Journal Club - Racism is a Public Health Problem
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Ijeoma Oluo, author of "So You Want to Talk About Race"
Background
In the United States, racism is a critical public health problem, permeating everyday systems including educational and health care systems; criminal justice and legal systems; financial, housing, and economic systems; environmental issues and beyond to create differential health outcomes that adversely affect Black, Indigenous, and other people of color. This pervasive system of power is based on the socio-politically constructed notion that non-Hispanic white people are inherently superior to people of color (Black, African American, Indigenous, Native American, Alaska Native, Native Hawaiian, Pacific Islander, Asian, Latine, Hispanic) and this ideology operates across multiple levels (individual, interpersonal, institutional) to unjustly advantage non-Hispanic white people, unjustly disadvantaging people of color. We recognize that racism is an important cause of health disparities and that, as health care providers, we have a responsibility to educate ourselves about racism so that we will be prepared to acknowledge the impact of racism on our patients’ health and work towards more equitable systems in support of health equity. One important component of that education is learning how to engage in productive conversations about race and racism.
In service of that goal, we chose Ijeoma Oluo’s book, So you want to talk about race, as our common read for this special Journal Club session.
Chapters discussed
1. Introduction
2. Chapter 1: Is it really about race?
3. Chapter 2: What is racism?
4. Chapter 3: What if I talk about race wrong?
5. Chapter 5: What is intersectionality and why do I need it?
6. Chapter 12: What are microaggressions?
7. Chapter 17: Talking is great, but what else can I do?
Introduction and Chapters 1&2 - Is it really about race? What is racism?
““Racism is any prejudice against someone because of their race, when those views are reinforced by systems of power.””
Ijeoma Oluo introduces So You Want to Talk About Race by offering that her experiences as a Black, queer woman living in US society have deeply affected her life. She describes growing up in poverty, the daughter of a Nigerian father and a white mother and begins by discussing the often-argued notion that the inequities we observe in US society are the result of class rather than race. She explains that our country was founded using racial oppression – the genocide of Indigenous people and enslavement of Black people – and was intentionally designed to benefit white men by stealing both land and labor from people of color. Systems were designed to maintain the wealth and privilege of those in power – white men – to the detriment of people of color. Our society and institutions continue to function in a manner that maintains this racist system, creating the many inequities we observe in health, education, and many other important outcomes. Oluo suggests that forms of oppression in US society are like cancer: classism is like one type of cancer and racism is another; treating one will not cure the other, so both need to be addressed. She argues that fighting racism is not about changing the minds of individual people, but rather changing the racist system that is designed to be self-perpetuating.
Olou defines racism as, ‘Any prejudice against someone because of their race, when those views are reinforced by systems of power.’ She believes that when we define racism as only ‘prejudice against someone because of their race,’ we reduce racism in America to be about individual racist people, rather than the larger system of oppression that it actually is.
Chapter 3 - What if I talk about racism wrong?
Talking about race and racism can be challenging and uncomfortable; however, being able to participate in productive conversations on these topics is critical to our ability to combat racism and advance health equity. Oluo asks readers to lean into their discomfort understanding that such conversations will not always go smoothly and that we will inevitably make mistakes. She offers some suggestions and strategies that can help us to have more productive conversations. These include:
Stating our intentions. Being clear about the purpose of a conversation. It can help those involved determine their willingness to participate, avoiding competing agendas and frustration.
Remember the top priority and avoid letting emotions take over. Keep focused on the goal of the conversation and do not let emotions steer the discussion elsewhere.
Do your research. Learn about the topic before engaging in conversation and, especially if you are a white person, understand that it is not the job of people of color to educate you.
Do not oppress other groups. Do not attempt to combat racism by oppressing other groups with sexism, ableism, transphobia, etc. We must be willing to fight all forms of oppression.
Do not “tone police.” Oluo describes “tone policing” as ‘when someone (usually the privileged person) in a conversation or situation about oppression shifts the focus of the conversation from the oppression being discussed to the way it is being discussed.’ This shifts the focus of the conversation to make it more comfortable for the privileged person. Conversations about race and racism require us to lean into and sit with our discomfort; we should not try to make things more comfortable for ourselves by tone policing those who experience oppression firsthand.
If you are white, watch how many times you say ‘I’ and ‘me.’ Avoid making conversations about race and racism focused on you and your feelings.
