How Is Colonialism a Sociostructural Determinant of Health in Puerto Rico?

Pérez-Ramos, José G.; Garriga-López, Adriana; Rodríguez-Díaz, Carlos E.

doi:10.1001/amajethics.2022.305

Cited by 27 publications

(14 citation statements)

References 22 publications

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“…The structural violence or hierarchical social structures of colonialism destroyed people's lives and livelihoods and laid the groundwork for the current health public systems of colonized countries. An example is United States imperialism in Puerto Rico, where neoliberal policies to privatize essential services such as healthcare degrade public health systems resulting in health inequities and ineffective responses to disasters (Ramos et al, 2022). Similarly, the end of colonial rule in sub‐Saharan Africa witnessed the withdrawal of medical personnel and health services, leaving decimated health systems.…”

Section: Discussionmentioning

confidence: 99%

Racism, colonialism and the implications for nursing scholarship: A discussion paper

Kimani

2023

Journal of Advanced Nursing

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Aim A critical discussion of the intersections between racism and colonialism as social determinants of health and explore how these discriminatory ideologies shape nursing inquiry. Design Discussion paper. Data Sources A review of pertinent discourse on racism and colonialism in nursing from 2000 to 2022. Implications for Nursing The failure to address health inequity plaguing racialized and marginalized populations locally and globally affects all groups, as illustrated in the COVID‐19 pandemic. Racism and colonialism are inextricably linked, creating potent forces that influence nursing scholarship and adversely affect the health of a culturally and racially diverse society. Power differentials exist within and between countries creating structural challenges that lead to inequitable distribution of resources and othering. Nursing cannot be abstracted from the sociopolitical context in which it exists. There have been calls to address the social drivers that influence the health of the communities. More still needs to be done to support an antiracist agenda and decolonize nursing. Conclusion Nurses, as the largest healthcare workforce, can be critical in addressing health disparities. However, nurses have failed to eliminate racism within their ranks, and essentialism ideology has been normalized. A multidimensional approach that includes interventions aimed at nursing education, direct patient care, community health, nursing organizations and policy is needed to address problematic nursing discourse rooted in colonialism and racism ideologies. Since knowledge generated from scholarship informs nursing education, practice and policy, it is imperative to implement antiracist policies that eliminate racist assumptions and practices from nursing scholarship. No Patient or Public Contribution The paper is a discursive paper using pertinent nursing literature. Impact For nursing to attain its potential as a leader in healthcare, standards of scientific vigour should be embedded within history, culture and politics. Recommendations are provided on possible strategies to identify, confront and abolish racism and colonialism in nursing scholarship.

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Section: Discussionmentioning

confidence: 99%

Racism, colonialism and the implications for nursing scholarship: A discussion paper

Kimani

2023

Journal of Advanced Nursing

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“…While the administration developed contradictory policies, the PR legislature enacted Act 43 of 2020 on April 16, 2020, which provided that COVID-19-related medical treatments would be free of charge for the duration of the state of emergency. This measure is similar to the public health measures implemented by the Trump administration, and, while important, it does not address the key limitations of a public health system that has been completely privatized (Pérez et al, 2022) Furthermore, V azquez's administration decided to grant immunity from civil cases to "medical facilities and professionals" providing services to COVID-19 patients through executive order OE-2020-36. This provision generated discomfort among Puerto Ricans since it does not guarantee access to PPE or hazard pay for healthcare workers but instead focuses on guaranteeing immunity to corporations that administer private hospitals .…”

Section: Facing the Public Health Crisis: Law States Of Emergency And...mentioning

confidence: 99%

“…Governor Vázquez issued 18 executive orders between January 7 and March 12, 2020, and she declared yet another state of emergency to address the aftermath of the earthquakes 26 . As a result, when the COVID‐19 global pandemic occurred, PR was in a more precarious position than any other state or territory of the US (Pérez et al, 2022). For example, PR was unprepared to face a $9.7 billion direct economic impact, the loss of approximately $2 billion in tax revenue, 27 the permanent loss of over 100,000 jobs, 28 and the loss of over 4757 lives due to the pandemic 29 .…”

Section: Multi‐layered Crisis In Pr: a Short Historical Overviewmentioning

confidence: 99%

“…In addition, since the 1990 s, PR has been experiencing a public health crisis driven by austerity policies, a lack of resources allocated for preventive health care, and primary care privatization (Pérez et al, 2022). As Pérez et al (2022, 305–6) remind us, “PR's political subordination to US federal policy has led to the degradation of the public health care system through measures such as chronic underfunding (e.g., through its exclusion from the provisions of the Affordable Care Act) and through the fragmentation and privatization of local health care systems.” Thus, the impact of COVID‐19 was exacerbated by the fact that PR had been enduring austerity measures and a permanent state of emergency to deal with previous disasters.…”

