(HEA3) Race and racism is a social determinant of health: A roadmap to challenging hate.

The session papers will examine the interrelationship of race and health using the social determinants of health. This issue can be discussed within a socio-political and Human Rights context. In any discussion of social equity and justice, illness and health must be a major concern when discussing health equity. Health equity is not only about health but must look at the issues of fairness in social arrangements. Racism is a social construct that systematically creates avoidable and unjust inequalities in power, resources, capabilities, and opportunities among different racial or ethnic groups within organized societies. Research shows us that documenting the health impacts of racism has made this a determinant of health in Canada. Racism was associated with poorer mental and physical health. The presentations will be followed by a discussion on how to challenge hate due to race and ethnicity, including the limitations and challenges that exist in society. Tags: Equality and Inequality, Health and Care, Policy

Organizer: Merle Jacobs, York University; Chair: Livy Visano, York University

Presentations

Reem Kadri, Western University

Structural Racism: its Operationalization and Intergenerational Health Impacts

Racial-ethnic minorities suffer from worse health outcomes, including higher morbidity and mortality rates, as compared to their white counterparts. Structural racism is a fundamental cause of health inequality and the root cause of the social determinants of health (SDOH). As a fundamental cause, it has lasting connections with health as it is consistently (re)producing the conditions necessary for the perpetuation of inequality. It is an oppressive system and ideology, ingrained at the macro-level in institutions and policy, intended to systematically subjugate racialized groups through exclusion from social, political, educational, health and occupational institutions. It differentially allocates and withholds symbolic resources from minoritized groups within social institutions and society, while also differentially exposing them to health risks across the life course. Families are the meso-level context through which structural (dis)advantage is experienced and transmitted across generations. Accumulation theories suggest that mechanisms of inequality begin in early-life and lead to growing health disparities between advantaged and disadvantaged groups over time. Research on the intergenerational transmission of health and health inequalities examines how adulthood health is related to earlier life conditions, specifically childhood disadvantage which has an enduring influence. Yet, most research focuses on only one generation with little understanding of the intergenerational health impacts of structural racism, especially regarding minoritized families across multiple generations. Although research highlights the significance of the effects of macro-level social circumstances on health, most literature focuses on the health effects of interpersonal racism. My research addresses this limitation while adding to the burgeoning research on the intergenerational transmission of health by examining the health effects of structural racism on three generations. Structural racism is a complex concept to observe and conceptualize and its role in driving health inequality has yet to be operationalized in-depth empirically. The comprehensive examination, operationalization and conceptualization of structural racism is a main objective and contribution of my research to fill this gap in the health inequality literature.  I employ the Panel Study of Income Dynamics (PSID), the longest-operating longitudinal household survey, and its Child Development Supplement (CDS) and Transition into Adulthood Supplement (TAS) to address three research questions. First, I examine the mental and physical health effects of growing up and residing in environments with high structural racism in childhood. Second, research into the “long arm of childhood” indicates early-life circumstances, beginning during the critical periods of gestation and childhood, have enduring effects on one’s health in later life. Thus, I examine the long-term impacts of structural racism experienced in childhood on physical and mental health in adulthood. Lastly, following the life course principle of linked lives, a mother’s health and wellbeing has persisting impacts on her developing fetus, with prenatal conditions preparing the fetuses’ biological stress response systems from its mother’s social circumstances. Consequently, my third research question examines the health effects of structural racism across generations, from mothers to their children, beginning at birth and through age 18.  The ability to link the CDS to the TAS and PSID’s Main Interview files is highly advantageous because of the availability of long-term data on family socioeconomic context and individual-level family structure variables that allow for detailed data analysis over a prolonged period, beginning in childhood through young adulthood into adulthood. Because no comparable Canadian data exists, this panel study provides the best opportunity to study the intergenerational impacts of structural racism. Moreover, the ability to link geospatial data to the PSID provides longitudinal contextual data on the poverty level, unemployment rate, and educational attainment of racialized groups in a geographic area, as well as vital data on neighbourhood quality, residential segregation, political participation and criminal justice. Although these variables by themselves do not capture the complex process of structural racism, they can be incorporated as indicators of a latent construct. Finally, the PSID includes multiple physical and mental health measures, such as health level, depression, emotional and psychiatric problems, cancer, and chronic illnesses allowing for the operationalization of health status.  Findings from this research respond to the growing calls from policymakers for studies that quantify structural racism’s impact on health disparities. Research into structural racism as a public health issue is critical for informing policy that aids Healthy People’s 2030 mission of eliminating health inequality by addressing the SDOH. 