Ask yourself: Am I trying to be right, or am I trying to do better? Conversations about race and racism are not about ‘winning’ or being right. We should engage in these conversations to share and learn.
Do not force people of color into discussions of race. People of color live with racism every day and should be free to choose how, when (or when not), and with whom to engage in conversations about race. Respect their decisions about engaging in conversation on these topics.
Chapter 5 - What is intersectionality and why do I need it?
Intersectionality as described by Oluo, is the notion that each of us has a myriad of identities – our gender, class, race, sexuality and so much more – that inform our experiences in life and our interactions with the world. The different hierarchies, privileges, and oppressions assigned to these identities affect our lives in many ways, but they do not exist in a vacuum. They combine with each other, compound each other, mitigate each other, and contradict each other. Unfortunately, many of today’s social justice movements fail to recognize this, centering on their one issue or group of focus and leaving others behind. Intersectionality theory addresses this issue by actively considering the ways that different aspects of identity come together to marginalize and oppress people and by working to consciously center those people and their experiences.
Oluo argues that incorporating intersectionality into our social justice work as a practice helps us to make our systems more fair and effective, helps us to identify our own privileges, and avoids oppressing others. She offers some reflective questions to help readers increase intersectionality in discussions about race, including consideration of:
How might race, gender, sexuality, ability, class, or sex impact this topic?
Could the identity differences between me and the person I’m talking with be contributing to our differences of opinion or perspective?
Am I listening to people whose identities and experiences are different than mine?
Am I shifting some focus and power away from the most privileged in the conversation?
Incorporating intersectionality into our work and discussions can help us to recognize and confront the privileges in our lives while nurturing a more inclusive and just society.
Chapter 12 - What are microaggressions?
Oluo describes microaggressions as the small daily insults and indignities perpetrated against marginalized or oppressed people because of their affiliation with that marginalized or oppressed group, in this case, microaggressions perpetrated against people of color. Microaggressions are constant reminders that the recipient is ‘less than,’ and regular exposure to microaggressions causes their recipients to feel isolated and invalidated. In addition, research has demonstrated that exposure to microaggressions is associated with experiencing mental and physical depressive symptoms.
Oluo explains that microaggressions can be difficult to address for a myriad of reasons including that they are, by definition, small acts that can be easily explained away; that they are cumulative – meaning that individually they may seem like no big deal, but collectively, they have a profound impact – and that they are perpetrated by many people, making it a challenge to address with each person without becoming exhausted and potentially written off as being hypersensitive.
When folks recognize that they are witnesses to a microaggression, they often wonder what they should say or how they should address the situation. Oluo shares some strategies that may be helpful such as:
State what actually happened, for example, ‘You just assumed that I don’t speak English.’
Ask some uncomfortable questions which can help the perpetrator to examine their motives, for example, ‘Why did you say that?’ or ‘I don’t get it. Please clarify what you meant.’
Ask some more uncomfortable questions, if the person becomes flustered or responds that they did not mean anything by what they said. Examples include, ‘Is this something you would have said to a white person?’ and ‘How exactly was I supposed to take what you just said?’
Reinforce that good intentions are not the point. ‘You may not have meant to offend me, but you did.’
Remember that you have every right to address the issue. ‘I can see that this is making you uncomfortable, but this is a real problem that needs to be addressed.’
It is also important to recognize when we commit a microaggression and we should avoid the tendency to deflect responsibility or deny we ‘meant anything’ by it. We should offer an authentic apology and spend time in reflection examining why we may have said what we did, whether or not we would have said the same thing to a person of our same race, and whether we might have been feeling threatened or uncomfortable at the time. If we want racial oppression to stop, we must take responsibility for the ways we contribute to it.
Chapter 17 - Talking is great, but what else can I do?
Oluo writes, ‘We cannot understand race and racial oppression if we cannot talk about it. But understanding, on its own, will never equal action.’ While having (many) conversations about race and racism is important, Oluo offers many suggestions for ways that we can all help to fight racial oppression. These include:
Vote and note that local elections are just as important as national ones. Be active in your schools and find out what the district is doing to address the racial achievement gap.
Bear witness when necessary. Especially if you are white, bear witness and offer to help if it is safe to do so if you see a person of color being harassed.
Speak up in your unions. Work to make your workplace more diverse and inclusive.
Support businesses owned by people of color.
Boycott banks that prey on people of color.
Give money to organizations working to fight racial oppression and support communities of color.
Boycott businesses that exploit workers of color.
