CNUR240 Week 5 Module - Race, Culture & Health PDF

Week 5 Module Introduction Race is a critical determinant of health that intersects with various other factors to create complex barriers to health equity and social justice. Understanding these intersections is essential for effectively addressing the structures of oppression that p...

Week 5 Module Introduction Race is a critical determinant of health that intersects with various other factors to create complex barriers to health equity and social justice. Understanding these intersections is essential for effectively addressing the structures of oppression that perpetuate inequalities. Community health nurses (CHNs) play a pivotal role in this process, leveraging their positions to advocate for and implement changes that support the health of marginalized populations. Socioeconomic Status: Racial minorities often experience higher rates of poverty due to long-standing economic disparities rooted in discrimination and historical injustices, such as redlining and employment discrimination. Poverty limits access to quality housing, education, and healthcare services, which are crucial for good health. Access to Healthcare: Racial discrimination in healthcare settings affects the quality of care received by minorities. This can manifest as less attention from healthcare providers, lower rates of medical procedures, and less pain management, compounded by underrepresentation of minorities in the health professions. Education: Educational opportunities are often stratified by race, influenced by historical and ongoing segregation, and disparities in school funding. Education is a powerful determinant of health, affecting health literacy, income potential, and job opportunities. Housing: Racial disparities in housing quality, stability, and location contribute to health disparities. Poor housing conditions can lead to health problems related to pollution, infestations, and mold. Neighbourhoods predominantly populated by racial minorities might lack health-promoting resources such as safe parks, supermarkets with healthy food options, and quality medical facilities. Employment and Working Conditions: Racial minorities are often overrepresented in low-wage jobs that may expose them to hazardous conditions without adequate health benefits or job security. Employment discrimination further limits opportunities for advancement and contributes to income disparities. Legal System Interaction: Racial profiling and disproportionate incarceration of racial minorities affect physical and mental health both directly and indirectly by limiting future employment opportunities, disrupting family structures, and creating social stigma. By addressing the structural determinants of health through approaches like advocacy, community engagement and empowerment, culturally competent care, and intersectoral collaboration, community health nurses can play a significant role in reducing health disparities and advancing equity and social justice. Their work not only helps individuals but also supports the broader goal of creating healthier communities free from oppressive structures. Topics Race and racism Intersection of race and other determinants of health Role of community health nurses (CHNs) in addressing structures of oppression Learning Objectives By successfully completing this module, you should be able to: Explain assumptions and characteristics of culture. Describe the relationship among culture, race and racism. Compare and contrast cultural competence, cultural safety and cultural humility. Outline components of an anti-racist and anti-oppressive community health nursing practice. Required Readings 1. McGibbon, E., & Mbugua, J. (2020). Race, culture and health. Chapter 9 in L. L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall. 2. Tisdale, D., & Campbell-McArthur, G. (2020). Indigenous health. Chapter 22 in L. L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall. 3. Government of Canada (2020). Social Determinants of and Inequities in Health for Black Canadians: A Snapshot. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health/social-determinants- inequities-black-canadians-snapshot.html. Videos 1. Racism and Health (2:49). Centers for Disease Control and Prevention (CDC). 2. Intersectionality (2:25). Centers for Disease Control and Prevention (CDC). 3. Tackling Structural Racism In Health: A Conversation (31:23). Health Affairs. Relationship Between Culture, Race, and Racism Culture A social construct. It encompasses language, beliefs, attitudes, values, norms, customs and traditions that characterize a group or society and organize social interactions. Socially Created and Transmitted: Culture is created by humans and is passed down from generation to generation. It evolves over time through shared experiences and social interactions. Culture is largely implicit and tacit. Fluid and Evolving: Culture is not static; it changes over time as societies evolve and interact with each other. Technological advancements, economic changes, political shifts, and other factors can influence cultural transformations.  Context-Dependent: Cultural practices and meanings can vary significantly across different societies and contexts. What is considered normal or acceptable in one culture might be seen differently in another. Race A social construct that categorizes people based on physical characteristics such as skin colour, facial features, and hair type, The concept of race has evolved over time, influenced by historical, cultural, and political factors. Race has significant social implications, affecting individuals’ identities, opportunities, and experiences. It has been used to justify social hierarchies and discrimination, leading to systemic inequalities in areas like education, healthcare, and employment. Racism Racism is the systematic practice of denying people access to rights, representation, or resources based on racial differences. It becomes evident when we consider that the term race is exclusively used to describe people of colour. Referred to as racialization. Racism and Health The ways in which racial discrimination and prejudice negatively impact the health and well-being of individuals and communities Manifest in several ways, including disparities in o Access to care, o Quality of care, and o Health outcomes The ways in which racial discrimination and prejudice negatively impact the health and well-being of individuals and communities Access to Care Barriers to Healthcare: Racism can create barriers to accessing healthcare services. This includes physical barriers (e.g., location of healthcare facilities), financial barriers (e.g., cost of care, insurance coverage), and systemic barriers (e.g., discriminatory policies and practices). Underrepresentation in Healthcare Workforce: A lack of diversity among healthcare providers can lead to cultural misunderstandings and mistrust, discouraging individuals from seeking care. Quality of Care Implicit Bias: Healthcare providers may unconsciously hold biases that affect their interactions with patients. This can lead to differences in diagnosis, treatment, and communication. Discrimination in Treatment: Studies have shown that people of colour often receive lower quality care compared to their white counterparts, including less thorough evaluations, fewer diagnostic tests, and less