Racism within the Canadian university: Indigenous students’ experiences

This article extends the investigation and understanding of the impact that everyday racism/microaggressions can have on the academic experience of Indigenous students by examining the racial climate of a major Canadian university to learn about the nature of anti-Indigenous racism. The data from seventeen interviews with students at McMaster University provide a deeper understanding of how Indigenous students perceive and experience racism within the university environment – including levels, impacts and coping mechanisms – and highlight the potential for racism to have a continuing impact on equality and access to education for Indigenous peoples. Subtle, modern racism is playing an active role in the daily lives of Indigenous university students, affecting both their academic and personal success. Despite increasing levels of successful degree completion and the creation of strong support systems, Indigenous students are consistently faced with barriers, including interpersonal discrimination, frustration with the university system and feelings of isolation.     

Ethical Implications of Case‐Based Payment in China: A Systematic Analysis

How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee‐for‐service to case‐based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case‐based payment in the Chinese health care system and applied a systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case‐based payment. Some ethical problems of case‐based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high‐income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient‐physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case‐based payment is currently more ethically acceptable than fee‐for‐service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case‐based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications.     

Germs and Jim Crow: The Impact of Microbiology on Public Health Policies in Progressive Era American South

Race proved not merely a disadvantage in securing access to prompt and appropriate medical care, but often became a life and death issue for blacks in the American South during the early decades of the twentieth century. This article investigates the impact some of the new academic disciplines such as anthropology, evolutionary biology, racially based pathology and genetics had in promoting scientific racism. The disproportionately high morbidity and mortality rates among blacks were seen as a consequence of inherent racial deficiencies that rendered any attempt to ameliorate their situation as futile. While the belief in a different pathology in blacks initially deterred most health officials from taking any action, advances in medicine and microbiology, in particular the germ theory, stirred a variety of responses out of sheer self preservation, as fears among whites at the first sign of an epidemic initiated sporadic and limited actions. Ironically, in an era of deepening scientific racism, public health initiatives based on a better understanding of disease causing microorganisms, gradually improved black health. However, some public health measures were hijacked by eugenicists and racists and, rather than addressing the ill health of blacks, public health policy complied with the new laws of heredity by promoting drastic measures such as involuntary sterilization or even abortion. This further complicated the strained relationship between southern blacks and health care professionals and effected ongoing distrust towards public healthcare services.     

In visible bodies: minority women, nurses, time, and the new economy of care

Health care reform in Canadian hospitals has resulted in increased workloads and bureaucratization of patient care contributing to the development of a new economy of care. Interviews with nurses and visible (non-white) minority women who have given birth in institutions undergoing health care reform revealed that nurses felt compelled to avoid interactions with patients deemed too costly in terms of time. Overwhelmingly, these patients were members of culturally marginalized populations whose bodies were read by nurses as potentially problematic and time consuming. As their calls for assistance go unanswered, visible minority women complained of feeling invisible. Taken in context of historical and contemporary interethnic relations, these women regarded such avoidance patterns as evidence of racism. Obstetrical nurses, too, understood that the new economy of care wrought by health care restructuring has altered nursing practice and patient care to the detriment of minority women.     

Building International Indigenous People’s Partnerships for Community-Driven Health Initiatives

