RACISM, SYSTEMIC OPPRESSION, AND HEALTH DISPARITIES

HOW TO ENGAGE IN EFFECTIVE ALLYSHIP AND BUILD ANTI-RACIST PRACTICES

MALINDA TRUJILLO, PHD

SARAH SÚÑIGA, PHD

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“WE MUST TAKE SIDES. NEUTRALITY HELPS THE OPPRESSOR,

NEVER THE VICTIM.SILENCE ENCOURAGES THE TORMENTOR,

NEVER THE TORMENTED.”

ELIE WIESEL

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LEARNING OBJECTIVES

• DEFINE RACISM, RACE BASED TRAUMA, AND SYSTEMIC OPPRESSION AND THEIR IMPACT ON VETERANS OF COLOR.

• DEFINE HEALTH DISPARITIES AND THEIR IMPACT ON VETERANS OF COLOR.

• IDENTIFY SKILLS AND RESOURCES FOR BECOMING AN ALLY WITHIN HEALTHCARE SYSTEMS.

• IDENTIFY SKILLS AND RESOURCES FOR ENGAGING IN ANTI-RACISM

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SYSTEMIC/STRUCTURAL RACISM

• NORMALIZATION & LEGITIMIZATION OF AN ARRAY OF DYNAMICS THAT:

• ROUTINELY ADVANTAGE WHITES

• WHILE PRODUCING CUMULATIVE AND CHRONIC ADVERSE OUTCOMES FOR PEOPLE OF COLOR

• DESIGNED TO REPRODUCE DISPARITIES AND REINFORCE ITSELF (ROSE & ROSEN, 2017)

• FUNCTIONS LARGELY ON AN IMPLICIT BASIS (ROSE & ROSEN, 2017)

• REFLECTED IN HISTORY, CULTURE, AND INTERCONNECTED INSTITUTIONS (KRIEGER, 2014)

• MANIFESTS IN VARIOUS SECTORS: HOUSING, EDUCATION, MEDIA, WEALTH/JOBS, CRIMINAL JUSTICE, AND HEALTHCARE (ROSE & ROSEN, 2017)

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STRUCTURAL RACISM & IMPLICIT BIAS

• EXAMINING TRAYVON MARTIN’S MURDER (ROSE & ROSEN, 2017) • SCHOOLS

• MORE SEVERE PUNISHMENT FOR BIPOC

• ESTABLISHES “A PATTERN”

• HOUSING

• CRIMINAL JUSTICE

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STRUCTURAL RACISM & IMPLICIT BIAS

• EXAMINING TRAYVON MARTIN’S MURDER (ROSE & ROSEN, 2017)

• SCHOOLS

• HOUSING

• IMPACT OF “WHITE FLIGHT”

• LEGACY OF REDLINING

• CRIMINAL JUSTICE

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STRUCTURAL RACISM & IMPLICIT BIAS• EXAMINING TRAYVON MARTIN’S MURDER

(ROSE & ROSEN, 2017) • SCHOOLS

• HOUSING

• CRIMINAL JUSTICE

• UNEVEN APPLICATION OF THE LAW

• JUSTIFICATION IMPACTED BY PERCEPTIONS OF “THREAT”

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SYSTEMIC OPPRESSION & HEALTH INEQUITY

• INSTITUTIONAL RACISM (BAILEY ET AL, 2017)• “RACIALLY ADVERSE ‘DISCRIMINATORY POLICIES AND PRACTICES CARRIED OUT…[WITHIN

AND BETWEEN INDIVIDUAL] STATE OR NON-STATE INSTITUTIONS’ ON THE BASIS OF RACIALIZED GROUP MEMBERSHIP”

• HEALTH INEQUITY• DISPARITY: RACIAL OR ETHNIC DIFFERENCES IN THE QUALITY OF HEALTH CARE THAT ARE

NOT CAUSED BY ACCESS-RELATED FACTORS OR CLINICAL NEEDS, PREFERENCES, AND APPROPRIATENESS OF INTERVENTION (SAHA ET AL, 2008)

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STRUCTURAL RACISM & HEALTH INEQUITY IN VA

• RACIAL DISPARITIES IN VA (SAHA ET AL, 2007)• MORE WHITE VETERANS RECEIVE NON-VA CARE COMPARED TO BLACK & LATINX VETERANS

• MOST PREVALENT DISPARITY: BLACK & LATINX VETERANS LESS LIKELY TO UNDERGO SURGERY/INVASIVE PROCEDURES AND LESS LIKELY TO ADHERE TO MEDICATION REGIMENS

• HEART DISEASE & INVASIVE PROCEDURES• BLACK PATIENTS: VALUE PLACED ON TRUST IN PHYSICIAN

• WHITE PATIENTS: VALUED PLACED ON CLINICAL INDICATIONS• BECAUSE TRUST IS ALREADY ASSUMED?

