DiversityNursing Blog

The Impact of Racism on Public Health

Posted by Nursing@USC Staff

Thu, Dec 01, 2016 @ 11:05 AM

53fc66d80604e.jpgThough discrimination exists in many forms, racial discrimination brings a unique set of implications that threaten the mental and physical health of patients and acts as a barrier to seeking care from medical professionals. Eliminating racism, therefore, is not just a concern for civil rights activists, but also for medical professionals.

Whether it’s the mere anticipation of discrimination, or violence as a manifestation of prejudice, racism has negative impacts on the mental and physical health of its victims, including “increased stress, depression, high blood pressure, cardiovascular disease, breast cancer, and mortality.” A study in the American Journal of Public Health found that perceived discrimination influences lifestyle decisions like overeating, internalizing aggression, and developing poor coping strategies that impact long-term health.

These lifestyle choices are part of a vicious cycle that can be influenced by social determinants of health, which are “conditions in one's environment — where people are born, live, work, learn, play, and worship — that have a huge impact on how healthy certain individuals and communities are or are not,” according to Healthy People 2020.

One study found that racism experienced by minority communities increased vulnerabilities to social and environmental factors that contribute to health, like access to health care and income level. The National Association of Social Workers found that these social determinants of health also include “poor health and health services, inadequate mental health services, low wages, high unemployment and underemployment, overrepresentation in prior populations, substandard housing, high school dropout rates, decreased access to higher education opportunities and other institutional maladies.”

In addition to affecting long-term health, social determinants can be barriers in seeking quality health care, and can lead to poorer outcomes after treatment. Many minorities cite racial discrimination as a primary barrier to seeking health care — particularly treatment for mental health issues. In a survey of adults who experienced an unmet need for mental health treatment in the past year, respondents across all racial group cited discrimination as a primary barrier to seeking treatment. Nearly a quarter of respondents said they anticipated negative stigmas surrounding treatment to impact relationships and employment circumstances.

As key resources in patients’ access to quality primary care, health care professionals, like Family Nurse Practitioners, must understand these implications of racial discrimination among other social determinants, and mitigate harmful, pervasive effects through opportunities like these:

  • Advocating for awareness: Nurses, as they interact with patients closely and regularly, can be advocates for patient needs, as they help identify key social determinants that leave patients vulnerable to the systemic racism. Public health advocates can also reach out to minority communities to help them understand the importance of physical and mental health.
  • Treating mental health as primary health: Integrating behavioral health care screening and treatment can help patients make better use of clinic visits and resources they might not otherwise be able to access. This increased access can reduce health disparities and increase effectiveness of treatment.
  • Promoting cultural competency: A diverse nursing staff can improve cultural competency — being conscious of social and cultural differences — and increase quality of care to underserved groups. By valuing diversity, nurses and other health professionals can take pivotal steps in ensuring access to care for an increasingly diverse patient population.

An integrated approach to mitigating discrimination can address both the causes and effects of its impact on accessing quality care. This means nurses should work together with other health practitioners, social workers and educators to understand and identify at-risk patients and appropriate strategies. Above all else, the goal is to help patients feel safe, understood and heard when seeking health care or treatment.

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Topics: racism, public health

Is Discrimination Bad for Your Health?

Posted by Nursing@USC Staff

Wed, Nov 16, 2016 @ 10:42 AM

discrimination_bad_for_health.jpgDiscrimination in the United States has historically cut a wide swath across a number of demographics, including race, gender, ethnicity, sexual orientation, age, disability and religion. Despite a major cultural and political shift through the implementation of the long overdue Civil Rights Act of 1964 and other efforts at fighting discrimination, we still see it today — particularly in the form of modern-day racism. According to the National Association of Social Workers (NASW), racism is “the ideology or practice through demonstrated power of perceiving the superiority of one group over others by reason of race, color, ethnicity, or cultural heritage.”

