females aged 20 + diagnosed with primary invasive breast cancer between 2006 and 2015 with a census tract-level index of home mortgage lending bias measuring the odds of mortgage loan denial for Black versus White applicants, generated from the 2007–2013 Home Mortgage Disclosure Act database. Poisson regression estimated cross-sectional associations of census tract-level racial bias in mortgage lending with race/ethnicity- and Luminal A and TNBC-specific incidence rate ratios, adjusting for neighborhood confounders. Results We identified n = 102,853 cases of Luminal A and n = 15,528 cases of TNBC over the study period. Compared to NH Whites, NH Black females had higher rates of TNBC, lower rates of Luminal A breast cancer, and lived in census tracts with less racial bias in home mortgage lending. There was no evidence of association between neighborhood racial bias in mortgage lending at the time of diagnosis and either subtype among either racial/ethnic group. Conclusion Future research should incorporate residential history data with measures of institutional racism to improve estimation and inform policy interventions.
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Affiliation(s)
- Eli K Michaels
- Division of Epidemiology, Berkeley School of Public Health, University of California, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Greater Bay Area Cancer Registry, San Francisco, CA, USA
| | - Kirsten M M Beyer
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yuhong Zhou
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Greater Bay Area Cancer Registry, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Greater Bay Area Cancer Registry, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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6
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Acosta DA, Skorton DJ. Making 'Good Trouble': Time for Organized Medicine to Call for Racial Justice in Medical Education and Health Care. Am J Med 2021; 134:1203-9. [PMID: 34062146 DOI: 10.1016/j.amjmed.2021.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022]
Abstract
"Never, ever be afraid to make some noise and get in good trouble, necessary trouble." - Representative John Lewis It is time now for organized medicine to make "good trouble" and call for racial justice in medical education and health care. It is also time to have an honest confrontation with reality in order to bring about racial healing and become anti-racist organizations. Using a racial justice framework, 4 elements described here can chart our course. Organized medicine must come together in solidarity to make "good trouble" and fight collectively for racial justice so that every community we serve can achieve their full health potential and achieve racial equity-that is, giving people what they need to enjoy full, healthy lives regardless of race.
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Pimentel Walker AP, Sanga N, Benson OG, Yoshihama M. Risk Communication and Institutional Racism: The Protective Health Effect of Refugee-Led Community Organizations. Health Secur 2021; 19:S89-S94. [PMID: 34096802 DOI: 10.1089/hs.2021.0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ana Paula Pimentel Walker
- Ana Paula Pimentel Walker, PhD, MURP, MA, JD, is an Assistant Professor and Naganika Sanga, MSc, is a PhD Candidate, Taubman College of Architecture and Urban Planning; Odessa Gonzalez Benson, PhD, MSW, is an Assistant Professor, School of Social Work and Detroit School of Urban Studies; and Mieko Yoshihama, PhD, LMSW, ACSW, is a Professor, School of Social Work; all at the University of Michigan, Ann Arbor, MI
| | - Naganika Sanga
- Ana Paula Pimentel Walker, PhD, MURP, MA, JD, is an Assistant Professor and Naganika Sanga, MSc, is a PhD Candidate, Taubman College of Architecture and Urban Planning; Odessa Gonzalez Benson, PhD, MSW, is an Assistant Professor, School of Social Work and Detroit School of Urban Studies; and Mieko Yoshihama, PhD, LMSW, ACSW, is a Professor, School of Social Work; all at the University of Michigan, Ann Arbor, MI
| | - Odessa Gonzalez Benson
- Ana Paula Pimentel Walker, PhD, MURP, MA, JD, is an Assistant Professor and Naganika Sanga, MSc, is a PhD Candidate, Taubman College of Architecture and Urban Planning; Odessa Gonzalez Benson, PhD, MSW, is an Assistant Professor, School of Social Work and Detroit School of Urban Studies; and Mieko Yoshihama, PhD, LMSW, ACSW, is a Professor, School of Social Work; all at the University of Michigan, Ann Arbor, MI
| | - Mieko Yoshihama
- Ana Paula Pimentel Walker, PhD, MURP, MA, JD, is an Assistant Professor and Naganika Sanga, MSc, is a PhD Candidate, Taubman College of Architecture and Urban Planning; Odessa Gonzalez Benson, PhD, MSW, is an Assistant Professor, School of Social Work and Detroit School of Urban Studies; and Mieko Yoshihama, PhD, LMSW, ACSW, is a Professor, School of Social Work; all at the University of Michigan, Ann Arbor, MI
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8
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Parks N, Kirby B. The Function of the Police Force: A Behavior-Analytic Review of the History of How Policing in America Came to Be. Behav Anal Pract 2021; 15:1205-1212. [PMID: 36605154 PMCID: PMC9744977 DOI: 10.1007/s40617-021-00568-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 01/07/2023] Open
