Marginalization and Stigma

by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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    00:06 I want to remind you, too, that I talked about making sure we're on the same page in terms of language.

    00:12 So, now, I want to talk specifically about marginalization and then we're going to talk about stigma before we move into some of those bias management strategies just to make sure, again, we're speaking from the same rule book and from the same glossary.

    00:27 So marginalization, you've heard me use the word relegation a lot, so relegation is insignificant and powerless within a society or group.

    00:36 And, relegating, remember what that is, it's putting people in a less than category.

    00:41 And I also want you to imagine about margins on a sheet of paper.

    00:46 You know, we were always taught to stay inside the margins, this is another one of those things and remember I want to remind you this, some things, even as simple as what I'm about to say may make you feel uncomfortable, but I'm going to say it anyway because this is factual.

    01:00 When we think about inside the margins and you heard me mention about centralizing whiteness as the norm, well that's what's inside the margin.

    01:09 Looking at a piece of loose-leafed paper and you look in the left margin, the right margin, now we operate a lot from an electronic space so we can control those margins.

    01:19 Well, that's also what happens in real life; we control those margins and imagine how small a margin is, and putting people in margins for whatever reason.

    01:30 So I just did it from a space of race, but it could also be from a space of economics.

    01:34 If I don't have as much money as someone else, I'm going to put people with less money or in a what I feel is in a less social class in that little small margin.

    01:45 So imagine trying to write a thesis in a margin.

    01:49 So that's what life may be like.

    01:51 We, if trying to function in this life, from birth to death, within that tiny little margin, you can't go but so far, so when we think about those determinants of health and them not improving, we can't ever improve them if we don't take the margins away, so I always talk about erasing the margin.

    02:10 We don't want to expand them, we want to erase them, so that when we think about that there are so many different norms and ways of being, and ways of doing, and that doesn't mean you need to change who you are.

    02:21 It means we need to share that space when we take those margins away, we're all going to operate in this space within what our own personal norms.

    02:30 Or we're not going to try to fit in, we're not going to try to make other people fit in.

    02:34 But we do want to compromise, we want to be flexible, we want to be adaptable without giving up who we are, unless it's negative, right? Unless it's operating from a space of bias and discrimination.

    02:47 Another definition for marginalizing is proliferation of people based on identities, affiliations, experiences and environment.

    02:58 So that's why I like to, even though I may bring up race because that's the most common thing, we need to expand that to think about it beyond race without denying that that is one of the issues we need to talk about and that's the one that makes people most uncomfortable, so we're not going to avoid it.

    03:16 We're not going to going to try to be politically correct because doing this work is not about political correctness.

    03:22 Remember, I said it's appropriately giving things names for the purpose of developing a treatment plan and I don't mean that just in the space of healthcare.

    03:32 I'm just talking about our transforming of treatment and becoming the best human beings that we could be.

    03:38 Again, more different definitions because, again, I like to think from a practical space.

    03:44 So I like to give as many different ways we can view this as possible, so whatever works for you to help you on your transformational journey, that would be the definition I offer you to remember or write down or look up, but whatever will help you to develop your own personal toolbox in your transformational journey.

    04:05 So I love pictures and there's one that is a big fish bowl with one little fish, in that huge fish bowl, when we think about marginalizing.

    04:16 And then there's another small fish bowl with a big fish in it, not much space in there to grow.

    04:21 Thinking about all the different ways that you can make this practical for your use or what are the roadblocks and obstacles for people being their best selves? So think about what your role could be in terms of erasing the margins, moving the roadblocks, removing the obstacles, focusing on all human beings deserving the opportunity for peace and the right.

    04:47 We all have the right to optimal health.

    04:50 We all have the right to live a peaceful life, and authentically and who we are which is why we want to erase those margins.

    04:57 So marginalization is also a spatial metaphor, that's why I gave you those different visuals of those pictures.

    05:04 How do we place people in society? Now, what did I just say? How do we place people in society? The question to ask yourself is, who am I to place someone somewhere? What gave me the right to decide where someone else is placed in society is? I just need to embrace everybody else within the society and allow, don't take up all the space, is what I'm trying to say, because, allow, I don't like that word.

    05:34 Again, who am I to allow somebody? I just don't want to take up all the space.

    05:38 I want to invite people into my space whether I agree or disagree.

    05:43 And even though people are different, I don't want to stick into the space of affinity.

    05:48 I don't want to stick into the space of commonalities and similarities.

    05:53 So the final one relegation to the fringes, think about that.

    05:59 The fringes of society. Being denied economic, political, and symbolic power; and pushing people toward being outside.

    06:09 Let's remember othering, I talked about that, and focus on that word relegation.

    06:13 Again, I talked about less than, but some other synonyms for that would be degradation, degrading people.

    06:20 Again, put yourself in that space, how would you feel if someone degraded you for whatever reason? And downgrading. So lessening is the keyword here, but think about those different little clues and keys, and that will help you to think about marginalization in a more detailed way and help you understand how bias is such a negative thing if we allow it to be.

    06:44 I talked about erasing the margins.

    06:47 There's currently a concept called centering in the margins, and what that refers to is thinking about the norms of those people who are in the margins, and how can I embrace those and, I don't want to use the word allow again, but engage and accept those different norms.

    07:05 So I have to do that from a broad-minded space, global acuity, and what is that match with when you think back? Cultural intelligence.

    07:14 Once we develop moderate to high levels, we get more acuity from a global space and thinking about global citizenship.

    07:23 So we talk a lot about things within our nation, but human beings are all over this world, so we want to think about global citizenship and how can we be good citizens, especially in a day and age of how we partner so much from a global perspective.

    07:41 And that's just not just our responsibility, but it's the responsibility of all human beings in this world and thinking of it as a multiplicity of norms, not one norm.

    07:52 I keep driving that home because that's very important and perspective will always matter.

    07:58 So you do have to own your own perspective, where it came from. Analyze it.

    08:03 Think about how it may be negatively impacting your relationships and focus on how you can make sure it's positive, and also, embracing other perspectives.

    08:13 And think about how society influences not only your own but also other people's perspectives because I will just admit, I'm guilty sometimes of focusing from my own box and then I have to remind myself, wait a minute, that's just your perspective and oftentimes, it's from having conversations.

    08:31 And sometimes conversations that, I'm on a different page with whoever I'm engaging with, but then we always have an understanding.

    08:40 And that understanding is because now I see and understand, okay it's not that they were wrong, I was wrong, it's just different, and different is okay.

    08:49 How do you erase those margins? I told you a little bit already but three key ways to erase them would be employing emotional intelligence, adapting that cultural intelligence framework and practicing it consistently, and then those humanitarian principles, keeping them at the forefront of your mind.

    About the Lecture

    The lecture Marginalization and Stigma by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE is from the course Bias in Healthcare.

    Author of lecture Marginalization and Stigma

     Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

    Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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