Though all discrimination is harmful, an examination of the effects of racism — the most commonly studied and cited form of discrimination — reveals implications for the mental and physical health of individuals and communities that can be applied to other types of discrimination. Racism, therefore, is not just a civil rights issue, but also a public health concern.

As key figures in addressing such consequences, health care professionals, such as Family Nurse Practitioners, must recognize the health implications involved and know the steps they can take to help stop discrimination and mitigate its negative outcomes.

Impact of Discrimination on Health

The NASW says racism results in “poor health and health services, inadequate mental health services, low wages, high unemployment and underemployment, overrepresentation in prior populations, substandard housing, high school dropout rates, decreased access to higher education opportunities and other institutional maladies.” Some of these factors can be classified as social determinants of health (SDOH), which have a major influence on health outcomes. According to Healthy People 2020, SDOHs are defined as “conditions in one's environment — where people are born, live, work, learn, play, and worship — that have a huge impact on how healthy certain individuals and communities are or are not.” 

In one study of the health effects of discrimination on black and white communities, SDOHs were defined as a critical factor, since populations that lack appropriate resources are affected the most: “On average, black adults typically experience more health risks in their social and personal environment than white adults (including higher poverty and lower-quality medical insurance), they may be especially vulnerable to negative health effects as a result of racial discrimination." 

There are a number of physical and mental health effects related to discrimination, including increased stress, depression, high blood pressure, cardiovascular disease, breast cancer, and mortality. According to a study published in the American Journal of Public Health, “Merely anticipating prejudice leads to both psychological and cardiovascular stress responses. These results are consistent with the conceptualization of anticipated discrimination as a stressor and suggest that vigilance for prejudice may be a contributing factor to racial/ethnic health disparities in the United States.” Additionally, discrimination has been found to impact lifestyle decisions that affect health long after the experience is over.

Communities at highest risk for discrimination are the same communities that are perpetually marginalized by the negative impact of SDOHs. In a 2013 Atlantic article titled “How Racism is Bad for Our Bodies,” writer Jason Silverstein points out that the cyclical effect of discrimination on health is what epidemiologist Nancy Krieger refers to as “embodied inequality,” which creates poor health outcomes that are often passed down through generations. This results in a vicious cycle where the sickest and poorest among us are more likely to remain sick and poor.

Solutions and Strategies

Health care professionals and policymakers can play a key role in curbing discrimination by supporting legislation and policies that address these issues, such as the U.S. Department of Health and Human Services (HHS) Action Plan to Reduce Racial and Ethnic Health Disparities. The U.S. Office of Minority Healthprovides a summary of this action plan, and serves as a “one-stop source for minority health literature, research and referrals for consumers, community organizations and health professionals.” Through use of such resources, and appropriate support networks, victims of discrimination can find the support they need to exercise their rights and end the various forms of discrimination they may be vulnerable to.

Additionally, it is essential that health care professionals work to better recognize the effects of discrimination by taking SDOHs into consideration as part of their approach to care, understanding which populationsmay be at greater risk for discrimination, screening for negative health outcomes that may be a direct result, and ensuring that discrimination is not occurring within their own practice settings. Providing access to necessary resources and additional support for these patients is critical.

Implications for FNPs

Family Nurse Practitioners are integral to comprehensive care for all patients, and serve as a key resource for those most vulnerable to discrimination’s negative effects on health. “At the University of Southern California Department of Nursing in the School of Social Work, we are teaching our students about the central importance of social determinants of health, with racism being a key determinant, in the health of individuals and families,” said Ellen Olshansky, Professor and Chair of Nursing at USC School of Social Work. Although the policy statement by the American Nurses Association, “Discrimination and Racism in Health Care,” dates to 1998, its principles are just as relevant today, addressing both the health care environment and the patients who are served:

ANA believes it is critically important for Americans to come to a shared understanding of the negative consequences of discrimination and racism which still pervades our society and be willing to take individual as well as collective actions to bring America closer to our ideal of equality and justice. Equality and justice must also extend to other minorities such as the aged and disabled. Health care that is individualized to the health practices and specific needs of each person and/or population group is vital to maintain and improve the health of all Americans.
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Topics: racism, Race-Discrimination, public health

The complexities of race and racism in healthcare

Posted by Alycia Sullivan

Wed, Jan 29, 2014 @ 02:00 PM

His tattoo read "White Power" in 3-inch calligraphic letters. Emblazoned across his chest for allPAUL LACHINE to see, the ink wasn't something I would normally have missed during my physical exam. In this case, though, his tattoo had been hidden by a bulky neck collar and the array of lines and tubes that come with being a comatose trauma patient.