Abstract
The racial differentiation of policing in America has been widely researched and documented (Walker & Katz, 2008; Wilson & Kelling, 1982). Although these discrepancies are largely documented, there have been few changes within the policies, procedures and laws governing police officers. The results of this are two-fold. First, it has led to the continuation of individual acts of racism of police officers across the country. Second, it has upheld the systemic racism that results in the discrepancies in outcomes between Black people and white people, making it more likely that Black individuals will interact with police officers and have more negative outcomes as a result of these interactions. The reasons for this include lack of data regarding the race of the police officers involved in fatal officer-involved shootings, reliance on self-report of officers regarding instances of excessive force, and lack of accountability of individuals and departments alike. These issues are symptoms of the larger problems of individual and institutionalized racism that not only increases racism within those within the police force, but also increases the likeliness that any police officer will engage in violence against a person of color. To develop effective interventions that will change policing behaviors and the racism observed within the police force, one must first understand the historical development and function of policing and its intersection with both individual and institutional racism. This paper will provide a clear definition of racism followed by a function-based behavior analytic examination of the historical development of policing in America.
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Affiliation(s)
- Natalie Parks
- Behavior Leader, Inc., 1429 Schoal Creek Dr, St. Peters, MO 63366 USA ,TeamABA LLC, Rockville, MD USA ,Applied Behavior Analysis Program, School of Social Work, Saint Louis University, St. Louis, MO USA
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9
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Mahabir DF, O'Campo P, Lofters A, Shankardass K, Salmon C, Muntaner C. Experiences of everyday racism in Toronto's health care system: a concept mapping study. Int J Equity Health 2021; 20:74. [PMID: 33691682 PMCID: PMC7943708 DOI: 10.1186/s12939-021-01410-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/14/2021] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto's health care system. METHODS This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. RESULTS Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: 'Racial/ethnic and class discrimination', 'Dehumanizing the patient', 'Negligent communication', 'Professional misconduct', and 'Unequal access to health and health services'. Two distinct conceptual regions were identified: 'Viewed as inferior' and 'Unequal medical access'. From the rating activity, racialized health care users reported 'race'/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include 'when the health care provider does not complete a proper assessment', 'when the patient's symptoms are ignored or not taken seriously', 'and 'when the health care provider belittles or talks down to the patient'. CONCLUSIONS Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.
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Affiliation(s)
- Deb Finn Mahabir
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada.
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
| | - Aisha Lofters
- Women's College Hospital, 76 Grenville St., Toronto, M5S 1B2, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario, N2L 3C5, Canada
| | - Christina Salmon
- Knowledge Translation Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Carles Muntaner
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M7, Canada
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Wilson YY. Bioethics, Race, and Contempt. J Bioeth Inq 2021; 18:13-22. [PMID: 33415595 PMCID: PMC7790350 DOI: 10.1007/s11673-020-10070-3] [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: 07/23/2020] [Accepted: 11/24/2020] [Indexed: 05/17/2023]
Abstract
The U.S. healthcare system has a long history of displaying racist contempt toward Black people. From medical schools' use of enslaved bodies as cadavers to the widespread hospital practice of reporting suspected drug users who seek medical help to the police, the institutional practices and policies that have shaped U.S. healthcare systems as we know them cannot be minimized as coincidence. Rather, the very foundations of medical discovery, diagnosis, and treatment are built on racist contempt for Black people and have become self-perpetuating. Yet, I argue that bioethics and bioethicists have a role in combatting racism. However, in order to do so, bioethicists have to understand the workings of contemptuous racism and how that particular form of racism manifests in U.S. healthcare institutions. Insofar as justice is part of the core mission of bioethics, then antiracism must also be part of the mission of bioethics.
