Introduction: Racism in the Canadian University

Henry, Frances; Tator, Carol

doi:10.3138/9781442688926-001

Cited by 59 publications

(136 citation statements)

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“…Organizations that develop strategies to counter racism and discrimination need to push back against dominant, neoliberal discourses that reinforce misconceptions about people having equal access to health care and resources [ 52 , 53 , 98 , 104 ]. The significance of ensuring that people feel welcome in health care spaces cannot be overemphasized.…”

Section: Resultsmentioning

confidence: 99%

Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study

Browne

Varcoe

Lavoie

et al. 2016

BMC Health Serv Res

253

337

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BackgroundStructural violence shapes the health of Indigenous peoples globally, and is deeply embedded in history, individual and institutional racism, and inequitable social policies and practices. Many Indigenous communities have flourished, however, the impact of colonialism continues to have profound health effects for Indigenous peoples in Canada and internationally. Despite increasing evidence of health status inequities affecting Indigenous populations, health services often fail to address health and social inequities as routine aspects of health care delivery. In this paper, we discuss an evidence-based framework and specific strategies for promoting health care equity for Indigenous populations.MethodsUsing an ethnographic design and mixed methods, this study was conducted at two Urban Aboriginal Health Centres located in two inner cities in Canada, which serve a combined patient population of 5,500. Data collection included in-depth interviews with a total of 114 patients and staff (n = 73 patients; n = 41 staff), and over 900 h of participant observation focused on staff members’ interactions and patterns of relating with patients.ResultsFour key dimensions of equity-oriented health services are foundational to supporting the health and well-being of Indigenous peoples: inequity-responsive care, culturally safe care, trauma- and violence-informed care, and contextually tailored care. Partnerships with Indigenous leaders, agencies, and communities are required to operationalize and tailor these key dimensions to local contexts. We discuss 10 strategies that intersect to optimize effectiveness of health care services for Indigenous peoples, and provide examples of how they can be implemented in a variety of health care settings.ConclusionsWhile the key dimensions of equity-oriented care and 10 strategies may be most optimally operationalized in the context of interdisciplinary teamwork, they also serve as health equity guidelines for organizations and providers working in various settings, including individual primary care practices.These strategies provide a basis for organizational-level interventions to promote the provision of more equitable, responsive, and respectful PHC services for Indigenous populations. Given the similarities in colonizing processes and Indigenous peoples’ experiences of such processes in many countries, these strategies have international applicability.

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Section: Resultsmentioning

confidence: 99%

Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study

Browne

Varcoe

Lavoie

et al. 2016

BMC Health Serv Res

253

337

View full text Add to dashboard Cite

show abstract

“…Indigenous peoples were subjected to “paternalistic and racist policies and legislation; … necessary conditions which had to be met if Indigenous peoples wanted to become citizens (of their own lands)” [ 17 ]. This early subjugation demanded that Indigenous ways of knowing and being were characterized as primitive and “savage.” As Henry et al (2000) have argued, the colonization of Canada “relied on a belief system that judged the original inhabitants to be inferior,” relying on racist ideologies of Social Darwinism [ 18 ]. This constructed inferiority of Indigenous peoples continues to influence deeply held stereotypes that perpetuate discrimination against Indigenous peoples today.…”

Section: Introductionmentioning

confidence: 99%

Insiders’ Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals

Wylie

McConkey

2018

J. Racial and Ethnic Health Disparities

105

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Discrimination in the health care system has a direct negative impact on health and wellbeing. Experiences of discrimination are considered a root cause for the health inequalities that exist among Indigenous peoples. Experiences of discrimination are commonplace, with patients noting abusive treatment, stereotyping, and a lack of quality in the care provided, which discourage Indigenous people from accessing care. This research project examined the perspectives of health care providers and decision-makers to identify what challenges they see facing Indigenous patients and families when accessing health services in a large city in southern Ontario. Discrimination against Indigenous people was identified as major challenges by respondents, noting that it is widespread. This paper discusses the three key discrimination subthemes that were identified, including an unwelcoming environment, stereotyping and stigma, and practice informed by racism. These findings point to the conclusion that in order to improve health care access for Indigenous peoples, we need to go beyond simply making health services more welcoming and inclusive. Practice norms shaped by biases informed by discrimination against Indigenous people are widespread and compromise standards of care. Therefore, the problem needs to be addressed throughout the health care system as part of a quality improvement strategy. This will require not only a significant shift in the attitudes, knowledge, and skills of health care providers, but also the establishment of accountabilities for health care organizations to ensure equitable health services for Indigenous peoples.

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“…Discourses are manifestations of ideologies and form individual and collective consciousness, which influence people’s actions [14]. In the health sector, liberal individualism is integral to dominant discourses that align with efficiency, egalitarian, culturalist, and racializing discourses, all of which can challenge the goal of equity [6, 15, 16]. Indeed, healthcare systems in most Western nations are located in a liberal political and economic ideology linked to the main tenets of capitalism.…”

Section: Introductionmentioning

confidence: 99%

“…Going hand in hand with a liberal ideology, egalitarian (also known as equality) discourses reinforce beliefs about the equal agency of all individuals, expecting them to be responsible for their social position and behaviour regardless of their circumstances [22]. In Canada, for example, it is widely accepted that all citizens and landed immigrants have an equal opportunity to achieve optimum health because healthcare is a legislated social policy, publicly funded, and a guaranteed right [15]. Hence, the ideal of equality is often operationalized at the point of care with “equal treatment” in the context of presumed “equal opportunity” with providers aiming to “treat everyone the same.” However, evidence shows that the life expectancy of Indigenous people and low-income Canadians remains lower than the life expectancy of the general population [23].…”

Section: Introductionmentioning

confidence: 99%

Understanding competing discourses as a basis for promoting equity in primary health care

Garneau

Browne

Varcoe

2019

BMC Health Serv Res

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BackgroundGlobally, health inequities persist with effects on whole populations and the most profound effects on populations marginalized by poverty, discrimination and other forms of disadvantage. In the current neoliberal political-economic context, health inequities are produced and sustained by the inequitable distribution of social determinants of health and structural inequities such as discrimination and institutional racism. Even in the context of healthcare organizations with an explicit commitment to health equity, multiple intersecting discourses, such as ongoing efficiency discourses, and culturalist and racialized discourses, are in constant interaction with healthcare practices at the point of care and the organizational level, limiting providers’ and organizations’ capacities to address structural inequities. Attention to discourses that sustain inequities in health care is required to mitigate health inequities and related power differentials. In this paper, we present findings from a critical analysis of the relations among multiple discourses and healthcare practices within four Canadian primary health care clinics that have an explicit commitment to health equity.MethodsInformed by critical theoretical perspectives and critical discourse analysis principles, we conducted an analysis of 31 in-depth interviews with clinic staff members. The analysis focused on the relations among discourses and healthcare practices, the ways in which competing discourses influence, reinforce, and challenge current practices, and how understanding these dynamics can be enlisted to promote health equity.ResultsWe articulate the findings through three interrelated themes: equity-mandated organizations are positioned as the “other” in the health care system; discourses align with structures and policies to position equity at the margins of health care; staff and organizations navigate competing discourses through hybrid approaches to care.ConclusionsThis study points to the ways in which multiple discourses interact with healthcare organizations’ and providers’ practices and highlights the importance of structural changes at the systemic level to foster health equity at the point of care.

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Introduction: Racism in the Canadian University

Cited by 59 publications

References 0 publications

Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study

Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study

Insiders’ Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals

Understanding competing discourses as a basis for promoting equity in primary health care

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