• PHYSICIAN DECISION-MAKING PLAYED THE BIGGEST FACTOR IN DISPARITY

• MENTAL HEALTH DISPARITY: • DIAGNOSIS AND TREAT BLACK PATIENTS FOR PSYCHOTIC DISORDERS

• DIAGNOSIS AND TREAT WHITE PATIENTS FOR AFFECTIVE DISORDERS

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STRUCTURAL RACISM & HEALTH INEQUITY IN VA

• RACIAL DISPARITIES IN VA (SAHA ET AL, 2007)• PROPOSED SOURCES FOR DISPARITIES

• HEALTH LITERACY• TRUST/SKEPTICISM

• PATIENT ENGAGEMENT• SOCIAL SUPPORT (TO MAKE DECISIONS)• CLINICIAN JUDGEMENT

• RACIAL/CULTURAL MILIEU• HEALTHCARE FACILITY CHARACTERISTICS

• UPDATE IN 2014: NOT MANY NEW STUDIES TO EXAMINE (PETERSON ET AL, 2014)• DISPARITIES MAINTAINED FOR BLACK AND LATINX VETERANS• STRONG RECOMMENDATION FOR RESEARCH BEYOND BLACK VS WHITE POPULATIONS

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STRUCTURAL RACISM & HEALTH INEQUITY IN VA• PATHWAYS BETWEEN

RACISM & HEALTH (BAILEY ET

AL, 2017)

• ECONOMIC INJUSTICE

• ENVIRONMENTAL HEALTH INEQUITIES

• PSYCHOSOCIAL TRAUMA

• TARGETED MARKETING

• INADEQUATE HEALTH CARE

• STATE SANCTIONED VIOLENCE

• POLITICAL EXCLUSION

• MALADAPTIVE COPING

• STEREOTYPE THREATS

• PROPOSED SOURCES FOR DISPARITIES (SAHA ET AL, 2007)

• HEALTH LITERACY

• TRUST/SKEPTICISM

• PATIENT ENGAGEMENT

• SOCIAL SUPPORT (TO MAKE DECISIONS)

• CLINICIAN JUDGEMENT

• RACIAL/CULTURAL MILIEU

• HEALTHCARE FACILITY CHARACTERISTICS

HOUSING

WEALTH & JOBS

MEDIA

EDUCATION

CRIMINAL JUSTICE

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THE CALL TO ACTION

“MULTICULTURAL COMPETENCIES,

HOLD PSYCHOLOGISTS TO A HIGH STANDARD AS WE ARE CHARGED

TO ALLY WITH, ADVOCATE FOR, AND, AT TIMES,

BECOME ACTIVISTS IN USING PSYCHOLOGICAL SCIENCE TO IMPROVE THE CONDITION OF INDIVIDUALS, ORGANIZATIONS, AND SOCIETY.”

MICHELLE MELTON

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WE ARE A PART OF THE PROBLEM ….?

HELPERS DO NOT HURT: AS HELPERS WE CAN EASILY IDENTIFY WHEN OTHERS HAVE ENGAGED IN BIASED OR OPPRESSIVE BEHAVIOR BUT ITS HARD TO VIEW OUR OWN BEHAVIORS FROM THIS LENS.

WE DON’T HAVE BIASES: UNCONSCIOUS BIAS , EXPLICIT BIAS, MICROAGGRESSIONS, AND PREJUDICE ARE AN EQUAL OPPORTUNITY VIRUS WE ALL HAVE THEM. PROFESSIONAL TRAINING AND EXPERTISE DO NOT REMOVE US FROM THE IMPACT OF OUR CULTURE, UPBRINGING, WOUNDS, PASSIONS, IDENTITIES, AND PRIVILEGES (MELTON, 2018).

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WE ARE A PART OF THE PROBLEM ….?

BEING AN ALLY, ADVOCATE, AND ANTIRACIST IS NOT IN OUR SCOPE OF PRACTICE: APA'S VISION STATEMENT, MULTICULTURAL GUIDELINES, AND ETHICS CODE SUPPORT PSYCHOLOGISTS SERVING AS AND USING PSYCHOLOGICAL SCIENCE AND KNOWLEDGE TO INFORM POLICY AND PROMOTE SYSTEMIC CHANGE (MELTON, 2018).

CULTURAL COMPETENCE IS A MISNOMER: WE ARE NEVER TRULY CULTURALLY COMPETENT AS DIVERSITY, INCLUSION, EQUITY, ANTIRACISM, AND ALLYSHIP ARE ONGOING SKILL SETS AND NEEDS.

