That we are criminals, dangerous, prone to violence, volatile, angry.
The People Project is an ever-growing movement of LGBTTQQ2SIA youth of colour and our allies, committed to individual and community empowerment. We are an organization facilitating innovative arts and leadership opportunities for and by Queer & Trans young people of colour and our allies. We work with Black, Indigenous and People of colour. We center our work and advocacy around our Queer, Trans & Two Spirit, Gender non-Conforming members as well as those who are cash-poor, working class, working poor, without status, and street involved.
About the author: The People Project
The People Project, a youth driven project based organizations focused on arts for social change, works in four primary capacities:
- Short and long-term community based education (workshops to 8 month programs)
- Large scale community art projects (murals, short documentaries, photography)
- Training and education for youth service providers
- Support youth led social entrepreneurship
Our movement is committed to individual and community empowerment through alternative education, activism and collaboration.
Join the Conversation
It is important for us to be part of the conversation as the communities we are a part of and work with sit at the intersection of many forms of discrimination because of overlapping or intersecting social identities. We lack influence and are often on the periphery of what dictates health care practices and therefore, we are less likely to get our needs met by institutions. The health care standards that are applied or taught rarely consider our needs but readily pathologize us, which can contribute to distrustful and often disappointing interactions with servicer providers.
We want patients to be encouraged to have a more participatory relationship with healthcare providers who are compassionate, informed and open to integrative practices.
Integrative healthcare utilizes the best therapeutic options from conventional Western medicine, as well as complementary therapies and healing practices, such as herbal medicine, acupuncture, massage, biofeedback, yoga, meditation, and stress reduction techniques. It offers a broad approach to healing that is patient-centered and focuses on the whole person- including their ties to their communities, traditions and support networks.
What impacts our health
Racial inequality in the health care context is most often indirect and systemic. Several factors contribute to serious shortcomings that then show up as health disparities and inequitable access to care. Playing into it are socio-economic factors, the under-representation of racialized groups in the medical profession, the unavailability of culturally sensitive care, and the evidence of discrimination in clinical-decision making and health outcomes.
Health issues and accessibility issues are made worse when we have to navigate the impact of several types of discrimination, for example, racism, transphobia, ableism and classism, among other things.
It can impact our access to healthy food and mean high levels of stress in parts because of having to suffer daily experiences of stigma and discrimination. It means being disproportionately street involved, can lead to severed family and community support networks, and reduce our economic opportunities.
Our communities face high rates of incarceration, deal with racial profiling and targeting by police. We suffer more incidents of police brutality and more deadly outcomes when coming into contact with law enforcement agencies.
In the context of health and health care, it plays out in several ways. For example, A recent study examining racial disparities reveals that people feel more empathy towards white people than towards black people, particularly in the context of medical treatment and the ability to feel pain. This has been coined as the racial empathy gap and it explains how people, including health care providers, assume black people feel less pain, which impacts pain management, diagnoses, treatment plans, and the general quality of the care we get.
The historical roots of a lack of trust
Interpersonal trust between health care providers and patient has been shown to be an important determinant of care because it can help acceptance of recommended care, care seeking, and increase satisfaction with care.
Views of the trustworthiness of health care providers are not so positive for people of colour because of a historical legacy of mistreatment. The records of experimentation by medical professionals globally and locally have taken a severe toll on those relationships. From the Tuskegee syphilis experiment to Indigenous Canadians being subjected to nutritional experiments by the federal government in the 1940s and 1950s as well as being used as medical test subjects, the historical records of medical experimentation on our bodies continues to contribute to a general mistrust between people of colour and health care providers.
There are several other reasons why black people and people of colour mistrust the health care system. One is that healthcare providers often are not members of communities of colour, which can increase the perception, or the reality of, the delivery of care not being culturally sensitive or, of having a higher chance of being mistreated.
Facing negative stereotypes
Then, stereotypes can get in the way too, with sexualized comments directed at Black women and other women of colour, or racist perceptions around ‘angry black women’ or ‘dangerous black men’, which can put us at higher risk of being seen as ‘non-compliant’, of being criminalized, or of being denied care. Same goes with stereotypes of ‘unwed black mothers’ taking advantage of programs and systems, and of reckless baby daddies, can also put us at risk of child apprehension, of being seen as manipulative, and of being denied assistance.
