Event Facilitated by Noriko Yamaguchi, PT, DPT
Written by Stephanie Molloy
Image ID: photo of a hospital's emergency sign. Photo by Pixabay: https://www.pexels.com/photo/emergency-signage-263402/
Our latest virtual workshop took place Thursday June 27th. Although it was early evening for our JCR hosts in Montreal, Canada it was 8:00am for Noriko in Tokyo, Japan. Despite it being early morning, Noriko was full of energy and passion as she got the workshop underway. We had participants coming in from across the United States of America (USA) and Canada, from a very wide variety of contexts.
Noriko started things off by discussing her own positionality, which set a reflective tone for all the participants. She discussed not quite resonating with labels such as “Asian” and “American” despite those usually being assigned to her, and connecting more with “Japanese” and “Immigrant”. Noriko also wanted to note that due to her experience of studying and working in the USA, the bulk of her content will be USA centered, however having international participants present will allow us to discuss how the same ideas are transferable to different contexts around the world. She then discussed books and media that have been influential to her, again setting a tone of reflection, honoring past knowledge holders, and acknowledging the work of others. A humble start to an excellent workshop.
Before fully getting underway we also had a quick discussion about “white supremacy” as a phrase and reactions to its usage. Noriko shared that in the USA “white supremacy” has a negative or accusatory connotation and [white] people generally tend to shy away from using it (see: white fragility). When Noriko told some of her colleagues she was presenting on white supremacy in the health system she was met with remarks of “we don’t have that here” and feelings of discomfort. This is part of the problem, failure to name issues and face them head on means they won’t be discussed and therefore won’t be addressed. This is an important starting point for our next hour and a half together.
THE WORKSHOP GOALS
Image ID: PowerPoint slide reading: "Workshop goals. Realize - Realize that white supremacy and white supremacy culture created current structural systems in society, including the health system. Recognize - Recognize the fingerprints of white supremacy in the health system where you work and/or receive services. Respond - Respond to the harm caused by white supremacy on you and on those in your care. Resist - Resist the perpetuation of white supremacist social norms within your spheres of influence."
REALIZE
We started by reflecting on and discussing on “why has inequality increased, despite health outcomes improving over the years?” . A further guiding question being “what are the root causes of health disparities that are not being addressed by health policy, health equity programs, or increased access to healthcare?”
We discussed how new innovations could disproportionately impact better resourced communities, interventions happening faster for dominant (white) groups, healthcare access and allocation of resources, the effects of Medicaid, and healthcare professionals not believing racialized patients and relatedly racialized groups having less trust in the healthcare system.
This made us realize that “white supremacy and white supremacy culture created current structural systems in society, including the health system” , that systems of oppression are intersectional and internalized, and that at the end of the day it’s about repressive power.
Image ID: green background and yellow flower, quotes reading “Whiteness is a constantly shifting boundary separating those who are entitled to have certain privileges from those whos exploitation and vulnerability to violence is justice by their not being white” - Paul Kivel, and “In this country, American means white. Everybody else has to hyphenate.” - Toni Morrison.
Race is not the only system of oppression in the USA or globally: sexism, classism, ableism, homophobia, and more are all at play. However in the USA, it is clear that all these systems of oppression are collectively rooted in white supremacy. Noriko shares the diagram below, and explains the connection between ‘thingification’, colonialism, and extractive capitalism - the building blocks of the USA - is white supremacy. Thingification being the act of dehumanizing something, if it is not a human then we’re making it a thing (for example humans were 'thingified' as a justification for chattel slavery). This is important as a ‘thing’ can be exploited and used for our benefit, whereas if we see and appreciate something for what it is then it is much harder to exploit.
Image ID: PowerPoint slide. It has a Venn diagram with 3 sides that are labelled Thingification, Colonialism, and Extractive Capitalism. The center overlap is labelled White Supremacy. The slide reads: Race is only one of the systems of oppression in the US. Other systems of oppression include classism, sexism, anti-trans, islamophobia, ableism, homophobia, antisemitism, xenophobia. Systems of oppression are intersectional and internalized. It's about repressive power. In the US, these systems of oppression are collectively rooted in white supremacy.
Reflection question: How does your training as a healthcare provider and the healthcare system where you work and/or receive care reflect …. Systemic oppression? Thingification? Colonialism? Extractive capitalism?
This question brought up therapeutic goals (return to walk, discharge home), patients being converted into “units billed”, the medical gaze that turns a human into a machine and thingifying it. We discussed society shaping patients into consumers and clinicians as providers, the emphasis of productivity. Lastly, the limits of therapy (both mental and physical), how patients are supposed to be better in a certain amount of time, otherwise they are unworthy of more treatment or can “fail” rehab.
None of these things being the reason that people get into allied health professions, none of these things being rooted in helping people thrive and a deep caring of their wellbeing.
Our last topic of Realize was a history lesson Noriko shared with us on Hereditary Slavery and Bacon’s Rebellion of 1676.