Only on my third day of being this man's physician did I find myself confronted with the aggressive declaration.

I found myself wondering whether he would want me, a black woman, to be his doctor.

There was no dissatisfaction apparent in many interactions with his family, but they were somewhat distant. Was the distance born of shock over a relative's sudden, life-threatening injury? Or of discomfort with me?

As physicians, we take note of patients' demographics in part because it helps with diagnosis: Black patient with anemia? Think sickle cell. Greek patient with anemia? Think of the blood disorder thalassemia.

The Hippocratic Oath cautions us against refusing to treat patients based on these characteristics.

Doctors aren't supposed to be racist. We tend to think of ourselves not so much as people with specific identities, but more as disembodied brains and skilled hands ready to go about the work of healing.

My patient's tattoo was an unwelcome reminder that the skin I inhabit can't be checked at the hospital door.

Race is sometimes overtly discussed in health-care encounters, but usually because a patient expresses a preference for a clinician of a particular racial or ethnic background.

It is rarer for a patient to say that he or she does not want to be cared for by certain people. A few high-profile cases in the last several years involved white patients refusing care by black nurses.

While these requests are perhaps reprehensible, more controversial was the facilities' responses - in all the cases, the patients' wishes were honored. Some of the affected nurses successfully sued their employers for accommodating the racist requests, which had essentially allowed prejudice to affect their working conditions.

How should health-care providers respond to a racist, sexist, or bigoted patient? Sachin Jain is a physician of Indian descent who wrote about his experience with a patient who yelled at him to go back to India. Jain chose to yell back, a decision he later questioned.

In the New York Times' "Well" blog, Asian physician Pauline Chen revisits the Jain story and describes her own encounter with a combative swastika-decorated patient in the emergency room. She didn't wait for the patient to express his discomfort with her - she instead chose to remove herself from his presence as soon as it was clinically appropriate.

I explored the topic of racist patients in a piece for the Journal of the American Medical Association this month. I argued that I wholeheartedly reject racism and race-based prejudice, but I also recognize that patients have the right to choose their care providers and to have some control over the conditions of their care.

The therapeutic relationship between doctors and nurses and their patients is founded on mutual trust and respect; when these are missing, communication suffers and care plans fall apart. If I care for a patient who does not want me as a doctor, I have done that patient a disservice.

The responses I received to the JAMA piece were mixed. Many people thanked me for tackling a difficult issue for minority clinicians.

A few, though, criticized me for condoning inappropriate behavior. One person suggested that the clinical encounter could become a "teachable moment" in which I could fight prejudicial tendencies.

As much as I want to stamp out racism, I continue to believe that a one-on-one clinical encounter is the wrong venue to address this issue, for at least two reasons.

First, behavior is difficult to change. If I cannot persuade a patient to stop smoking or to eat more healthily, how will I convince them to shed long-held beliefs?

Second, asking for someone's respect when they are not inclined to give it is an exercise in futility. I learned that in high school.

I do think that there is a role for hospitals and other institutions to express that racism is not tolerated in clinical encounters. Similar to the "no smoking" signs that adorn healthcare facilities, I can imagine a "no offensive language or pre-judging" sign.

Health-care providers are under no obligation to treat patients in nonemergency situations, so perhaps instead of merely changing their clinicians, we should be referring bigoted patients to facilities willing to care for them.

That wouldn't have helped my trauma patient, though. He was at the brink of death, unable to declare his preference for care providers one way or the other.

