Structural Racism, Bias, and Discrimination

00:06 So, in talking about all this work, I just want to address the elephant in the room.

00:10 You know, it's uncomfortable.

00:12 So I'm just gonna lay a foundation and say that even though something's uncomfortable, we can avoid it, especially in the space of health care and organizational wellness.

00:22 So what I liken this too, is I have diagnosed people with cancer before.

00:27 And it was very hard to walk into a room and tell someone they have cancer, and it was harder for them to hear that.

00:34 However, if I didn't put a name to it, then I couldn't create an accurate health care plan.

00:40 So it's the same thing when we talk about some of these concepts that are around DEIB. One of those is structural racism.

00:49 And what structural racism is just foundations that created all these systems through interconnection of public policies, institutional practices, cultural representations, I'm sorry, and other historic traditions.

01:04 And all these things work together to reinforce and perpetuate racial group identity.

01:09 Well, what happens is, it's okay to have those different identities but the problem comes in when we advantage one group and disadvantage another group.

01:18 So historically, what has happened is that this system of structural racism, institutional racism, you hear all those things working together, is that it centralizes whiteness as the norm and marginalizes and disadvantages non white people.

01:34 So what I want to acknowledge there is that, does that mean that I'm shaming and blaming white people? Absolutely not.

01:41 What we're saying is we're going to talk about what led us to where we are, and how can we work toward undoing that? How can we take away privileges that aren't earned, for any human being? Doesn't matter what your race is, what your ethnicity, nationality, what your gender is? How can we take that away and think about humans? The next word would be bias.

02:04 So bias happened as a result of the racist issues and ethnocentrism, which is when you show favoritism towards your own ethnicity.

02:15 We can all do that.

02:17 So what I like to say is because I'm from Louisiana, ethnocentrism in terms of cuisine. Right? Sometimes I'm like, "Oh, yeah, we have the best food in the world." And that's okay for me to say that.

02:28 But if I disparage it to someone else's food, because I'm comparing and mine is so much better than that's wrong.

02:35 And it's insulting to other people, if I encourage people to be discriminatory.

02:40 So that's a simple example. But it goes way beyond that.

02:44 And that's where, why we're here to talk about how it impacts people negatively in terms of leadership positions, in terms of people having health equity, which is my biggest passion with doing this work.

02:57 So what is bias? Is when you show prejudice.

03:00 Is prejudice, the same thing as racism? Absolutely not.

03:04 You have prejudices within racists, you have prejudices within gender.

03:08 But it's when you show prejudice in favor of or against one thing person, group compared to someone else, usually, in a way that's unfair.

03:17 So going back to those disadvantages.

03:20 It also is a way to advantage people because we know there are biases, the favoritism that happens when people get things that they don't necessarily deserve.

03:30 So some other synonyms when we think about bias, think about being partial, think about showing favoritism, being unfair, being intolerant, and bigotry, all those things happen as a result of their favoritism.

03:43 So another key term, if we're going to move forward in this is discrimination and understanding what it is and I just gave a few examples.

03:52 But usually what happens is we show unfair or prejudicial treatment to people in groups because of characteristics like race, gender, gender identity, age, sexual orientation, ability identification, social class, nationality, body composition, financial status, religious beliefs, practices, and affiliations or any other characteristic about certain individuals, that we, in our ethnocentric ways label as abnormal, and are not in alignment with what the norm is.

04:24 So when we think about that, we have to know that there's more than one norm and that's where cultural intelligence comes into place where we recognize that people are allowed to have different ways of being.

04:36 The other thing when we talk about discrimination is broad.

04:40 So usually the treatment is unjust.

04:44 That is where it becomes dangerous and leads to health inequities.

04:48 That's where it happens where people are unhappy in organizations and end up leaving, right? But differential treatment based on all those characteristics that I just talked about, typically you can recognize discrimination based on some of those behavioral manifestations such as being hostile, bullies at work, injurious treatment, talking to patients in very demoralizing ways, patients and families.

05:15 And I want to stick to that for a minute when we talk about talking to patients.

05:19 I want you to focus on being vulnerable, when you're a patient, no matter who you are, no matter what those characteristics or putting yourself in the care and hands of somebody else's.

05:31 That takes a lot.

05:32 And so typically, we don't have a whole long time to build trust with the patient or their family, right? So you want to come in there and be sincere and genuine, fair, honest, because otherwise, that jeopardizes people's health.

05:46 Why? They won't tell you all the issues that they're going through because they don't trust you.

05:51 So even if you're having a bad day, you cannot bring your bad day into a patient's room.

05:57 I typically tell people that when you get out of your car and you close your car door, leave all your problems and issues in your car.

06:05 At the end of your shift, you can pick that back up.

06:08 But we don't want that to impact relationships period, but especially when we talk about patients and patient safety and sentinel events, which we'll talk more about further along in the series.