Jaclyn Tompalski, Carleton University

The Transformative Role of Indigenous Birth Workers in Promoting Indigenous Family Well-being: A Decolonial Approach

This article examines the invaluable role of Indigenous birth workers in reducing adverse outcomes and promoting the well-being of Indigenous families while simultaneously functioning as cultural actors. Drawing on transformative justice and decolonization frameworks, this study explores how these birth workers dedicate additional time, resources, and emotional support to families, often adopting the role of "auntie" within their clients inner circle. By providing enhanced support to parents, encompassing respite, healthy postpartum meals, emotional guidance, and cultural connection, Indigenous birth workers exemplify the principles of transformative justice and decolonization, effectively setting Indigenous families on a path towards success. Furthermore, the article highlights the transformative shift in approach away from traditional Western models, which primarily provide support to Indigenous families only when child and family services involvement becomes necessary. This research employs a qualitative methodology grounded in the personal experiences and expertise of the author, a full-spectrum Indigenous doula and graduate student. The theoretical framework is informed by principles of transformative justice, which aims to challenge oppressive systems, and decolonization, which seeks to dismantle colonial structures and restore Indigenous autonomy. The main argument of this article centers on the significant contributions of Indigenous birth workers in supporting Indigenous families and promoting the overall well-being of Indigenous children and youth. By offering additional time, resources, and emotional support, as well as incorporating cultural practices and traditions, Indigenous birth workers create a nurturing and empowering environment for families during the perinatal period (and beyond). This approach not only has the potential to enhance positive health outcomes but also fosters a sense of cultural pride and resilience within Indigenous communities. Indigenous birth workers engage in the decolonial process by rejecting the insular model of the Western nuclear family and instead prioritizing community-based child-rearing. The article concludes that recognizing and supporting the role of Indigenous birth workers is crucial for addressing the existing health inequities within Indigenous communities. Their impact on Indigenous families can be maximized by acknowledging their unique cultural knowledge and expertise, integrating them into mainstream healthcare systems, and providing appropriate resources and compensation. Moreover, this transformative approach challenges the dominant Western biomedical model and aligns with the principles of social equity, justice, and the promotion of Indigenous child, youth, and family rights. The relevance of this article lies in its contribution to the session theme "Race and Health: Social Determinants of Health, Social Equity, and Justice" within the field of social sciences. It sheds light on the interrelationship between racism, the health outcomes of Indigenous families, and the instrumental role of Indigenous birth workers in addressing health inequities. By emphasizing how Indigenous birth workers embody transformative justice and decolonization principles, this research adds to the understanding of how racism perpetuates avoidable and unjust health disparities. Furthermore, it underscores the need to challenge systemic racism and invest in community-based approaches that prioritize cultural safety and Indigenous self-determination. Doing so could support long-term desirable outcomes for Indigenous families while supporting Indigenous autonomy and self-determination. Collaboration and community engagement in the research process are foundation elements of desire-based Indigenous research. Presenting this ongoing research to members within and outside our communities would surely benefit from colleague and audience insights.