aggressive treatments for certain conditions. Health Outcomes Disparities in Health Conditions: Racial and ethnic minorities often experience higher rates of chronic diseases (e.g., diabetes, hypertension), infectious diseases (e.g., HIV/AIDS), and other health conditions. Mortality Rates: There are significant disparities in mortality rates among racial and ethnic groups, with minorities often experiencing higher death rates from various causes, including heart disease, cancer, and maternal mortality. Social Determinants of Health Economic Inequities: Socioeconomic status, influenced by systemic racism, affects access to resources like healthy food, safe housing, and education, which are critical for good health. Environmental Factors: Minority communities are more likely to be exposed to environmental hazards, such as pollution and unsafe living conditions, which can lead to poorer health outcomes. Mental Health Psychological Impact: Experiences of racism and discrimination can lead to significant psychological stress, contributing to mental health issues such as anxiety, depression, and trauma. Stigma and Access to Mental Health Services: Racial minorities may face additional stigma related to mental health, coupled with barriers to accessing culturally competent mental health care. Addressing Racism in Health Policy Changes: Implementing policies that promote health equity, such as expanding access to healthcare, improving social services, and addressing social determinants of health. Cultural Competence Training: Training healthcare providers to recognize and address their own biases, and to provide culturally competent care. Community Engagement: Involving communities in the design and implementation of health interventions to ensure they are culturally relevant and address the specific needs of different populations. Research and Data Collection: Conducting research to better understand health disparities and to develop evidence-based interventions. Collecting and analyzing data on health outcomes by race and ethnicity to identify and address disparities. Oppression: “Discrimination backed up by systemic power” Stereotype: “Exaggerated, beliefs, fixed images” Discrimination: “Actions or inactions based on prejudice” Prejudice: “A whole way of thinking based on stereotypes” “Oppression: discrimination backed up by systemic, structural power (e.g., political and public policy, economics; education, legal, health & media system decision making. Results in ageism, classism, colonialism, heterosexism, racism, sexism…)”  “Stereotype: exaggerated, oversimplified, fixed image, often negative, held by persons, groups, systems (e.g., political, economic, education, legal, health governing systems, media…)” “Discrimination: actions or inactions based on prejudice – made possible/condoned implicitly or explicitly by systemic, structural power” “Prejudice: preconceived opinions based on stereotypes. Results in consistent, interconnected ways of thinking, understanding” Cultural Competence, Safety and Humility Cultural competence, cultural safety, and cultural humility are concepts essential for providing inclusive, effective, respectful, and equitable health. Cultural competence is a process through which nurses plan effective and appropriate interventions that address culturally specific health needs. A process of approaching relationships with openness and humility rather than focusing on “knowing” specific cultures. Cultural Safety Extend beyond cultural competence by focusing on the patient’s experience of care. It involves creating an environment where patients feel respected and safe in expressing their cultural identity without fear of discrimination or judgment. Cultural Humility Is A recent term that enhances and extends culturally safe care. An ongoing process of self-reflection and self-critique, recognizing the limits of one’s own cultural knowledge and being open to learning from others. It emphasizes a lifelong commitment to understanding and respecting cultural differences. Cultural humility and cultural competence are very much consistent with CHNC (2011) standards and competencies. Racism in Nursing Impact the quality of care, the work environment, and health outcomes. Workplace Discrimination Hiring and Promotion: Nurses from minority backgrounds often face discrimination in hiring and promotion practices, leading to underrepresentation in leadership positions. Pay Disparities: There can be significant wage gaps between nurses of different races, even when controlling for experience and education. Work Environment: Minority nurses may face hostile or unwelcoming work environments, including microaggressions, exclusion, and lack of support. Racism in Nursing Includes Systemic racism toward nurses of colour and racialist discourses in nursing; White privilege in the nursing profession; Nurse education through a white lens, including racism in the mentor–student relationship. Patient Care Implicit Bias: Nurses may unconsciously hold biases that affect their interactions with patients, leading to differences in the quality of care provided to racial and ethnic minorities. Communication Barriers: Lack of cultural competence can result in misunderstandings and inadequate communication with patients from diverse backgrounds. Healthcare Access: Minority patients might receive less attention, fewer diagnostic tests, and substandard treatment compared to white patients. Anti-Racist and Anti-Oppressive Lens Understanding and addressing the cycle of oppression is crucial in creating equitable systems and practices, especially in fields like healthcare, education, research, policy making, and leadership. Understanding privilege, understanding how the cycle of oppression operates, and acting for social change are key components of anti-oppression practice, including anti-racism. The overall process is for CHNs to learn how to actively “see” stereotyping, prejudice, and discrimination. Cycle of Oppression in Various Spheres It is important to see how the cycle of oppression unfolds in our everyday practice, education, research, policy making, and social action leadership. Implicit Bias: Healthcare providers might unconsciously hold biases that affect their interactions with patients, leading to disparities in diagnosis, treatment, and care. Differential Treatment: Patients from marginalized groups might receive less thorough evaluations, fewer diagnostic tests, or different treatments compared to their privileged counterparts. Patient-Provider Relationship: Trust can be eroded when patients perceive discriminatory attitudes or behaviours from healthcare providers. Module Summary In summary, race intersects with several determinants of health like income, education, housing, access to healthcare, food security and can highly jeopardize people’s health. Community health nurses can be pivotal in addressing and reducing racial discrimination thereby improving health outcomes and reducing health disparities for all community members. Their role extends beyond individual patient care to encompass broader societal impacts, making their contribution vital in the fight against healthcare disparities and promoting social justice. Their direct collaboration with diverse racialized and minority populations puts them in a unique position to advocate for and implement practices that promote equity and inclusion.