Persistent health disparities may be related to the anxiety we feel about being confronted by these negative racial stereotypes when we seek or receive health care.
Other stereotypes we may face
That we are irresponsible can’t be trusted, non-compliant, unwilling or unaware of how to take care of our health.
That we exaggerate; make up stuff to access resources or programs.
That we are less intelligent, less aware of what is going on in our bodies, that we won’t be able to make informed choices when given medical information.
That there is a universalized Black experience / Indigenous experience / LGBTQ experience / Migrant experience, etc.
That we are unfit parents, not in control of our reproductive health, that we shouldn’t have “more kids”, that we have unplanned pregnancies.
That we are not desirable, or alternatively, that we are promiscuous, over sexualized, have low inhibitions.
That we are vectors of diseases.
That we are addicted to drugs, to alcohol.
The impacts of encountering negative stereotypes in health care settings range from reducing adherence to treatment or treatment plans, damaging communication between patients and service providers, discounting feedback from our care providers, to disengaging from the health care system. It can also lead to reduced motivation to adhere to medication, diet and lifestyle recommendations and increase the rates of race-based clinical decisions.
The last one is important as there is a real threat to our health that comes from basing care on what works for white people, on how injuries look like on white skin or on what symptoms white patients experience.
What does that look like?
“I have experienced first hand the dangerous impacts of medicalized racism. I sustained third degree burns after spilling a pot of boiling water over my arm. After calling the ambulance and having the Emergency medical technicians (EMTs) look at my injury, they determined that it wasn’t serious because my skin didn’t appear red enough so they left. Within minutes the skin on my arm charred to a black dust and the visual cues of the injury became a lot more evident and I had to call the ambulance to return and ended up spending the evening in the emergency room with very serious burns. The assumption that a burn on brown skin looks remotely similar to a burn on white skin almost left me with permanent damage. It was a terrifying experience to be arguing with health care providers about the seriousness of my injury. They both continually remarked how “I looked fine” while dismissing how I felt.”
This is symptomatic of the general inability for medical practitioners to trust communities of colour’s descriptions of our problems. Medial studies are usually conducted within all white groups, not taking into consideration that white people cannot be the default for all human beings. There are many intersecting, cultural and biological elements that are not considered in many of the readily available support tools and resources.
“There is a general feeling of being unwelcome. I recently went to a chiropractor to address my severe lower back and shoulder pain. Upon arrival, the practitioner was short and disengaged. He didn’t extend his hand when he greeted me, offered very little feedback about my condition and ultimately rushed through the process. I was given the bare minimum of effort and the chiropractor showed no interest at all in my physical well-being. This incident was just one of many where I am made to feel like a burden and not a patient.”
Many people of colour perceive, and studies show, that there is a general disregard and lack of empathy when it comes for the health and longevity of people or colour. There is a lack of understanding that racism, and living with its daily manifestations, impacts our health.
So where does it leave us?
It leaves us dealing with the results of what is a long and often sinister history between the health care establishment and Black & Indigenous people (in particular), which include such things as forced sterilization, eugenics and racist studies;
For example, one can look up the work of John Philippe Rushton, a Canadian psychology professor at the University of Western Ontario who became known to the general public during the 1980s and 1990s for research on race and intelligence, race and crime where he argued that Black people had smaller brains than everyone else. Even for those who are not explicitly aware of this history, it has an impact on people’s implicit biases and how we are treated. This can make these relationships incredibly strained.
It is crucial to understand these implicit biomedical biases and how it shows up in the doc’s office. It is important to inform ourselves on the historical construction of a persistent discourse that actively contributes to the conceptualization of black bodies, and the bodies of people of colour, as vectors of diseases, as lesser, and as ‘abnormal’ (versus the white ‘normal’). To this day, it impacts health service delivery as black communities and communities of colour experience it.
