Discrimination and inequities can affect women at many different points in the process and experience of health and health care. Institutional Racism shapes the context in which people live. It does not refer to interpersonal discrimination, but rather to the historical factors that have privileged and oppressed certain groups, current structural factors (also known as structural violence), and the failure of society to acknowledge and/or address these structural differences. Institutional racism and structural violence affect people in many different ways. First of all, they shape the risk factor exposures of populations, making them more likely to develop certain health conditions related to factors such as pollution or living in a violence-filled community. Structural violence may also constrain access to valuable resources that could be protective for good health. Limited access to fresh produce and green space for exercise actually constrains the health behaviors of the people who live in the areas of poor access (Curtis 2004). The stress experienced by people in response to being marginalized by society, be it geographically, politically, or socially also increases the risk for the development of many health conditions, including cardiovascular disease, depression, and diabetes (McClure, et al 2010) (Panchanadeswaran and Dawson 2011). Therefore, at the community level, racism and structural violence have already increased the propensity for poor health of minority and low-income women.
Access to health care, which is related to structural violence, is shaped by geographical and social context. Access is influenced by geographical proximity and availability of transportation, affordability, health literacy, availability of services in terms of number of providers and hours of operation, as well as other factors. Therefore, there are many opportunities for barriers to present themselves in the effort to access health services. Limited acceptance of Medicaid as an insurance provider and the high cost of health care can be especially significant deterrents for preventive care visits necessary to good health.
Quality of care is another important aspect of health care services to consider. Although we would all hope that everyone receives the same quality of care when they visit health care facilities, many studies have demonstrated that the quality of health care varies by the racial/minority status of the patient being treated (Berry 2008)(Fiscella, et al. 2000). Quality of care also relates to cultural competence (or cultural humility), which encompasses being aware of one´s own culture, providing care in a language in which the patient feels comfortable communicating, respecting a patient´s cultural traditions and preferences and providing accordingly appropriate care.
Scope and relevance of care is an overlooked but also crucial piece of health equity. Ignoring the needs of a patient population or not providing the needed services to this community (or not enough of the needed services) means providing incomplete or low quality care (Barnes-Josiah 2004). For example, if a clinic fails to address a health threat such as violence against women that has presented itself in the community the clinic serves, it is aiding in the perpetuation of that violence and the health inequities that result from it.
For further reading on race and racism:
“Undoing Racism in Public Health: A Blueprint for Action in Urban Maternal and Child Health” (PDF)
“Maternal Nutrition and Infant Mortality in the Context of Relationality” (PDF)
“Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality” (PDF)
Dr. Camara Jones describes three kinds of racism
Segment excerpt from “When the Bough Breaks”: Unraveling the mystery of Black-white differences in infant mortality
Video Clips and Information about the Series: Un-Natural Causes…Is Inequality Making Us Sick?
Links to several videos compiled by creators of the website for Race: The Power of an Illusion
For further reading on health disparities:
Kaiser Family Foundation Disparities Policy page
American Psychological Association
Fact Sheet: Health Disparities and Stress
National Conference of State Legislatures
Thanks to the Midwives´ association of Washington state for identifying these resources