Chapter 1: History of Race and Racism

Important Concepts and Definitions

Race is a way to categorize humans by their physical qualities, such as skin colour, eye shape, or hair texture (Smedley et al., 2020; Thurman et al., 2019). The concept of race was introduced in the 1600s, when Europeans were colonizing the Americas, Africa, Australia, and many parts of Asia (Santos Zanchetta et al., 2021; Smedley et al., 2020). By the 1700s, race was widely used to sort and rank people in society. It gave higher social status to White people and lower social status to Black, Brown, and Indigenous people (Smedley et al., 2020). These ideas about racial hierarchies were then put into laws, policies, and social practices. Many still exist in Canada today (Smedley et al., 2020; Thurman et al., 2019).

However, people in one racial group are not biologically or genetically distinct from people in others (Ackerman et al., 2019; Smedley et al., 2020). Across races, humans have much more in common biologically than not (Ackerman et al., 2019; Smedley et al., 2020). Race does exist, but racial differences are created by society (Ackerman et al., 2019; Iheduru-Anderson et al., 2020; Smedley et al., 2020; Thurman et al., 2019). This is known as a social construct: over time, society has pointed out certain physical traits of humans to divide people nto groups, deeming one group superior and other groups inferior (Iheduru-Anderson et al., 2020; Thurman et al., 2019). Race is then “used as a basis for privilege and economic exploitation” (Iheduru-Anderson et al., 2020, p. 116). Race is used to create racism.

Racism is “a system of oppression and privilege based on race” (Iheduru-Anderson et al., 2020, p. 115). It is a combination of racial prejudice and social power. This means that for racism to exist, there must be discrimination coming from those who have more social power than the people facing the prejudice (Calgary Anti-Racism Education, n.d.). In Canadian society, it is White people who hold the social power when it comes to race. Therefore, White people cannot face racism, but all other racial groups in Canada can and do. Racial prejudice can be any discriminatory or derogatory behaviour, attitude, or belief that is based on views about race (Calgary Anti-Racism Education, n.d.; Iheduru-Anderson et al., 2020). Racism both influences and happens in economics, employment, politics, health, justice, education, and the environment. It can come from individual people, groups, companies, institutions, or major social structures (Coleman, 2020; Iheduru-Anderson et al., 2020; Thurman et al., 2019).

Racism causes negative health outcomes for Indigenous, Black, and Brown people (Coleman, 2020; Iheduru-Anderson et al., 2020). As Coleman (2020) noted, “Studies have linked racism to higher mortality rates, earlier onset of more severe and progressive diseases, and higher levels of comorbidity and impairment” (p. 642). These phenomena are known as racial health inequities. Yet, because people of different races are not genetically or biologically different, these health inequities are not because of physical race. They are due to the social determinants of health, one of which is racism (Coleman, 2020). The social determinants of health are defined as a set of life conditions that influence a person’s health. They include income, employment, education, health literacy, early childhood development, food security/insecurity, housing, environment, social safety networks, access to health services, gender, race/racism, Indigenous status, and disability (Gibson, 2024). In recent years, people saw how several of the determinants of health, including poverty, physical environment, and race, had a considerable effect on COVID-19 outcomes (Gibson, 2024). This textbook will examine multiple racial health inequities and their causes among the social determinants of health. It will also address how health care providers can consider these in their daily interactions with clients they meet in the community and hospital.

Systemic racism (also called institutional racism) is one of the main factors that leads to racial health inequities (Coleman, 2020; Thurman et al., 2019). It is “the differential access to goods, services, and opportunities of society by race” (Thurman et al., 2019, p. 91). Canada’s major systems like the health system, education system, and justice system were built long ago through colonialism. These systems give advantages to White men (the people who built them). Whiteness is inherent in them. This means that White people are seen as the norm or the default, and as superior (Bonini & Matias, 2021). Whiteness is also a social construct, and it includes everything that it means to be “White” (Bonini & Matias, 2021). It upholds White supremacy (Bonini & Matias, 2021). In systems created by White people, people of all other races are seen as deficient, inferior, or “other”—that is whiteness in action (Bonini & Matias, 2021). Therefore, when Black, Brown, or Indigenous people use these systems that were developed for White people, they often face racism and its harmful effects.

The Whiteness of the Nursing Profession and Whiteness in Nursing Education

As this textbook will show, people in marginalized groups often have health inequities compared to people in groups with power. Marginalized groups include people with dark skin, accents, physical disabilities, neurodiversity, 2SLGBTQIA+ identities, vulnerable mental health, low socioeconomic status, large body sizes, unstable housing, and low levels of education, among other things (Duckworth, 2020). People facing one type of oppression experience discrimination, but if someone is marginalized in more than one way, their experiences can be unique and exponentially worse. This concept is called intersectionality.