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Elias A, Paradies Y. The Costs of Institutional Racism and its Ethical Implications for Healthcare. J Bioeth Inq 2021; 18:45-58. [PMID: 33387263 PMCID: PMC7778398 DOI: 10.1007/s11673-020-10073-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 02/18/2020] [Accepted: 11/30/2020] [Indexed: 05/13/2023]
Abstract
This paper discusses the ethical implications of racism and some of the various costs associated with racism occurring at the institutional level. We argue that, in many ways, the laws, social structures, and institutions in Western society have operated to perpetuate the continuation of historical legacies of racial inequities with or without the intention of individuals and groups in society. By merely maintaining existing structures, laws, and social norms, society can impose social, economic, and health costs on racial minorities that impinge on their well-being and human dignity. Based on a review of multidisciplinary research on racism, particularly focusing on healthcare, we demonstrate how institutional racism leads to social and economic inequalities in society. By positing institutional racism as the inherent cause of avoidable disparities in healthcare, this paper draws attention to the ethical significance of racism, which remains a relatively neglected issue in bioethics research.
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Affiliation(s)
- Amanuel Elias
- Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Yin Paradies
- Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
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Lim GHT, Sibanda Z, Erhabor J, Bandyopadhyay S. Students' perceptions on race in medical education and healthcare. Perspect Med Educ 2021; 10:130-134. [PMID: 33415681 PMCID: PMC7790028 DOI: 10.1007/s40037-020-00645-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/12/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 05/23/2023]
Abstract
Major racial disparities continue to exist in our healthcare education, from the underrepresentation of ethnic minorities when teaching about clinical signs to health management in primary and secondary care. A multi-centre group of students discuss what needs to change in medical education to cultivate physicians who are better prepared to care for patients of all backgrounds. We argue that the accurate portrayal of race in medical education is a vital step towards educating medical students to consider alternative explanations to biology when considering health inequities.
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Affiliation(s)
- Guan Hui Tricia Lim
- University College London Medical School, University College London, London, UK
| | | | | | - Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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Mukandi B. Being Seen by the Doctor: A Meditation on Power, Institutional Racism, and Medical Ethics. J Bioeth Inq 2021; 18:33-44. [PMID: 33449314 DOI: 10.1007/s11673-021-10087-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/27/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
The following pages sketch the outlines of "a Canaanite reading" of the health system. Beginning with the Black person-African, Afro-diasporic, Aboriginal, and Torres Strait Islander-who is seen by a health professional, the functions and effects of the racializing gaze are examined. I wrestle with Al Saji's understanding of "colonial disregard," Whittaker's insights into the extractive disposition of settler institutions vis-à-vis Indigenous peoples, and Saidiya Hartman and Fred Moten's struggle with the spectacular. This leads me to conclude that the situation of the Black within the health system is a tragic one. The prescription for the path out of this tragedy that I settle on, responding to Okiji's opening call, is found in Vernon Ah Kee's "Unwritten" series.
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Affiliation(s)
- Bryan Mukandi
- St Lucia Clinical Unit, Faculty of Medicine, The University of Queensland, Room 415, Building 69, St Lucia, Brisbane, QLD, 4072, Australia.