As a result, he received superior care from people that he might have deemed inferior. Maybe the fact that we saved his life will serve as the ultimate teachable moment.

Source: Philly.com

 

Topics: racism, implications, bigoted, what to do, healthcare

Dealing with racism in the workplace

Posted by Alycia Sullivan

Fri, Aug 02, 2013 @ 12:49 PM

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One of our fellow nurses needs some help dealing with racism in the workplace. Do you have any advice or experiences that will help her out?:

"How do you deal with racist comments directed toward yourself from patients? I've experienced racist attitudes before, but never verbalized comments in a derogatory manner from a patient until this week. Naturally I felt very down for a few hours afterward and I continue to think about it. It wasn't the negativity toward me per se, it was the thought that there could be more people out there thinking/feeling the same animosity toward me over something I cannot control, my phenotype. I take pride in my cultural heritage and wonder how anyone cannot see the beauty in diversity. I also thought that because they are sick they let their true thoughts out. Could any healthy person walking around be feeling the same thing but be inhibited from making it known? Then I thought of the people who could be dealing with this on a regular basis. How do you deal?"


Topics: help, racism, nurses, coping

Ethnically Diverse Areas Are Happier, Healthier And Less Discriminatory, Study Finds

Posted by Alycia Sullivan

Mon, Jun 03, 2013 @ 09:59 AM

If you live a neighbourhood which is ethnically diverse, you're more likely to be healthier and less likely to experience racial discrimination, a new study has found.

Researchers at the University of Manchester say diversity is associated with higher social cohesion and a greater tolerance of each other's differences.

They also found that someone from an ethnic minority is less likely to report racial discrimination in an ethnically diverse neighbourhood.

multicultural

And that a neighbourhood's high level of deprivation - rather than diversity - is linked with poor physical and mental health, low social cohesion and race discrimination.

The findings, based on analysis of census and survey data, will be presented tomorrow at a conference attended by the study researchers, policy makers and community organisations

Professor James Nazroo, director of the university's Centre on Dynamics of Ethnicity,said: "Our research and this conference is all about setting the record straight on those diverse neighbourhoods which are so widely stigmatised.

"So often we read in our newspapers and hear from our politicians that immigration and ethnic diversity adversely affect a neighbourhood, but careful research shows this to be wrong.

"In fact, the level of deprivation, not diversity, is the key factor that determines these quality of life factors for people in neighbourhoods.

"So our research demonstrates the disadvantages of living in deprived areas but the positives of living in ethnically diverse areas.

"It's deprivation which affects those Caribbean, Black African, Pakistani, and Bangladeshi people who are disproportionately represented in these neighbourhoods, as well as those white people who live alongside them."

Also according to the researchers, one in five (20%) people identified with an ethnic group other than White British in 2011 compared with 13% in 2001.

The ethnic minority populations of England and Wales lived in more mixed areas in 2011 and this mixing has accelerated over the past 10 years, says the study.

Traditional clusters of ethnic minority groups have grown but the rate of minority population growth is greatest outside these clusters with ethnic diversity spreading throughout the country.

Fellow researcher Dr Nissa Finney said: "Despite the clustering of ethnic minority people in some areas, the vast majority of ethnic minority people have a strong sense of belonging to Britain, feel part of Britain and feel that Britishness is compatible with other cultural or religious identities."

While colleague Dr Laia Becares said: "Increased diversity is beneficial for all ethnic groups so we say the policy agenda should develop strategies for inclusiveness rather than marginalising minority identities, religions and cultures.

"Policies aimed at reducing the stigmatisation of diverse neighbourhoods and promoting positive representations can only be a good thing."

The conference, entitled 'Diverse Neighbourhoods: Policy messages from The University of Manchester', will take place at Manchester Town Hall.

Source: UK Huffington Post

Topics: racism, ethnic diversity, Happiness, Health News, Race-Discrimination, UK NEWS, diversity, ethnicity

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