Section: Multi‐layered Crisis In Pr: a Short Historical Overviewmentioning

confidence: 99%

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Emergency powers, anti‐corruption, and policy failures during the COVID‐19 pandemic in Puerto Rico

Atiles-Osoria

2023

Law & Policy

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This paper explores how the use of emergency powers by the US and Puerto Rican governments exacerbated the impact of the COVID‐19 pandemic and manufactured the conditions for furthering the multilayered economic, legal, political, and humanitarian crisis affecting Puerto Rico since 2006. The paper discusses three cases. First, it examines how the multiple declarations of the state of emergency, and its constant renewals, produced contradictory public health policies. Since the start of the COVID‐19 pandemic in March 2020, the Puerto Rican government has issued over 90 executive orders aimed at addressing the emergency, producing an unclear, contradictory, and unequal emergency management policy. Second, the paper focuses on the impact of the passing of Law 35 on April 5, 2020, which imposed severe penalties on those who disobeyed executive orders. As a result, hundreds of Puerto Ricans were arrested, fined, and incarcerated for violating the issued order. Third, the paper studies how, citing the presence of corruption, the Puerto Rican government implemented anti‐corruption and anti‐fraud policies that made it more difficult for those most in need of it—mainly poor and racialized individuals, as well as immigrants and working women—to access Pandemic Unemployment Assistance. Thus, the paper argues that emergency policies designed to address the pandemic, punitive governance, and anti‐corruption and anti‐fraud policies undermined Puerto Rico's capacity to handle the pandemic, exacerbated its impact, and created an unequal recovery scenario.

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“…The twenty-first century in the Commonwealth of Puerto Rico (hereafter, Puerto Rico)-an unincorporated United States (US) territory-is an era characterized by rapid population aging, reductions in social and economic resources, rampant disparities in access to adequate healthcare, and the ongoing reconstruction of the built environment post-Hurricanes Irma and María (1)(2)(3)(4)(5)(6). The constellation of these factors infers that many older Puerto Rican adults may lack access to resources, services, and contexts considered necessary for promoting healthy aging.…”

Section: Introductionmentioning

confidence: 99%

The neighborhood context and all-cause mortality among older adults in Puerto Rico

García

McEniry

et al. 2023

Front. Public Health

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BackgroundRecent efforts have been made to collect data on neighborhood-level attributes and link them to longitudinal population-based surveys. These linked data have allowed researchers to assess the influence of neighborhood characteristics on the health of older adults in the US. However, these data exclude Puerto Rico. Because of significantly differing historical and political contexts, and widely ranging structural factors between the island and the mainland, it may not be appropriate to apply current knowledge on neighborhood health effects based on studies conducted in the US to Puerto Rico. Thus, we aim to (1) examine the types of neighborhood environments older Puerto Rican adults reside in and (2) explore the association between neighborhood environments and all-cause mortality.MethodsWe linked data from the 2000 US Census to the longitudinal Puerto Rican Elderly Health Conditions Project (PREHCO) with mortality follow-up through 2021 to examine the effects of the baseline neighborhood environment on all-cause mortality among 3,469 participants. Latent profile analysis, a model-based clustering technique, classified Puerto Rican neighborhoods based on 19 census block group indicators related to the neighborhood constructs of socioeconomic status, household composition, minority status, and housing and transportation. The associations between the latent classes and all-cause mortality were assessed using multilevel mixed-effects parametric survival models with a Weibull distribution.ResultsA five-class model was fit on 2,477 census block groups in Puerto Rico with varying patterns of social (dis)advantage. Our results show that older adults residing in neighborhoods classified as Urban High Deprivation and Urban High-Moderate Deprivation in Puerto Rico were at higher risk of death over the 19-year study period relative to the Urban Low Deprivation cluster, controlling for individual-level covariates.ConclusionsConsidering Puerto Rico's socio-structural reality, we recommend that policymakers, healthcare providers, and leaders across industries to (1) understand how individual health and mortality is embedded within larger social, cultural, structural, and historical contexts, and (2) make concerted efforts to reach out to residents living in disadvantaged community contexts to understand better what they need to successfully age in place in Puerto Rico.

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How Is Colonialism a Sociostructural Determinant of Health in Puerto Rico?

Cited by 27 publications

References 22 publications

Racism, colonialism and the implications for nursing scholarship: A discussion paper

Racism, colonialism and the implications for nursing scholarship: A discussion paper

Emergency powers, anti‐corruption, and policy failures during the COVID‐19 pandemic in Puerto Rico

The neighborhood context and all-cause mortality among older adults in Puerto Rico

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