Intersectional insights into racism and health: not just a question of identity

Shannon, Geordan; Morgan, Rosemary; Zeinali, Zahra; Brady, Leanne; Couto, Márcia Thereza; Devakumar, Delan; Eder, B; Karadağ, Özay; Mukherjee, Mala; Peres, Maria Fernanda Tourinho; Ryngelblum, Marcelo; Sabharwal, Nidhi S.; Schonfield, Amos; Silwane, Pamela; Singh, David Emmanuel; Ryneveld, Manya Van; Vilakati, Siyasanga; Watego, Chelsea; Whyle, Eleanor; Muraya, Kui

doi:10.1016/s0140-6736(22)02304-2

Cited by 47 publications

(28 citation statements)

References 44 publications

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“…There is increasing evidence it not only effects the discriminated groups but all groups within. Changing these systems requires doctors that can support legal and political measures and empowerment of affected communities to promote change [ 9 , 10 , 12 , 48 , 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Applicability of working abroad for physicians with a specialization in Global Health and Tropical Medicine

et al. 2023

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Background In The Netherlands, physicians specialized in global health and tropical medicine (Ps-GHTM) are trained to work in low-resource settings (LRS) after their training program of 27 months. After working for a period of time in LRS, many Ps-GHTM continue their careers in the Dutch healthcare system. While there is limited evidence regarding the value of international health experience for medical students and residents, it is unknown to what extent this applies to Ps-GHTM and to their clinical practice in the Netherlands. Methods In this qualitative study we conducted semi-structured interviews and focus group discussions (FGDs) with Ps-GHTM to explore the perceived applicability of their experience abroad for their subsequent return to the Netherlands. Topic guides were developed using literature about the applicability of working abroad. Findings from the interviews served as a starting point for FGDs. The interviews and FGDs were analysed using directed content analysis. Results 15 themes are described relating experience abroad to healthcare delivery in The Netherlands: broad medical perspective, holistic perspective, adaptive communication skills, creativity, flexibility, cultural awareness, self-reliance, clinical competence, cost awareness, public health, leadership, open-mindedness, organization of care, self-development, and teamwork. Highlighting the variety in competencies and the complexity of the topic, not all themes were recognized by all respondents in the FGDs nor deemed equally relevant. Flexibility, cultural awareness and holistic perspective are examples of important benefits to work experience in LRS. Conclusion Ps-GHTM bring their competencies to LRS and return to the Netherlands with additionally developed skills and knowledge. These may contribute to healthcare delivery in the Netherlands. This reciprocal value is an important factor for the sustainable development of global health. Identifying the competencies derived from work experience in LRS could give stakeholders insight into the added value of Ps-GHTM and partly help in refining the specialization program.

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Section: Discussionmentioning

confidence: 99%

Applicability of working abroad for physicians with a specialization in Global Health and Tropical Medicine

et al. 2023

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“…It is often difficult to delineate the boundaries of violence and the motivations for which it occurs. But the vulnerability of marginalized people is recognized in the literature, and they need to continue to be highlighted, as this violence continues to occur (Shannon et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

A National Study on Psychological Violence in Brazil: Differences by Sex and Skin Color

Garcia Neves,

Goulart Peres,

Nogueira Gonzalez

et al. 2023

J Interpers Violence

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Violence is a global public health problem that affects especially the most vulnerable people. The aim was to analyze the prevalence of psychological violence in the Brazilian population and inequalities according to sex and skin color. This was a cross-sectional study in which the database of the National Health Survey 2019 was used. Psychological violence was considered present when an individual answered yes to at least one of the five variables investigated: In the last 12 months, has anyone (a) offended you, humiliated you, or ridiculed you in front of other people?; (b) yelled at you or called you names?; (c) used social media or cell phones to threaten, offend, curse, or expose your images without your consent?; (d) threatened to hurt you or hurt someone important to you?; and (e) destroyed something of yours on purpose? The independent variable was skin color. The crude prevalence ratio (PR) was determined by Poisson regression. All analyses were stratified by sex. Of the 88,531 respondents, 41,662 were males and 46,869 were females. The prevalence of the presence of psychological violence was 19% in women and 15.6% in men. Men and women with black/brown/yellow/indigenous skin color were 20% and 15% more likely to suffer one or more items of psychological violence, respectively, than men and women with white skin color ( PR = 1.20; 95% CI [1.11, 1.30] and PR = 1.15; 95% CI [1.08, 1.23]). Psychological violence occurred predominantly against females and individuals with black/brown/yellow/indigenous skin color. There were notable inequalities in the exposure to this type of violence that need to be considered when making plans to address this problem. The findings emphasize the relevance of constantly reviewing political and social constructions to promote a reduction of inequalities.

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“…This situation may explain the difference in the way minoritised groups rate their breast cancer care experience. Institutional oppression is not unique to the UK, with evidence suggesting that embedded racism and discrimination in healthcare institutions is a global issue (Shannon et al, 2022b). Therefore, similar differences in breast cancer experience may occur in other countries.…”

Section: Discussionmentioning

confidence: 99%

“…Rather, through intersectional lenses, socially-constructed identities (e.g., gender, ethnicity), occurring within broader contexts (e.g., culture, religion) and power structures (e.g. racism, discrimination) are seen to operate simultaneously to create privileges or challenges at the point they intersect (Hankivsky et al, 2010, Shannon et al, 2022a). It is at this intersecting social location where it is understood that unique social and health inequities arise (Sayani, 2017).…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study

de Mesa,

Marcu,

Ream

et al. 2023

Preprint

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PurposeGuided by the intersectionality framework, we examined the differential in breast cancer care experience across population subgroups in England.MethodsSecondary data analysis using the 2017/2018 English National Cancer Patient Experience Survey (NCPES). We applied disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with deprivation status. We then applied multivariable logistic regression (odds ratios, 95% confidence intervals) to ascertain the relationship of reporting a positive care experience adjusting for patient, clinical, and trust-level factors.ResultsPoorer breast cancer care experience was mostly reported by the most deprived younger and minoritised ethnic groups. Similar findings were observed in adjusted multivariable analyses. Younger respondents were less likely than older patients to rate their care favourably. Pakistani, Indian, Chinese, and Black African women were less likely than White British women to rate their care favourably. Respondents from the most socioeconomic deprived backgrounds were less likely than the most affluent ones to rate their care favourably.ConclusionThere is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalization to inform improvement initiatives targeting patients at higher risk of vulnerability.

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Intersectional insights into racism and health: not just a question of identity

Cited by 47 publications

References 44 publications

Applicability of working abroad for physicians with a specialization in Global Health and Tropical Medicine

Applicability of working abroad for physicians with a specialization in Global Health and Tropical Medicine

A National Study on Psychological Violence in Brazil: Differences by Sex and Skin Color

Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study

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