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THE COIN MODEL OF PRIVILEGE

• THE COIN MODEL OF PRIVILEGE:

• THERE ARE NORMS, PATTERNS, BEHAVIORS AND SYSTEMS THAT PRIVILEGE SOME SOCIAL GROUPS OVER OTHERS, SUCH AS SEXISM, HETEROSEXISM, RACISM, ABLEISM, AND CLASSISM

• THESE SOCIAL STRUCTURES CREATE INEQUITIES IN HEALTH, HOUSING, VOCATION, AND EDUCATION (NIXON, 2019).

• INDIVIDUALS AND GROUPS ON THE UP AND DOWN SIDE OF POWER ARE INTERCONNECTED (NIXON, 2019).

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COIN MODEL OF PRIVILEGE

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WHAT IS ALLYSHIP?

• ALLYSHIP: AN INDIVIDUAL OR GROUP ON THE UPSIDE OF POWER WHO ACTIVELY ALLIES WITH, ADVOCATES FOR, AN INDIVIDUAL OR GROUP ON THE DOWN SIDE OF POWER (NIXON, 2019).

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SKILLS FOR ALLYSHIP AND ANTIRACISM: EDUCATION AND OWNERSHIP

• ASK YOURSELF HOW HAVE I BEEN A PART OR THE PROBLEM AND HOW I BENEFITTED FROM SYSTEMIC RACISM?

• IF YOU DID NOT SEE RACISM AND SYSTEMIC OPPRESSION ITS BECAUSE YOU CHOSE NOT TO LOOK AND THAT’S PRIVILEGE AND A PROBLEM.

• APATHY AND SILENCE ARE INTERPRETED AS ACCEPTANCE TO BOTH PERPETRATORS AND VICTIMS OF RACISM (SOUTHERN POVERTY LAW CENTER, 2017).

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SKILLS FOR ALLYSHIP AND ANTIRACISM: EDUCATION AND OWNERSHIP

• TAKE ACTIVE STEPS TO LEARN ABOUT THE SYSTEMS OF INEQUALITY FOR WHICH ONE IS IN A POSITION OF PRIVILEGE (MELTON, 2018).

• LEARN FROM THE EXPERTISE OF, AND WORK IN SOLIDARITY WITH, HISTORICALLY MARGINALIZED GROUPS BUT NOT AT THE EXPENSE OF THEIR WELLBEING (NIXON,2019).

• LEARN FROM EXPERIENTIAL REALITY: HAVE INTIMATE CONTACT WITH PEOPLE WHO ARE DIFFERENT FROM YOU BUT (SUE, 2003). DON’T ENGAGE IN TOKENISM.

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SKILLS FOR ALLYSHIP AND ANTIRACISM: DE-CENTER YOURSELF AND WATCH HOW YOU TAKE UP SPACE

• MAKE SURE BIPOC PEOPLE DON’T JUST HAVE A PLACE AT THE TABLE BUT ARE AT THE CENTER.

• DON’T TRY TO BE A SAVIOR INSTEAD ACT IN SOLIDARITY.

• DE-CENTER YOURSELF AND STEP BACK.

• THIS IS NOT ABOUT YOUR INNOCENCE OR GUILT.

• DO NOT USE ALLYSHIP TO ENHANCE YOUR PERSONAL POWER.

• WHEN WORKING IN COLLABORATION WITH HISTORICALLY MARGINALIZED GROUPS DON’T TREAT THEM LIKE A COMMODITY TO ELEVATE YOUR AGENDA.

(NIXON, 2019).

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SKILLS FOR ALLYSHIP AND ANTIRACISM:INTERACT FROM A PLACE OF EQUITY AND COLLABORATION

• SLOW YOUR ROLL. URGENCY CAN BE A BARRIER.

• PROMOTE INCLUSIVE COLLABORATION AT ALL LEVELS OF REPRESENTATIONAND POWER (SUE, 2003).

• ARE DIFFERENT GROUPS AND PERSPECTIVES REPRESENTED IN THE AGENDAS, ACTIONS STEPS, AND CHANGES YOU ARE MAKING?

• ARE THE CHANGES YOU ARE MAKING REALLY MAKING A DIFFERENCE TO THEPEOPLE YOU ARE TRYING TO ALLY WITH AND ADVOCATE FOR?

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SKILLS FOR ALLYSHIP AND ANTIRACISM:CHANGE AND REPRESENTATION ARE NEEDED AT THE SYSTEMIC LEVEL

• EXPAND OPPORTUNITY AND ACCESS FOR INDIVIDUALS AND GROUPS THAT HAVE BEEN MARGINALIZED AND OPPRESSED (SUE,2003).