Understanding the harms of racism
There is no possible explanation for the barriers experienced by communities of colour when trying to access services or receiving care if we don’t tap into the subconscious and its discourse on black bodies and the bodies of people of colour, and then understand how they are rooted in racism.
Racism takes a huge toll on people’s health! Racism means that people are not going to the hospital if they constantly get mistreated by service providers when they do, that they are not accessing services where they feel unwelcome, that they might use drugs as a coping mechanism, that they might feel anger in the face of injustice, that they experience depression and hopelessness, that they are disproportionately affected by poverty and poor access to resources, etc. There are epidemiological effects associated to experiencing racism and people are literally getting sick from the mistreatment.
What can health care providers do?
Language and trust building
Bring in competent interpreters if a patient speaks a different language as to proceed without one is not in the patient’s best interest.
Make efforts to ensure that the consent of non-English speaking patients is adequately informed and suggest the expansion of the use of interpreters and of the presence of translated consent forms where needed.
Be mindful of and inform yourself about the different ways people can communicate their suffering or their symptoms. Differences in status and culture between doctor and patients can be a barrier to effective communication. If a health care provider is unable to “read” the verbal and non-verbal cues of a patient, the ability to make the right diagnosis or choose the right treatment is reduced. This issue is intimately related to the delivery of culturally sensitive care.
Be aware that some of commonly used language such as “Let’s try this medicine” and behaviours like rushing through an exam can raise fear and worries of experimentation or discrimination. This can easily be offset by using direct and precise language like “This medication works well for people with this problem”. Take your time to build trust and rapport with your patients, respect their pace in disclosure, take the time to answer questions and address their concerns. Use a conversational tone and ask questions too.
Do not make racialized comments about skin or culture or make any assumptions about someone’s background.
Do not try to lapse into overly familiar slang to mirror client or based on stereotypes about our communities.
Give people the opportunity to actively participate and feel valued and respected when discussing treatment plans, how to overcome challenges in adhering to treatment, exploring different modalities to treat symptoms, etc.
Recognize and respect that many community members have chosen family as opposed to close relationships with blood relatives. Ask open ended questions about people’s relationships and respect the relationship dynamics of your patients.
Protect your patients’ confidentiality and privacy. Inform them of their rights in that regard and be upfront about limitations or when you need to share information. Beware of ways in which sensitive information may be unintentionally or carelessly disclosed.
Clinical / practical skills
Educate yourself on clinical signs and symptoms as they manifest in different people. For example, get trained to be able to recognize what jaundice, rashes, inflammation, bruising look like on darker skin.
Educate yourself on how to diagnose pain and illnesses in different people. Look for pain assessment methods that recognize biases affecting communities of colour. Always include the perspective of patients on their symptoms and pain in your assessment of the situation by creating space for patients to explain what they feel and take into consideration the context of their emergency or injury.
Do not assume your patients’ sexual orientation, sexual preferences and behaviours or their gender identity. Do not assume your patients’ pregnancy intentions, pregnancy options, the services they may need, or their family structures. Put measures in place to make sure you facilitate discussions about sexual and reproductive health for all of your patients.
Avoid ‘color blindness’ in your practice. Respectfully ask questions to your patients to ensure you get their perspective on why they are seeking care, on their pain, on their symptoms, on their life circumstances, and on anything else that can impact your ability to give them the best and most responsive care.
Learn the unique cultural background of each patient and note that information on their file. Seek out information that is specific to their ethnic background when it comes to health and health care.
Be mindful that some patients may sustain illnesses for longer because of factors like unstable employment, reduced access to resources, including financial resources, living in unsafe housing or unsafe environments where we are exposed to more toxins, mould, etc.
Ask more questions about health determinants in people’s background.
Always treat your patients with dignity and respect. This includes how you speak to them, how much eye contact you make, how you answer questions, and how much time you take with them.
Your office / your space
Take steps to ensure high standards of treatment by all employees so that all patients feel valued and respected. Post a ‘mission statement’ about the commitment to ensure equitable care.