In this article we present an international Indigenous people’s partnership project co-led by two Indigenous communities, Musqueam (Coast Salish, Canada) and Totoras (Quichua, Ecuador), as a community-driven health initiative. The Musqueam-Totoras partnership includes Indigenous organizations, universities, international agencies, government, and nongovernmental organizations to address Indigenous health concerns in both communities. Our collaborative approach provides a framework to (a) increase the development expertise of Indigenous people internationally, (b) increase skills among all participants, and (c) facilitate Indigenous knowledge mobilization and translation to promote cultural continuity. This international Indigenous people’s partnership between north and south reflects the diversity and commonalities of Indigenous knowledge, contributes to cultural revitalization, and minimizes the impact of assimilation, technology, and globalization. Indigenous people’s partnerships contribute to self-determination, which is a prerequisite to the building and maintenance of healthy communities and the promotion of social justice. The exchange of Indigenous knowledge upholds Indigenous values of respect, reciprocity, relevance, and responsibility. Given the history of colonization and the negligence of governments in the exercising of these values with respect to Indigenous communities, this contemporary exchange among Indigenous people in the Americas serves to reclaim these values and practices. International cooperation empowering Indigenous people and other marginalized groups has become fundamental for their advancement and participation in globalized economies. An international Indigenous people’s partnership provides opportunities for sharing cultural, historical, social, environmental, and economic factors impacting Indigenous health. These partnerships also create beneficial learning experiences in community-based participatory research and community-driven health initiatives, provide culturally sensitive research ethics frameworks, increase capacity building, and address basic human needs identified by participating communities.     

Research versus practice: The dilemmas of research ethics in the era of learning health‐care systems

In this article we attempt to answer the question of how the ethical and conceptual framework (ECF) for a learning health‐care system (LHS) affects some of the main controversies in research ethics by addressing five key problems of research ethics: (a) What is the difference between practice and research? (b) What is the relationship between research ethics and clinical ethics? (c) What is the ethical relevance of the principle of clinical equipoise? (d) Does participation in research require a higher standard of informed consent than the practice of medicine? and (e) What ethical principle should take precedence in medicine? These questions allow us to construct two opposite idealized positions on the distinction between research and practice: the integration model and the segregation model of research and practice. We then compare the ECF for an LHS with these two idealized positions. We argue that the ECF for a LHS does not, in fact, solve these problems, but that it is a third, separate position in the relationship between research ethics and clinical ethics. Moreover, we suggest that the ECF for a LHS raises new ethical problems that require additional ethical analysis and justification. Our article contributes to the discussion on the relationship between research ethics and clinical ethics, revealing that although a learning health‐care system may significantly change the landscape of health care, some ethical dilemmas still require resolving on both theoretical and policy‐making levels.     

Looking for immigration law

Culling the Masses by Professors David Scott FitzGerald and David Cook-Martín is an impressive work that makes important scholarly contributions. It analyses the trend in the USA, Canada, Cuba, Mexico, Brazil and Argentina away from explicit racial discrimination in immigration laws. One layer of the book's argument examines how ‘vertical’ (domestic) and ‘horizontal’ (external) forces led these countries to abandon explicit racism. In another layer, the book argues that this anti-racist turn was not a product of democracy. Instead, racist immigration laws were often the product of democratic influences and institutions. The nuanced examination of external influences on national immigration laws in Culling the Masses is an invaluable contribution. However, its inconsistent definition of ‘immigration law’ across countries leaves incomplete both its assessment of racism in the present-day immigration laws, and in turn, its assessment of the relationship between democracy and racism.     

Factors Influencing the Health Behaviour of Indigenous Australians: Perspectives from Support People

Disparities between the health of Indigenous and non-Indigenous populations continue to be prevalent within Australia. Research suggests that Indigenous people participate in health risk behaviour more often than their non-Indigenous counterparts, and that such behaviour has a substantial impact on health outcomes. Although this would indicate that reducing health risk behaviour may have positive effects on health outcomes, the factors that influence Indigenous health behaviour are still poorly understood. This study aimed to interview people who support Indigenous groups to gain an understanding of their views on the factors influencing health behaviour within Indigenous groups in Western Australia. Twenty nine people participated in the study. The emergent themes were mapped against the social ecological model. The results indicated that: (1) culture, social networks, history, racism, socioeconomic disadvantage, and the psychological distress associated with some of these factors interact to affect health behaviour in a complex manner; (2) the desire to retain cultural identity and distinctiveness may have both positive and negative influence on health risk behaviour; (3) strong social connections to family and kin that is intensified by cultural obligations, appears to affirm and disrupt positive health behaviour; (4) the separation between Indigenous and non-Indigenous social connection/networks that appeared to be fostered by marginalisation and racism may influence the effect of social networks on health behaviour; and (5) communication between Indigenous and non-Indigenous people may be interrupted by distrust between the groups, which reduces the influence of some non-Indigenous sources on the health behaviour of Indigenous people.     