Angie Wong, University of Calgary

Whose Voices Really Matter? Indigenous Maternal-Child Health Research in Alberta

Racism against Indigenous Peoples has been identified in news media, grey literature, and personal testimony as a critical social determinant of health that has direct impacts on the relationships between patients and providers in healthcare settings. Unfortunately, and despite the growing scholarship on the ways in which racism against Indigenous Peoples in health care settings impacts delivery of care, testimonials from urban First Nations and Métis women in Calgary and Edmonton, Alberta reveal that their child birthing experiences in the provincial healthcare system were entrenched with racist interactions and encounters. This is no surprise given the ways in which western Canadian settler colonial expansion utilized the residential school and the Indian hospital systems to absorb Indigenous children and youth into the establishing Canadian body politic. To this end, distrust due to an awareness of colonial health systems and colonial health interactions continues to shape health care interactions in Alberta. To better understand the facilitators and barriers that shape Indigenous mothers and families’ experiences in health care, the provincial health care system of Alberta, known as Alberta Health Services (or AHS), developed and adopted a number of statements and policies that speak directly to how race and racism are social determinants of health. Indeed, AHS even published a guiding organizational document called the “Indigenous Health Commitments: Roadmap to Wellness,” which explains how AHS intends to engage more fulsomely with First Nations and Métis health authorities and partners. As a Humanities scholar and senior consultant in the sector of Indigenous health, innovation, and research I was invited to conduct community-based participatory action research. In November 2023, I developed a report entitled “Voices for Indigenous Maternal-Child Health and Wellness,” which contains testimonials, sharing circle stories, and interviews with Blackfoot, Dene, Chippewan, and Métis mothers, their families, scholars, grandmothers (Elders, specifically), Aunties, and practicing midwives and doulas about child birthing and child rearing in Alberta. The findings of this report align with grey literature to reveal that systemic racism is a major contributing factor to the distrust of the health care system, which leads to poor health outcomes for Indigenous mothers and children. Yet, five major recommendations were made for organizational change and individual health care provider reform. How AHS is taking up these recommendations is ongoing. As health care systems adopt new understandings for how to address and eliminate racism in health care (e.g. B.C. “In Plain Sight” report), there remains a feeble understanding of why and how settler colonialism shapes Canadian health care (most still refer to Canada as a classical colonial situation, or even worse, post-colonial ). As a result, imbalanced power dynamics emerge in interactions between racialized health care providers and Indigenous patients, confusing an understanding of how racism is expressed and experienced. I would like to share the findings of the “Voices for Indigenous Maternal-Child Health and Wellness” report and further explore the disconnect between the priorities of First Nations and Métis and the agendas of provincial health care systems that are influenced by provincial politics. I believe this presentation would fit well in the potential session: (HEA3) Race and racism is a social determinant of health: A roadmap to challenging hate.

Merle Jacobs, York University

Race and Racism and Health Equity: COVID-19 as an example.

Over the past few decades, there has been a significant increase in scientific research exploring the various ways in which racism can negatively impact ones health. This paper looks into Health Equity and how racism justifies a hierarchical system based on race, which deprives equal treatment because of one’s race. Health Equity is when “all people have the opportunity to attain their full health potential, and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance” (Braveman, 2003. p.181). Racism is a complex issue, an ideology that refers to the presence of organized systems within societies that lead to avoidable and unfair inequalities in power, resources, capacities, and opportunities among different racial or ethnic groups. It can manifest in various forms, including beliefs, stereotypes, prejudices, and discrimination. From overt threats and insults to deeply ingrained social structures, the effects of racism can be wide-ranging and profound. As a systematic issue, racism intertwines with other social institutions, influencing and being influenced by them in order to maintain and justify a hierarchical system based on race. This has led to the development of a complex and interdependent network of components, or subsystems, that work in tandem to perpetuate racial inequalities across various facets of society. The psychosocial stresses of racism can harm health among r minority groups. Several studies have found that as the number of incidents of ethnic discrimination that individuals have experienced increases, their physical and mental health deteriorates. The COVID-19 pandemic has had a profound worldwide impact, affecting individuals in diverse ways. The loss of employment has been widespread, and limitations on typical activities have resulted in prolonged separation from family and friends. A considerable portion of the global population has also experienced psychological distress due to the pandemic. Regrettably, certain groups, including younger adults, women, the poor, and individuals from Black, Asian, and Minority Ethnic backgrounds, have been disproportionately affected by the negative effects of COVID-19. Overall, racial and ethnic minorities in Canada have had higher rates of infection, hospital stays, and death caused by the COVID-19 virus than white Canadians. This paper explores how race affects outcomes relating to Health Equity.