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Baptist AP, Lowe D, Sarsour N, Jaffee H, Eftekhari S, Carpenter LM, Bansal P. Asthma Disparities During the COVID-19 Pandemic: A Survey of Patients and Physicians. J Allergy Clin Immunol Pract 2020; 8:3371-3377.e1. [PMID: 32980585 DOI: 10.1016/j.jaip.2020.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has demonstrated significantly worse outcomes for minority (black and Hispanic) individuals. Understanding the reasons for COVID-19–related disparities among patients with asthma has important public health implications. Objective To determine factors contributing to health disparities in those with asthma during the COVID-19 pandemic. Methods An anonymous survey was sent through social media to adult patients with asthma, and a separate survey was sent to physicians who provide asthma care. The patient survey addressed demographic information including socioeconomic status, asthma control, and attitudes/health behaviors during COVID-19. Results A total of 1171 patients (10.1% minority individuals) and 225 physicians completed the survey. Minority patients were more likely to have been affected by COVID-19 (eg, became unemployed, lived in a community with high COVID-19 cases). They had worse asthma control (increased emergency visits for asthma, lower Asthma Control Test score), were more likely to live in urban areas, and had a lower household income. Initial differences in attitudes and health behaviors disappeared after controlling for baseline demographic features. Institutional racism was demonstrated by findings that minority individuals were less likely to have a primary care physician, had more trouble affording asthma medications due to COVID-19, and were more likely to have lost health insurance because of COVID-19, and that 25% of physicians found it more challenging to care for black individuals with asthma during COVID-19. Conclusions Differences in socioeconomic status and the effects of institutional racism, but not health behaviors, sources of information, or attitudes, are playing a role in disparities seen for patients with asthma during COVID-19.
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Avant ND, Gillespie GL. Pushing for health equity through structural competency and implicit bias education: A qualitative evaluation of a racial/ethnic health disparities elective course for pharmacy learners. Curr Pharm Teach Learn 2019; 11:382-393. [PMID: 31040014 DOI: 10.1016/j.cptl.2019.01.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 05/17/2018] [Revised: 10/11/2018] [Accepted: 01/05/2019] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND PURPOSE Health equity attainment requires dismantling implicit bias and structural racism. Mitigating bias in clinical interventions and implementing structural interventions to impact where people live, work, play, and eat fosters optimal patient outcomes. Consequently, pharmacy students need exposure to these concepts. The objective of this project was to evaluate an elective course focused on exposing students to the root causes of health disparities, contemporary factors that perpetuate disparities, and evidence-based policies to reduce health disparities. EDUCATIONAL ACTIVITY AND SETTING This three-credit course emphasized critical thinking, robust discussions, and learning challenging constructs through self-discovery. Nine second-year and third-year learners were assessed by short-answer exams, learning management system discussion threads, weekly reflections, participation, and a class project. A qualitative descriptive design was used for this study. Weekly reflections were subjected to thematic analysis using a constant comparative analysis method to generate themes. FINDINGS Five themes were derived from the data underlying strategies to facilitate this course: (1) create and maintain a welcoming and inclusive learning environment; (2) utilize experiential learning for personal awareness development and knowledge expansion; (3) incorporate intergroup diversity to empower learners to create change; (4) anticipate and acknowledge emotions to facilitate learning; and (5) provide students with an opportunity to complete a final self-reflection paper. SUMMARY This course provided pharmacy learners with unique, differential skill sets and knowledge, potentially adding depth to their careers and impacting the way they will practice pharmacy.
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Affiliation(s)
- Nicole D Avant
- University of Cincinnati Experience-Based Learning and Career Education, Cincinnati, OH, United States.
| | - Gordon L Gillespie
- University of Cincinnati College of Nursing, Cincinnati, OH, United States.