Scholar Kimberlé Crenshaw coined the term intersectionality in 1989 as she studied the experiences of Black women who were oppressed due to racism and sexism (Ruiz et al., 2021). However, the discrimination they faced was different from the racism felt by Black men and the sexism felt by White women. The sexism and racism combined to make their experiences uniquely oppressive (Ruiz et al., 2021). As Ruiz et al. (2021) stated, “While all women are impacted by patriarchy, ethnic minority women face inequality based on gender, race, and class” (p. 2). Big systems of oppression like racism, sexism, ableism, classism, homophobia, and anti-fat bias are interlocked (Ruiz et al., 2021). Oppressions do not just add up, they multiply (Ruiz et al., 2021). Intersectionality affects how people are seen by society and how much power they have, which then strongly impacts their health and well-being (Ruiz et al., 2021). In nursing, one of our main purposes is to eliminate health inequities. Intersectionality helps us start that process by looking at all the power imbalances and marginalization that lead to the health inequities.

YouTube video to embed: “Intersectionality and Health Explained” https://www.youtube.com/watch?v=rwqnC1fy_zc

Some of the core values central to nursing are advocacy, social justice, and optimization of health for clients, families, and populations (Bonini & Matias, 2021). What can we do to combat racism and eliminate racial health inequities as nurses and nursing students? Something we can do is employ cultural safety, which means to “critically reflect on [our] views of the world and the values and attitudes [we] bring to practice, and to be reflexive in [our] relationships with individuals and populations” (Greenwood & Fyers, 2018, p. 229). Another action we can take is to learn about racial health inequities and their social causes, then work toward eliminating the inequities. This is an example of anti-racism, which is the process of actively recognizing and opposing racism (Kendi, 2019). By learning how to assess patients of colour effectively, as well as taking action to end racial health inequities, we are actively engaging in cultural safety and anti-racism.

References

Ackerman, R., Athreya, S., Bolnick, D., Fuentes, A., Lasisi, T., Lee, S., McLean, S., & Nelson, R. (2019).        American Association of Biological Anthropologists statement on race and racism. American Association of Biological Anthropologists. https://physanth.org/about/position-statements/aapa-statement-race-and-racism-2019/

Bonini, S. M. & Matias, C. E. (2021). The impact of Whiteness on the education of nurses. Journal of Professional Nursing, 37(3), 620–625. https://doi.org/10.1016/j.profnurs.2021.02.009

Calgary Anti-Racism Education. (n.d.). The basics: Level 1. https://www.aclrc.com/the-basics-level-1

Coleman, T. (2020). Anti-racism in nursing education: Recommendations for racial justice praxis. Journal of Nursing Education, 59(11), 642–645. DOI: 10.3928/01484834-20201020-08

Duckworth, S. (2020). Wheel of power/privilege [Figure]. Flickr. https://www.flickr.com/photos/sylviaduckworth/50500299716/

Gibson, D. (2024) Health and wellness. In B. Astle & W. Duggleby (Eds.), Potter and Perry’s Canadian Fundamentals of Nursing (7th ed., pp. 1–18).

Greenwood, S. & Fyers, K. (2018). Epistemological development in first-year nursing students undertaking cultural safety education. Journal of Nursing Education, 57(4), 229–232. DOI: 10.3928/01484834-20180322-07

Iheduru-Anderson, K., Revis Shingles, R., & Akanegbu, C. (2020). Discourse of race and racism in nursing: An integrative review of literature. Public Health Nursing, 38, 115–130. DOI: 10.1111/phn.12828

Kendi, I. (2019). How to be an antiracist. Random House.

Ruiz, A. M., Luebke, J., Klein, K., Morse, K., Gonzalez, M., Dressel, A., & Mkandawire-Valhmu, L. (2021). An integrative literature review and critical reflection of intersectionality theory. Nursing Inquiry, 28(e12414), 1–11. https://doi.org/10.1111/nin.12414

Santos Zanchetta, M., Cogent, M., Rahman, R., Byam, A., Carlier, P., Foubert, C., Lagersie, Z., & Espindola, R. F. (2021). Blindness, deafness, silence, and invisibility that shields racism in nursing education-practice in multicultural hubs of immigration. Journal of Professional Nursing, 37(2), 467–476. https://doi.org/10.1016/j.profnurs.2020.06.012

Smedley, A., Takezawa Yasuko, I., & Wade, P. (2020, November 23). Race. In Encyclopedia britannica. https://www.britannica.com/topic/race-human

Thurman, W. A., Johnson, K. E., & Sumpter, D. F. (2019). Words matter: An integrative review of institutionalized racism in nursing literature. Advances in Nursing Science, 42(2), 89–108. DOI: 10.1097/ANS.0000000000000265