Consequences of colonialism: A microbial perspective to contemporary Indigenous health

Nearly all Indigenous populations today suffer from worse health than their non‐Indigenous counterparts, and despite interventions against known factors, this health “gap” has not improved. The human microbiome—the beneficial, diverse microbial communities that live on and within the human body—is a crucial component in developing and maintaining normal physiological health. Disrupting this ecosystem has repercussions for microbial functionality, and thus, human health. In this article, we propose that modern‐day Indigenous population health may suffer from disrupted microbial ecosystems as a consequence of historical colonialism. Colonialism may have interrupted the established relationships between the environment, traditional lifeways, and microbiomes, altering the Indigenous microbiome with detrimental health consequences.     

Application of Ethical Principles to Research using Public Health Data in The Global South: Perspectives from Africa

Existing ethics guidelines, influential literature and policies on ethical research generally focus on real‐time data collection from humans. They enforce individual rights and liberties, thereby lowering need for aggregate protections. Although dependable, emerging public health research paradigms like research using public health data (RUPD) raise new challenges to their application. Unlike traditional research, RUPD is population‐based, aligned to public health activities, and often reliant on pre‐collected longitudinal data. These characteristics, when considered in relation to the generally lower protective ethico‐legal frameworks of the Global South, including Africa, highlight ethical gaps. Health and demographic surveillance systems are examples of public health programs that accommodate RUPD in these contexts. We set out to explore the perspectives of professionals with a working knowledge of these systems to determine practical ways of appropriating the foundational principles of health research to advance the ever growing opportunities in RUPD. We present their perspectives and in relation to the literature and our ethical analysis, make context relevant recommendations. We further argue for the development of a framework founded on the discussions and recommendations as a minimum base for achieving optimal ethics for optimal RUPD in the Global South.     

Gypsies,Celts and tinkers: Colonial antecedents of anti‐traveller racism in Ireland

Post‐colonial nationalist ideologies and practices construct an Irish Republic free of ‘ethnicity’ and ‘racism’. The ethnicization of the Irish Travelling People ('itinerants’, ‘tinkers') and the existence of anti‐traveller racism, however, reveal the limitations of this construction. This article focuses upon the antecedents of anti‐traveller ideologies by concentrating on the period that preceded Irish independence in 1922. The history of Irish itinerancy from the middle ages to the mid‐nineteenth century is first described and located within the context of British colonialism. This is followed by a consideration of scholarly, literary and popular representations of ‘tinkers’ during the late nineteenth century. Three interelated discourses, those of the British Gypsylorists, the Anglo‐Irish Celtic Literary Revivalists, and the folklore of the Irish peasantry, are described and linked to British imperialism, Irish cultural nationalism, and agrarian class relations respectively. It is argued that an analysis of these discourses, grounded in political economy, provides a useful historical context for analyses of more recent constructions of Travellers that have arisen in the course of struggles over a state settlement programme initiated in the 1960s. Through documentation and analysis of historical constructions of Travelling People, especially constructions of their origins, this article aims to challenge contemporary essentialist constructions of both ethnic identity and racism by redirecting attention instead towards the economic and political processes and relations of power that produce difference and inequality within the Irish context. Such analysis can also raise broader issues regarding the existence and specificity of racism in the Irish Republic.     

Targeting Latino men: mass deportation from the USA, 1998–2012

The number of people being removed from the USA on an annual basis is far higher than ever before. The increases in removals since the passage of the 1996 laws have had a disproportionate impact on Mexican and Central American male immigrants. Moreover, the changes made to the laws in 1996 were draconian insofar as they removed judicial discretion in certain removal cases, and the laws were applied retroactively. The raced and gendered disparities in immigration law enforcement are one more instance of institutionalized racism in the USA insofar as these laws primarily harm black and Latino families.     

