Week 4

Week 4 How does racism operate as a social determinant of health? 1. Define systemic racism and structural discrimination Canadian charter stresses protection from discrimination as a right of all Canadians  Equal rights - no discrimination Racism  Racism refers to historically and context specific systems of ideas and practices that operate to naturalize the unequal distribution of power and privilege in a context  Racism is a SDH  Acts of discrimination are key mechanisms through which racism operates within healthcare system What are acts of discrimination?  Actions within systems of power that adversely affect populations directly and indirectly  Socially structured actions that are unfair and cause harm to less powerful individuals and groups  Can be overt or subtle, intentional and unintentional  Often normalized and naturalized (expected and even sometimes 'explained away' as logical as opposed to unfair)  These are productive acts: these reinforce the power of the more powerful and privileged groups in that context Racism/discrimination occur at structural and individual levels  Structural Discrimination o Macro-level conditions that limit resources, opportunities and the well being of less privileged groups  Individual Discrimination o Negative interactions with another person (health care provider, salesperson, etc.) based on an individual's characteristics (race, gender, etc.) Structural Discrimination / Racism  Structural: institutionalized, widespread, normalized  Operates and is sustained based on multiple mutually reinforcing systems of discrimination Is racism really relevant to analysing health in Canada today??  YES  In Canada... 81% of those who self-identify as belonging to a visible minority group have experienced racial or ethnic discrimination

 " One in five women in Canada have experienced racism when using the healthcare system, as a result of cultural insensitivity, stereotypes, name-calling, and inferior quality of care." - Wellesley Institute report  "Initial results suggest that in Canada, experience of discrimination is a determinant of chronic disease and chronic disease risk factors, and Blacks and Aboriginals are far more exposed to experiences of discrimination."  Blacks were 4 times for likely to be feared my others  Indigeonous 2 times more likely  Racial disparities were especially pronounced, with White Quebec residents reporting three times greater odds of thyroid screening than visible minorities Poverty is key SDH  Poverty is racialized in Canada  In Toronto, 62% of people living in poverty identify with a racial group  For every dollar earned by non-racialized (white) Canadian, racialized Canadians earn 81.4 cents Racial Discrimination by Toronto Police  Blacks made up 8.8% of Toronto's population in 2016 yet faced 32.4% of all police charges that year  Blacks represented "35.2% of those charged with driving offences where the officer may have observed the driver's race before deciding to stop them or check their licence plate." Systemic racism in Canada is a fact and impacts on health through a number of pathways 2. Explain pathways by which racism and discrimination operate as social determinants of health Structural racism = systemic racism  Structural: institutionalized, widespread, normalized  Operates and is sustained based on multiple mutually reinforcing systems of discrimination  reproduced through multiple spaces, interactions, ideas Examples of DIRECT impacts on health - Discrimination on basis of race (racism)  Higher chronic disease risk: diabetes & cardiovascular disease  Reduced health seeking  Higher levels of unhappiness, loneliness and depression Examples of INDIRECT impacts on health - Discrimination on basis of race (racism)  Higher levels of poverty = poorer health outcome

 Chronic stress FACT: every income bracket in Canada harbors slightly better health outcomes than the one below it 1 in 5 racialized families lives in poverty in Canada, as opposed to 1 in 20 non-racialized families Where racialized identity & income intersect for disadvantage...  Social deprivation: e.g. can't get job/schooling want, can't support kids' participation in 'normal' extra-curricular activities  Material deprivation: can't buy healthy or sufficient food  Neighborhood / housing conditions  Access to green spaces /nature/recreation  more physically risky and/or stressful situations: e.g. taking more dangerous employment; taking a job that requires you to get to or from work late at night; staying in abusive relationship Racism impacts on health as a psychosocial stressor  Anticipatory stress of negative interactions  Stress of navigating being hyper-visible in society where non-Whites are more noticed and judged  Stress of worrying about loved ones navigating risks of discrimination Allostatic load  "refers to physiological changes across different biological systems in response to chronic social and environmental stress"- Social Determinants of Health" Public Health Reports  Physiological changes resulting from chronic stress include changes to the: hypothalamic-pituitary-adrenal axis, sympathetic nervous system, immune/inflammatory system, cardiovascular and metabolic systems