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Cykert S, Eng E, Manning MA, Robertson LB, Heron DE, Jones NS, Schaal JC, Lightfoot A, Zhou H, Yongue C, Gizlice Z. A Multi-faceted Intervention Aimed at Black-White Disparities in the Treatment of Early Stage Cancers: The ACCURE Pragmatic Quality Improvement trial. J Natl Med Assoc 2019; 112:468-477. [PMID: 30928088 DOI: 10.1016/j.jnma.2019.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reports continue to show that Blacks with curable lung or breast cancer complete treatment less often than similar Whites contributing to worse survival. ACCURE is an intervention trial designed to address this problem. PATIENTS AND METHODS A pragmatic, quality improvement trial comparing an intervention group to retrospective and concurrent controls. Patients with early stage breast or lung cancer aged 18 to 85 were enrolled (N = 302) at 2 cancer centers between April 2013 and March 2015 for the intervention component. Data from patients seen between January 2007 and December 2012 with these diagnoses were obtained to establish control completion rates. Concurrent data for non-study patients were used to identify secular trends. The intervention included: a real time registry derived from electronic health records of participants to signal missed appointments or unmet care milestones, a navigator, and clinical feedback. The primary outcome was "Treatment Complete", a composite variable representing completion of surgery, recommended radiation and chemotherapy for each patient. RESULTS The mean age in the intervention group was 63.1 years; 37.1% of patients were Black. Treatment completion in retrospective and concurrent controls showed significant Black-White differences (Blacks (B) 79.8% vs. Whites (W) 87.3%, p < 0.001; 83.1% B vs. 90.1% W, p < 0.001, respectively). The disparity lessened within the intervention (B 88.4% and W 89.5%, p = 0.77). Multivariate analyses confirmed disparities reduction. OR for Black-White disparity within the intervention was 0.98 (95% CI 0.46-2.1); Black completion in the intervention compared favorably to Whites in retrospective (OR 1.6; 95% CI 0.90-2.9) and concurrent (OR 1.1; 95% CI 0.59-2.0) controls. CONCLUSION A real time registry combined with feedback and navigation improved completion of treatment for all breast and lung cancer patients and narrowed disparities. Similar multi-faceted interventions could mitigate disparities in the treatment of other cancers and chronic conditions.
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Affiliation(s)
- Samuel Cykert
- The University of North Carolina School of Medicine, 145 N Medical Drive CB# 7165, Chapel Hill, NC 27599, USA.
| | - Eugenia Eng
- Department of Health Behavior, The Gilling's School of Global Public Health, 360 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
| | - Matthew A Manning
- Cone Health Cancer Center, 501 N Elam Ave, Greensboro, NC 27403, USA
| | - Linda B Robertson
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine 5150 Centre Avenue POB2 Cancer Pavilion, Room 438 Pittsburgh, PA 15232, USA
| | - Dwight E Heron
- Department of Radiation Oncology UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine5230 Centre Ave. Pittsburgh, PA 15232, USA
| | - Nora S Jones
- The Partnership Project, 301 S. Elm Street, Suite 414 Greensboro, NC 27401, USA
| | - Jennifer C Schaal
- The Partnership Project, 301 S. Elm Street, Suite 414 Greensboro, NC 27401, USA
| | - Alexandra Lightfoot
- Department of Health Behavior, The Gilling's School of Global Public Health 1700 Martin Luther King, Jr. Boulevard CB #7426, Chapel Hill, NC 27599, USA
| | - Haibo Zhou
- Department of Biostatistics, The Gilling's School of Global Public Health, The University of North Carolina at Chapel Hill, 3104C McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC 27599, USA
| | - Christina Yongue
- Department of Public Health Education, University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC 27402-6170, USA
| | - Ziya Gizlice
- Biostatistical Support Unit, The Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill NC 27599, USA
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Came H. Sites of institutional racism in public health policy making in New Zealand. Soc Sci Med 2014; 106:214-20. [PMID: 24583568 DOI: 10.1016/j.socscimed.2014.01.055] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 11/04/2013] [Accepted: 01/31/2014] [Indexed: 11/21/2022]
Abstract
Although New Zealanders have historically prided ourselves on being a country where everyone has a 'fair go', the systemic and longstanding existence of health inequities between Māori and non-Māori suggests something isn't working. This paper informed by critical race theory, asks the reader to consider the counter narrative viewpoints of Māori health leaders; that suggest institutional racism has permeated public health policy making in New Zealand and is a contributor to health inequities alongside colonisation and uneven access to the determinants of health. Using a mixed methods approach and critical anti-racism scholarship this paper identifies five specific sites of institutional racism. These sites are: majoritarian decision making, the misuse of evidence, deficiencies in both cultural competencies and consultation processes and the impact of Crown filters. These findings suggest the failure of quality assurance systems, existing anti-racism initiatives and health sector leadership to detect and eliminate racism. The author calls for institutional racism to be urgently addressed within New Zealand and this paper serves as a reminder to policy makers operating within other colonial contexts to be vigilant for such racism.
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