Utz Wachil: Findings from an International Study of Indigenous Perspectives on Health and Environment

This article reports previously unpublished results of a collaborative study undertaken in 2003 by health workers of the UK-based organisation Health Unlimited, and by researchers of the London School of Hygiene and Tropical Medicine. This study marked the first of a series of collaborative activities aimed at highlighting the situation of Indigenous peoples, some in the most isolated ecosystems of the planet. While many researchers focus on quantitative analysis of the health and environmental conditions of Indigenous peoples, our 2003 study aimed at exploring the views of Indigenous peoples in isolated communities in five countries on their environment and their health. In this article we look closely at the web of knowledge and belief that underpins Indigenous peoples’ concepts of health and well-being, and their relationship to land and the environment. Although many Indigenous people have been forced off their traditional lands and live in rural settlements, towns, and cities, there are still a large number of people living in very small Indigenous communities in remote areas. This article focuses on 20 such communities in six countries. We explore traditional knowledge and practice and its relationship to Western medicine and services. The research findings highlight the importance of Indigenous knowledge systems for the emerging ecohealth community and suggest that we have much to learn from Indigenous peoples in our pursuit of a more holistic science. Utz Wachil is from the K’iche language originating in Totonicapan Department, Guatemala. It translates literally as “fine/well face-ness,” face meaning one’s aspect in general, not only physical appearance.     

Community engagement in global health research that advances health equity

Community engagement is gaining prominence in global health research. So far, a philosophical rationale for why researchers should perform community engagement during such research has not been provided by ethics scholars. Its absence means that conducting community engagement is still often viewed as no more than a ‘good idea’ or ‘good practice’ rather than ethically required. In this article, we argue that shared health governance can establish grounds for requiring the engagement of low‐ and middle‐income country (LMIC) community members in global health research, where such research aims to help reduce health disparities. This philosophical basis has important implications for the ethical goals ascribed to engagement and the approach adopted to undertake it. We suggest the ethical goals of engagement in equity‐oriented global health research should include: (a) generating research topics and questions that reflect the key problems disadvantaged groups face in accessing healthcare, services and broader social determinants of health and (b) promoting the translation of research findings into policy and practice in ways that benefit the health of disadvantaged groups. We propose engagement practice should have the following features: deliberation with LMIC community members to make a range of project decisions, beginning with setting research topics and questions; inclusion of members of disadvantaged groups and those with the power to change policy and practice to benefit them; and purposeful structuring of deliberations to minimize the impact of power disparities between LMIC community members. Finally, we reflect on how these features differ from those typical of much current community engagement practice in LMICs.     

Adjusting the focus: A public health ethics approach to data research

This paper contends that a research ethics approach to the regulation of health data research is unhelpful in the era of population‐level research and big data because it results in a primary focus on consent (meta‐, broad, dynamic and/or specific consent). Two recent guidelines – the 2016 WMA Declaration of Taipei on ethical considerations regarding health databases and biobanks and the revised CIOMS International ethical guidelines for health‐related research involving humans – both focus on the growing reliance on health data for research. But as research ethics documents, they remain (to varying degrees) focused on consent and individual control of data use. Many current and future uses of health data make individual consent impractical, if not impossible. Many of the risks of secondary data use apply to communities and stakeholders rather than individual data subjects. Shifting from a research ethics perspective to a public health lens brings a different set of issues into view: how are the benefits and burdens of data use distributed, how can data research empower communities, who has legitimate decision‐making capacity? I propose that a public health ethics framework – based on public benefit, proportionality, equity, trust and accountability – provides more appropriate tools for assessing the ethical uses of health data. The main advantage of a public health approach for data research is that it is more likely to foster debate about power, justice and equity and to highlight the complexity of deciding when data use is in the public interest.     

