Racism and Discrimination in Healthcare
Healthcare systems are microcosms of the larger society in which they exist. Where there is structural violence or cultural violence in the larger society, so will there be evidence of systematic inequities in the institutions of these societies. The healthcare system in Australia is one example—from an excess of similarly situated healthcare systems—in which the colour of a patient’s skin or the race of his parents may determine the quality of medical received. Life expectancy and infant mortality rates are vastly different for non-Aboriginal, Aboriginal, and Torres Strait Islanders residing in Australia. The life expectancy of Aboriginal men is 21 years shorter than for non-Aboriginal men in Australia. For women, the difference is 19 years. The infant mortality rate of Aboriginal and Torres Strait Islander male infants is 6.8% and the infant mortality rate for female infants is 6.7%. For non-Aboriginal infants, the infant mortality rates are 1% for male infants and 0.8% for female infants. Further, the Aboriginal population is subject to a wide-range of diseases that do not exhibit comparatively high incidence rates in non-Aboriginal Australians.
To say that racism is institutional is to refer “to the ways in which racist beliefs or values have been built into the operations of social institutions in such a way as to discriminate against, control, and oppress various minority groups” (Henry et al, 2004). Institutional racism is a facet of structural violence—but is by definition restricted to structural violence or cultural violence for which race is the means and with racial bias or prejudice the sustaining element.
Structural violence is differentiated from direct violence both in terms of nature. Direct violence is a result of events or the actions of individuals that kill or harm people. Structural violence, on the other hand, is a phenomenon made manifest through social inequalities (Christie, 1997). The organizational structures of political and economic systems cause and sustain the sort of hierarchical relations that enable dramatic differences between and across sectors of societies. Within these hierarchies, the people at the top have privilege, wealth, and power, while those at the bottom of the hierarchy are dominated, oppressed, and exploited (Christie, 1997). People are harmed and killed as a result of structural violence but, unlike direct violence, it occurs more slowly. The harm or death of oppressed people may come about because “some people are deprived of food, shelter, healthcare, and other resources” (Christie, 1997). Because structural violence is embedded in a society’s way of being, over the long-term, groups of people may not be able to meet their basic needs to the degree that normal development and growth is impacted.
In the 1960s, Johan Galtung posited the construct of violence as a phenomenon generated by the existence of social barriers that deny needs satisfaction in certain sectors of society. Galtung's conceptual framework illustrates the relationship between the structure of society and the inequalities experienced by its citizens. Gilman's seminal definition of structural violence reads, “Physical and psychological harm that results from exploitive and unjust social, political, and economic systems” (1983, p. 8).
Direct violence is referred to by Galtung as the “tip of the iceberg,” under which are the twin invisible aspects of cultural violence and structural violence. Cultural violence occurs when people justify their actions because of what they believe. Structural violence occurs when people are kept from achieving their full potential because of political and economic structures. Both cultural and structural violence can be reinforced by direct violence. Gilman argues that structural violence is a form of “physical and psychological harm that results from exploitive and unjust social, political, and economic...
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