Social science & medicine
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Social science & medicine · Feb 2018
Historical ArticleThe enduring impact of historical and structural racism on urban violence in Philadelphia.
Public health approaches to crime and injury prevention are increasingly focused on the physical places and environments where violence is concentrated. In this study, our aim is to explore the association between historic place-based racial discrimination captured in the 1937 Home Owners Loan Corporation (HOLC) map of Philadelphia and present-day violent crime and firearm injuries. The creators of the 1937 HOLC map zoned Philadelphia based in a hierarchical system wherein first-grade and green color zones were used to indicate areas desirable for government-backed mortgage lending and economic development, a second-grade or blue zone for areas that were already developed and stable, a third-grade or yellow zone for areas with evidence of decline and influx of a "low grade population," and fourth-grade or red zone for areas with dilapidated or informal housing and an "undesirable population" of predominately Black residents. ⋯ After adjusting for socio-demographic factors at the time the map was created from the 1940 Census, firearm injury rates are highest in historically red-zoned areas of Philadelphia. The relationship between HOLC map zones and general violent crime is not supported after adjusting for historical Census data. This analysis extends historic perspective to the relationship between emplaced structural racism and violence, and situates the socio-ecological context in which people live at the forefront of this association.
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Social science & medicine · Feb 2018
Biocultural citizenship and embodying exceptionalism: Biopolitics for sickle cell disease in Brazil.
In 2006, the committee that developed the National Health Policy for the Black Population (NHPBP) chose sickle cell disease as their "flag to demand health rights." The drafting of this policy was official recognition from the Ministry of Health for racial differences of its citizens in order to address certain inequalities in the form of racial health reparations. Through an ethnographic study which consisted of participant observation, life-story and semi-structured interviews, and surveys in the urban centers of Rio de Janeiro, São Paulo, Salvador, Belo Horizonte, and Brasília between November 2013 and November 2014, I introduce a new conceptual approach called biocultural citizenship. It is a flexible mode of enacting belonging that varies depending on disease status, skin color, social class, recognition of African lineage, and other identifiers. ⋯ Specifically, I demonstrate that the SCD movement strategically uses Blackness to make claims for health rights. Biocultural citizenship is dependent on the idea of biological and cultural difference that is coproduced by the State and Afro-Brazilian citizens. The use of biology to help legitimate cultural claims, especially in the Black Atlantic, contributes a new and distinct way to think about how race and skin color are used as tools of agency for diasporic communities.
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Social science & medicine · Feb 2018
A safe haven for the injured? Urban trauma care at the intersection of healthcare, law enforcement, and race.
Patients with traumatic injuries often interact with police before and during hospitalization, particularly when their injuries are due to violence. People of color are at highest risk for violent injuries and have the poorest outcomes after injury. The purpose of this study was to describe how injured, Black patients perceived their interactions with police and what these perceptions reveal about police involvement within trauma care systems. ⋯ Injured participants valued police officers' involvement when they perceived that officers provided safety at the scene, speed of transport to the hospital, or support and information after injury. Injured participants also found police questioning to be stressful and, at times, disrespectful or conflicting with clinical care. Communities, trauma centers, and professional societies have the opportunity to enact policies that standardize law enforcement access in trauma centers and balance patients' health, privacy, and legal rights with public safety needs.
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Social science & medicine · Feb 2018
Institutional racism in public health contracting: Findings of a nationwide survey from New Zealand.
Public institutions within New Zealand have long been accused of mono-culturalism and institutional racism. This study sought to identify inconsistencies and bias by comparing government funded contracting processes for Māori public health providers (n = 60) with those of generic providers (n = 90). Qualitative and quantitative data were collected (November 2014-May 2015), through a nationwide telephone survey of public health providers, achieving a 75% response rate. ⋯ The qualitative material showed disparate provider experiences, dependent on individual portfolio managers, with nuanced differences between generic and Māori providers' experiences. This study showed that monitoring government performance through a nationwide survey was an innovative way to identify sites of institutional racism. In a policy context where health equity is a key directive to the health sector, this study suggests there is scope for New Zealand health funders to improve their contracting practices.
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Social science & medicine · Feb 2018
ReviewA decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.
Disparities in the care and outcomes of US racial/ethnic minorities are well documented. Research suggests that provider bias plays a role in these disparities. The implicit association test enables measurement of implicit bias via tests of automatic associations between concepts. ⋯ Two studies tested interventions aimed at reducing bias, but only one found a post-intervention reduction in implicit bias. This review reveals a need for more research exploring implicit bias in real-world patient care, potential modifiers and confounders of the effect of implicit bias on care, and strategies aimed at reducing implicit bias and improving patient-provider communication. Future studies have the opportunity to build on this current body of research, and in doing so will enable us to achieve equity in healthcare and outcomes.