Support music, film, television, art, and books created by people of color.
Support minimum wage increases.
Push your local leaders for policing reform.
Demand diversity in colleges and universities.
Vote for diverse government representatives.
Our journal club discussed additional actions that we can take specific to healthcare and the practice of Emergency Medicine. These included continuing to conduct research on health disparities and strategies to promote health equity, ensuring that our educational materials accurately reflect the spectrum of skin tones so that clinicians are prepared to identify alterations in health in patients of color, ensuring that medical devices and prediction rules are accurate in patients of color, engaging in a reflective pause when planning patient care to ensure that bias is not influencing our care decisions, supporting and mentoring students from historically marginalized or underrepresented groups, and continuing to engage in antiracist educational activities.
Racism is a public health crisis in the United States, contributing to the differential health outcomes we observe for people of color.
The ability to effectively converse about race and racism is critical to our ability to understand racism’s origins, causes, and systems that maintain it. We need this understanding to be able to fight racial oppression and dismantle systems of white supremacy.
Talking about racism can be hard, but there are strategies we can use to have more effective, productive conversations.
While talking about racism is important, antiracism is an action, not a sentiment. We must actively work to dismantle racist systems and nurture racial equity.
Interested in Learning More?
Watch Iljeoma Oluo lead a discussion on her book with
Tufts University Tisch College of Civic Life and Dr. Joyce Sackey
Additional Resources
IMPLICIT BIAS
Implicit Bias: Peanut Butter, Jelly and Racism from PBS/NYT POV
A TED talk by Verna Meyers, who is an attorney working as an inclusion strategist. Her talk is about how we can overcome our biases.
SYSTEMIC RACISM
Animated video explaining systemic racism
Classic article by Dr. Carmara Phyllis Jones from the American Journal of Public Health offering a model for understanding the various forms of racism
WHITE FRAGILITY
Robin DiAngelo, PhD is a fantastic Associate Professor of Education and a Sociologist at the University of Washington who came to speak at Tufts on her book White Fragility: Why It’s So Hard for White People to Talk About Racism a few years ago. Here are a couple of videos of her sharing some concepts from her work.
Here is a quick read from Dr. DiAngelo regarding “White Fragility”
INTERSECTIONALITY
Kimberlé Crenshaw is a legal scholar, civil rights advocate, and professor at the UCLA School of Law and Columbia Law School. She is a leading scholar on critical race theory and is the person who introduced and developed intersectionality theory.
Here is a brief video of Professor Crenshaw explaining intersectionality
Here is a fantastic TED talk where she discusses intersectionality more in-depth
Many folks probably first learn about intersectionality theory in readings from Women’s Studies, Sociology, etc., but it is interesting that, as a legal scholar, Professor Crenshaw’s ideas stemmed from legal cases where a court’s narrow definition of discrimination did not account for the experiences of folks who identified as both female and Black, leading to the development of her theory. You can read more about its origins and those cases here:
Intersectionality, explained: meet Kimberlé Crenshaw, who coined the term - Vox
Here is Professor Crenshaw’s original paper (1989, University of Chicago Legal Forum) is also attached for those who are interested in her arguments and ideas
CALLING FOLKS INTO THE WORK VS CALLING THEM OUT
Over the last few years, I think that many of us have heard about the importance of ‘calling out’ racist behavior, microaggressions, etc. when we witness these things. Acknowledging the importance of not letting these things slide, but finding a potentially more constructive way of addressing them is the idea of ‘calling in’ people to the discussion with compassion and understanding that we are all learning. I thought that idea was really cool and Professor Ross (Smith College) does a really nice job explaining it.
Video from Loretta Ross on the notion of calling in vs. calling out
Here is a New York Times article where she explores the importance of calling in vs. calling out
MICROAGGRESSIONS
How microaggressions can reinforce and normalize racism video by the Black Experience Project
A tool for recognizing microaggressions and the messages they send
Here is an article by Dr. Molina on Addressing the Elephant in the Room: Microaggressions in Medicine; Annals of Emergency Medicine
CALL TO ACTION
Here is a great editorial by Dr. Cortlyn Brown, Dear White People in Emergency Medicine
Antiracism in Emergency Medicine – EMRA video presented by Dr. Sadiqa Kendi
SAEM Diversity, Equity & Inclusion Curriculum – a compendium of resources by topic that is in development and available for use
Authored by Tania Strout
Edited and Posted by Jeffrey A. Holmes, MD