Women's Yarning Circles: A gender‐specific bail program in one Southeast Queensland Indigenous sentencing court,Australia

In response to the over‐representation of Australian Indigenous women in the criminal justice system, culturally relevant and gender‐specific bail programs operate in several Queensland Indigenous sentencing courts or Murri Courts. Queensland Murri Courts are a specialist criminal law practice, which includes Elders and respected persons of Community Justice Groups in the sentencing process of Indigenous peoples. This paper explores the role of one gender‐specific bail program, Women's Yarning or Talking Circles, in one Southeast Queensland Murri Court. Women's Yarning Circles aspire to create an Indigenous‐centred space outside of court proceedings where defendants and Community Justice Group members of the same gender can build a rapport. Gender‐specific bail programs aim to recognise the intricacies of an Indigenous woman's intersectional identity and the diverse needs of each defendant that comes before the Murri Court.     

Oh,you're racist? I've got a cure for that!

It has recently been discovered that the beta blocker drug, propranolol, can potentially reduce implicit racial bias among its users. By acting upon the affective conditions associated with implicit racial bias functioning at the non-conscious and pre-conscious levels, researchers have expressed excitement about the potential of propranolol and similar drugs to decrease implicit racial attitudes, and, thus, potentially decrease racism. This study and others like it not only provide indications of an affective component to modern-day racism, but, more importantly, an epistemological shift in the meaning of racism within academia from a social and cultural problem to a medical problem. In this article, we examine this shift in academic discourse towards a pathologization of racism and the implications of this on the sociological study of race and racism.     

Fair Resource Allocation to Health Research: Priority Topics for Bioethics Scholarship

This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non‐domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients. These three topics should be priorities for bioethics research because their outcomes have a substantial bearing on the achievement of health justice. The proposed agenda aims to move discussion on the ethics of health research funding beyond its current focus on the mismatch between worldwide basic and clinical research investment and the global burden of disease. Individual funders’ decision‐making on whether and to what extent to allocate resources to non‐domestic health research, health systems research, research on the social determinants of health, capacity development, and recipients in certain countries should also be the focus of ethical scrutiny.     

How race becomes biology: Embodiment of social inequality

The current debate over racial inequalities in health is arguably the most important venue for advancing both scientific and public understanding of race, racism, and human biological variation. In the United States and elsewhere, there are well-defined inequalities between racially defined groups for a range of biological outcomes—cardiovascular disease, diabetes, stroke, certain cancers, low birth weight, preterm delivery, and others. Among biomedical researchers, these patterns are often taken as evidence of fundamental genetic differences between alleged races. However, a growing body of evidence establishes the primacy of social inequalities in the origin and persistence of racial health disparities. Here, I summarize this evidence and argue that the debate over racial inequalities in health presents an opportunity to refine the critique of race in three ways: 1) to reiterate why the race concept is inconsistent with patterns of global human genetic diversity; 2) to refocus attention on the complex, environmental influences on human biology at multiple levels of analysis and across the lifecourse; and 3) to revise the claim that race is a cultural construct and expand research on the sociocultural reality of race and racism. Drawing on recent developments in neighboring disciplines, I present a model for explaining how racial inequality becomes embodied—literally—in the biological well-being of racialized groups and individuals. This model requires a shift in the way we articulate the critique of race as bad biology. Am J Phys Anthropol 2009. © 2009 Wiley-Liss, Inc.     

Race, Ethnicity, and Racism in Medical Anthropology, 1977–2002

Researchers across the health sciences are engaged in a vigorous debate over the role that the concepts of "race" and "ethnicity" play in health research and clinical practice. Here we contribute to that debate by examining how the concepts of race, ethnicity, and racism are used in medical–anthropological research. We present a content analysis of Medical Anthropology and Medical Anthropology Quarterly , based on a systematic random sample of empirical research articles ( n = 283) published in these journals from 1977 to 2002. We identify both differences and similarities in the use of race, ethnicity, and racism concepts in medical anthropology and neighboring disciplines, and we offer recommendations for ways that medical anthropologists can contribute to the broader debate over racial and ethnic inequalities in health.