Race & Ethnicity in Health Care What are the Issues?

1. Race & Ethnicity in Health Care What are the Issues? Elizabeth Sluyters Kimberly Stoop John Doyle MHST/NURS 620 - Culture and Health Athabasca University 2005

2. Introduction For many years, biological explanations have been used to justify the partitioning of humanity into racial groups. But does this model adequately account for the characteristics of human biological races as they have traditionally been defined? Does this model of humanity account adequately for the biological and genetic variability? Does it do a good job of describing how human populations vary across the earth as well as within and between human populations? And do race models help in the clinical world? This presentation is concerned with making you think about these issues.

3. Race and Ethnicity in Health Care: Some Questions • What is race? • Is race just a social construct? • Is there any biological basis to the notion of race? • Should race ever be a consideration in clinical decision making? • Should race ever be a factor in medical research?

4. What is Race?

5. Race Definitions …. from the Internet • “Members of the same species that can be differentiated by unique characteristics into various groups” • “A taxonomic group that is a division of a species; usually arises as a consequence of geographical isolation within a species” • “People who are believed to belong to the same genetic stock …. but some biologists doubt that there are important genetic differences between races of human beings” http://www.biology-online.org/dictionary.asp?Term=race

6. Statistics concerning race and ethnicity are collected by many agencies, for reasons such as planning or to meet government regulations.

7. What is Race?The Old (Classical) View Naturalists divided mankind into several distinct races. One classification describes five races: the Caucasian, or white race, to which belong the greater part of the European nations and those of Western Asia; the Mongolian, or yellow race, occupying China, Japan, etc.; the Ethiopian, or negro race, occupying most of Africa (except the north), Australia, Papua, and other Pacific Islands; the American, or red race, comprising the Indians of North and South America; and the Malayan, or brown race, which occupies the islands of the Indian Archipelago, etc. http://www.biology-online.org/dictionary.asp?Term=race

8. What is Race?A Modern View Race has no scientific merit outside of sociological classification - it is a biologically meaningless category. There are no significant genetic variations within the human species to justify the division of races.Race is merely a cultural term that people use to describe what a person's ancestry is.

9. What is Race?A “Postmodern” View Race is a meaningless concept that people in power use to suppress other people with different skin pigmentation.

10. What is Race?The Neoclassical View Since the 1990s, data and models from genomics and cladistics (phylogenetic systematics) have resulted in a revolution in our understanding of human evolution, which has led some to propose a new "lineage" definition of race in terms of fuzzy sets, clusters, or extended families. Currently, opinions differ substantially within and among academic disciplines. http://en.wikipedia.org/wiki/Racial_theory

11. Racism … any action, practice, or belief that reflects the racial worldview—the ideology that humans are divided into separate and exclusive biological entities called "races," that there is a causal link between inherited physical traits and traits of personality, intellect, morality, and other cultural behavioral features, and that some races are innately superior to others. Encyclopedia Britannica 2004

12. Race in Biomedicine There is a debate among biomedical researchers about the meaning and importance of race. The primary impetus for considering race in biomedical research is the possibility of improving the prevention and treatment of diseases by predicting hard-to-ascertain factors on the basis of more easily ascertained characteristics. But some fear that the use of racial labels in research risks unintentionally exasperating health disparities, and suggest alternatives to the use racial taxonomies. http://en.wikipedia.org/wiki/Racial_theory#Race_in_biomedicine

13. The Case for Race • Some diseases (like sickle cell disease) occur with much higher frequency in certain racial or ethnic groups. • Some drugs are metabolized at a different rate in different racial or ethnic groups. • Minorities might be poorly represented in clinical trials if race were ignored.

14. The Case Against Race • Diseases which occur with a much higher frequency in certain racial or ethnic groups still occur in other individuals. • At the present time one cannot tell a person’s race from his or her DNA. • In the past race has been used as a means to suppress certain groups.

15. DNA Slight variations in a person’s DNA can have a major impact on whether or not we develop a disease, as well as impact on reactions to drugs and to other therapies.

16. Example: Sickle Cell Disease Sickle cell disease is an inherited condition that is most common among people whose ancestors come from Africa, the Middle East, the Mediterranean basin, and India.

17. Sickle Cell Disease In the U.S., it affects primarily African Americans, about 0.3% of whom have some form of sickle cell disease, and approximately 10% of whom carry the sickle cell trait. There are approximately 80,000 individuals in the United States with sickle cell disease.

18. Race, Ethnicity and Healthcare CRITICAL FORUM LEADERSHIP Readings and discussion questions: Unit 4

19. Literature • Kaufert, O’Neill (1998). Culture, Power, and Informed Consent: The Impact of Aboriginal Health Interpreters. Decisions Making in Health and Canadian Society pg 131 • Williams, P., Domnick, K., Vayda, E. (1998). Women in Medicine: Toward a Conceptual Understanding of the Potential for Change. Decisions Making in Health and Canadian Society. pg 347 • Pfeffer, N., (1998). Theories of race, ethnicity and culture. Obtained from the internet at http://www.bmjjournals.com/cgi/contnet/full/317/7169/1381

20. LITERATURE/READINGS ADDITIONAL READINGS • Garcia, R. (2003). The Misuse of Race in Medical Diagnosis. The Chronicle of Higher Education,49-B15 ADDITIONAL WEBSITES • http://academic.udayton.edu/health/03access/97demora.htm#Ethnicity%20and%20Attitude • http://racerelations.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.nih.gov%2Fsigs%2Fbioethics%2Fculturalcomp.html

21. PARADIGMS • What paradigms are present in the discourse of the topic and what paradigm dominates the discourse? • Justify your answers by referring to evidence of underlying assumptions about the world.

22. POWER • How are the power relations among the differing parties depicted in the discourse about the topic?  • Who is more powerful in the discourse and how does the discourse serve their interests?  • Who is less powerful and how does the discourse create or maintain their powerlessness?

23. SILENCE • What silences are present: that is, what views and voices are not heard?

24. RESISTANCE • What “discourses of resistance” could challenge the dominant discourse about the topic?

25. ACTIONS • Based on the above, what actions could be taken to transform health care in a direction of equity?