• AS A PUBLIC SERVICE PSYCHOLOGIST YOU CAN ENGAGE IN SOCIAL JUSTICE, BE CIVICALLY ENGAGED, AND INFORM/CREATE PUBLIC POLICY. THE HATCH ACT DOES NOT APPLY HERE (MELTON, 2018).

• ACTION IS NEEDED AT THE INSTITUTIONAL, INTERPERSONAL, AND INTERNAL LEVELS (NIXON,2019).

• PEOPLE WITH POWER, PRIVILEGE, LEADERSHIP/AUTHORITY, MUST BE A PART OF THE SOLUTION BUT ACT IN INTERCONNECTION, EQUITY, AND SOLIDARITY WITH MARGINALIZED GROUPS AND PEOPLE ON THE DOWN SIDE OF POWER (SUE, 2003; NIXON, 2019).

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SUMMARY

“IF YOU HAVE COME HERE TO HELP ME, YOU ARE WASTING YOUR TIME.

BUT IF YOU HAVE COME BECAUSE YOUR LIBERATION IS BOUND UP WITH MINE,

THEN LET US WORK TOGETHER.”

LILLA WATSON

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REFERENCES

BAILEY, Z., KRIEGER, N., MADINA, A., GRAVES, J., LINOS, N., BASSETT, M., (2017). STRUCTURAL RACISM AND HEALTH INEQUITIES IN THE USA: EVIDENCE AND INTERVENTIONS. THE LANCET, 389, 1453-1463.

CARTER, R.T., (2007). RACISM AND PSYCHOLOGICAL AND EMOTIONAL INJURY: RECOGNIZING AND ASSESSING RACE-BASED TRAUMATIC STRESS. THE COUNSELING PSYCHOLOGIST, 35 (1),13-105.

CUNNINGHAM, B.A., SCARLATO, A., ENSNARED BY COLORBLINDNESS: DISCOURSE ON HEALTH CARE DISPARITIES ETHNICITY & DISEASE, 28, (1), 235-240.

KRIEGER, N. (2014). DISCRIMINATION AND HEALTH INEQUITIES. INTERNATIONAL JOURNAL OF HEALTH SERVICES, 44, 643-710.

MELTON, M. L., (2018). ALLY, ACTIVIST, ADVOCATE: ADDRESSING ROLE COMPLEXITIES FOR THE MULTICULTURALLY COMPETENT PSYCHOLOGIST. PROFESSIONAL PSYCHOLOGY: RESEARCH AND PRACTICE, 49(1), 83–89.

NIXON, (2019). THE COIN MODEL OF PRIVILEGE AND CRITICAL ALLYSHIP: IMPLICATIONS FOR HEALTH. BMC PUBLIC HEALTH, HEALTH 19, 1637 (2019). HTTPS://DOI.ORG/10.1186/S12889-019-7884-9.

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REFERENCESPETERSON, K., MCCLEERY, E., & WALDRIP, K. (2014). EVIDENCE BRIEF: UPDATE ON PREVALENCE OF AND INTERVENTIONS TO REDUCE RACIAL AND ETHNIC DISPARITIES WITHIN THE VA. VA ESP PROJECT #09-199.

ROSE, T. & ROSEN, S. (2017). HOW STRUCTURAL RACISM WORKS. [RECORDED LECTURE]. RETRIEVED FROM HTTPS://WWW.YOUTUBE.COM/WATCH?V=BC3TWX9IOUE

SAHA, S., FREEMAN, M., TOURE, J., TIPPENS, K., WEEKS, C., & IBRAHIM, S. (2008). RACIAL AND ETHNIC DISPARITIES IN THE VA HEALTH CARE SYSTEM: A SYSTEMATIC REVIEW. JOURNAL OF GENERAL INTERNAL MEDICINE, 23(5), 654-671.

SUE, D.W (2003). OVERCOMING OUR RACISM: THE JOURNEY TO LIBERATION. JOHN WILEY & SONS.

SUE, D.W, (2013). RACE TALK: THE PSYCHOLOGY OF RACIAL DIALOGUES. AMERICAN PSYCHOLOGIST, 68(8), 663–667.

SUE, D.W. (2017). THE CHALLENGES OF BECOMING A WHITE ALLY. THE COUNSELING PSYCHOLOGIST. 45(5) 706–716.

SPANIERMAN, L.B., & SMITH, L., (2017). ROLES AND RESPONSIBILITIES OF WHITE ALLIES. THE COUNSELING PSYCHOLOGIST, 45(5) 606–617

SOUTHERN POVERTY LAW CENTER NEWSLETTER (AUGUST, 2017).TEN WAYS TO FIGHT HATE: A COMMUNITY RESOURCE GUIDE. HTTPS://WWW.SPLCENTER.ORG/SITES/DEFAULT/FILES/COM_TEN_WAYS_TO_FIGHT_HATE_2017_WEB.PDF

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