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
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