Put up visible cues about how black people and communities and other communities of colour are valued in your space, such as images of highly valued people of colour, including LGBTQ people of colour, and artwork that reflects the achievements of the community. Have magazines with non-white people, newspapers from local communities, translated materials, etc.
Make your space accessible by, among other things, providing transportation vouchers/bus tickets, having chairs, gowns and tools of different sizes, ramps, international fire exit signs, patient advocates, etc.
When possible, offer complementary therapies at low or no cost. Alternatively, facilitate the integration of many modalities of care in a patient’s treatment plan and work to develop partnerships with other service providers or healers who work with your patients.
Ensure that your intake forms include lots of space to write out names that may be longer, that there is space to identify gender / preferred names and sexual orientation. If race is being captured, ensure there are opportunities to include intersections and people of multiple racialized heritages.
Culturally sensitive delivery of health care
Be aware that equality of access is not ensured by uniformity or a one-size fits “all” approach. Evaluate your practice and explore if the current delivery of services is equitable, and if not, assess how it could be made equitable.
“Indirect discrimination occurs when “exactly the same services are provided to everybody (so that they appear fair) but when for cultural, religious, linguistic or other reasons it is not possible for members of one or more black and minority ethnic groups to benefit equally from them.” Thus, what might appear to be perfectly equitable access (a small town doctor who sees everyone who needs to be seen) may not be (the doctor is male and Muslim women can therefore not be examined by him). By such examples we see that adopting the usually well-meant “colour-blind approach” and treating all people the same does not result in equal access.”
Recruit and retain health care providers, support workers and staff who are black or people of colour. The positive impact of a “match” between patient and clinician cannot be understated as it generally increases service utilisation and reduces drop-out rates.
Make sure that your office / clinic/ hospital / practice offers multilingual information products (pamphlets, consent forms, info sheets, etc.). If you are in a larger health care center, make sure to offer appropriate diets and multifaith facilities. Advocate for “anti-racism service delivery” which means making sure that providers are part of different communities accessing your services and are knowledgeable about issues of race, gender, trans health, power and privilege, among other things.
Make sure people of colour are involved in planning, implementing and evaluating services and that services are appropriate to the needs of communities of colour.
Be mindful of the sometimes difficult and/or antagonistic dynamics between law enforcement and black communities and other communities of colour. Train yourself/your staff in de-escalation techniques to keep your patients safe and make calling law enforcement agencies a last resort.
Inform yourself on cultural content that is relative to the patients needs.
Understand healthcare as not only an issue about an individual’s relationship to their body but as a social and cultural system that is influenced by racial and socioeconomic factors.
Respect the information or knowledge a patient may have about what’s happening in their body. Be open to the idea that the patient has knowledge and information that will be useful in making a complete diagnosis, particularly if the client is from a part of the world that is unfamiliar to the service provider.
Have locations in communities of colour or provide outreach services in neighbouring areas.
Challenge your own bias and prejudice around health, teen pregnancy and other issues that may be prevalent in the local community.
Seek out research published by innovative scholars writing around race and medicine to understand the history of the mistrust black people and communities and other people of colour may have in the health care system. For example, read the work of Dr. Moya Bailey who teaches at Northwestern University and is interested in how race, gender, and sexuality are represented in media and medicine, or about Henrietta Lacks and the history of sterilization in residential schools in Canada and other such abuses by the medical system.
Consult medical research and journals from countries where clients have immigrated from, recognizing that even that information is incomplete. Even if there are certain genetic differences among populations, we know that self-reported race is at best a crude proxy for indicating them.
Be aware that studies often do not adjust for all other variables besides genetics, such as socioeconomic status, culture, and discrimination – meaning if differences are shown, the knee-jerk tendency to think biology might overshadow important environmental disparities that deserve our attention.
Be mindful of how, historically, ethnicity in research has been abused by pseudo scientists with racist agendas to demonstrate the superiority of certain people over others.
Recognize the importance of having culturally relative care, staff and service providers who can read cues from different people and communities as it will generate stronger relationships of trust. The absence of service providers who are culturally familiar greatly influences whether clients will visit the clinic. Be an advocate in your community to continue expending access to quality health care for all.
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