Image ID: PowerPoint slide that reads: Hereditary slavery was invented by law makers (i.e. the ruling class, aka wealthy landowners). Partus Sequitur Ventrem - Before 1660, in English common law, the legal status of children followed the status of the father. In the colonies, this doctrine followed the colonists. Elizabeth Key, an enslaved bi-racial woman sued for her freedom in Virginia on the basis that her father was white. The court granted freedom to her and her child in 1656. In response to this case, Virginia instituted partus sequitur ventrem making children's legal status follow the mother. Partus Sequitur Ventrem was passed in 1662 and codified racialized slavery as hereditary. Nnoli (2023) identifies this law as one of the key historical events that led to racialized health disparities in obstetrics and gynecology. How are you connecting the dots between Partus Sequitur Ventrem and health disparities? https://nmaahc.si.edu/learn/talking-about-race/topics/historical-foundations-race
This hereditary slavery brought up a parallel to blood quantum used in Canada and the USA to determine if individuals are “Indigenous enough” to gain legal status (ie under the Indian Act in Canada) and the same use of lineage being passed down by only one parent or being revoked if one left the reserved/married/went to university. How the government can control one’s identity and access to resources. This can then exacerbate inequities, access to healthcare, and experiences dealing with health systems and workers.
Bacon’s Rebellion, in short being that Nathaniel Bacon, a wealthy property owner in the Virginia colony, organized a milita of his white and black indentured servants and black slaves to expand his property in exchange for their freedom, through conflicts with the colonial government they eventually captured and destroyed Jamestown. This inspired many more uprisings. This alliance between white and black individuals was feared by the (white) people in power, causing laws to be made that people of African descent are hereditary slaves and people of European descent are not and can pursue freedom. This was to create a higher social class for those of European descent so that they would no longer have a reason to form alliances with those of African descent, thus deepening the power imbalance and avoiding further rebellions from happening.
Image ID: PowerPoint slide reading: Take home point: rules were created by the ruling class (aka wealthy landowners) to control uprisings based on class. ”By permanently enslaving Virginians of African descent and giving poor white indentured servants and farmers some new rights and status, they hoped to separate the two groups and make it less likely that they would unite again in rebellion. ” [down arrow] The ruling, wealthy elite chose to protect their power by creating whiteness and “othering” by race rather than by class. [down arrow] Question -How does the evolution of whiteness and blackness connect with the rise of commerce and capitalism? Source - Bacon’s Rebellion: Inventing Black and White. (2016, August 2). https://www.facinghistory.org/resource-library/inventing-black-white
Now for realize we can: 1) Define whiteness and white supremacy within a historical context, and 2) see the interconnectedness of white supremacy, colonization,
and extractive capitalism.
RECOGNIZE
The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. But is this actually being put into practice?
A large theme that came up in our reflection of this question was the external pressure put on therapists.
Can the patient be discharged? Only treat the problem they came in with nothing else. Get the patient back to work. Don’t look at their social-wellbeing, that's not a physiotherapist’s problem, you won’t get visit payment for enhancing social well-being - you need something to bill.
Our (North America’s) current system is not designed to enable therapists to consider a patient’s “complete physical, mental, and social well-being”.
Noriko highlights Blue Zones Power 9 - Reverse Engineering Longevity, 9 evidence based common denominators on living longer.
Image ID: Image showing 9 things divided into 4 categories, they are drawn in a circle and are all equal. Move - move naturally. Right Outlook - purpose, down shift. Eat Wisely - 80% rule, plant slant, wine at 5. Connect - right tribe, loved ones first, belong.
The 9 things listed then begs the question “if health can be low-tech and relatively low-cost, why is healthcare so expensive?”. What’s your answer to this question?
We discussed both this and examples of the Healthcare Industrial Complex:
We brought up Founders Syndrome - the fear of change, and Scarcity Mindset - the fear of not enough, playing a large role in healthcare systems and access to it. Burnout was another large theme, with one participant stating “e went into healthcare to HELP people not to just BILL them” and bringing up that healthcare is a business now which leads to more burnout. Another participant bringing up that it’s all about who has the power, and that its not the patient and often not even the therapist - given that the therapist has to make a case to get each session covered.
Noriko leaves this topic on a few slides discussing features of white supremacy culture:
Image ID: PowerPoint slide reading: Features of white supremacy culture. Fear ; Perfectionism, One Right Way, Paternalism, Objectivity, and Being Qualified ; Either/Or and the Binary ; Progress is Bigger/More and Quantity over Quality ; Worship of the Written Word ; Individualism and I’m the Only One ; Defensiveness and Denial ; Right to Comfort, Fear of Open Conflict, and Power Hoarding ; Urgency (Okun 2021). Questions - How are these features of white supremacy culture enacted in the way we were trained and provide healthcare? How are these features of white supremacy culture enacted in the way we receive healthcare?
Image ID: PowerPoint slide showing a book cover that reads Michael Fine - On Medicine as Colonialism. The rest of the slide reads: "...health care in the United States is a business, not a service provided for the public good, and that we have a medical services marketplace, not a health care system that cares for all Americans" (pg 6). "Hospitals, like every other marketplace participant, follow the money. They choose services that create the best return on investment ... not services that maximize the public's health" (pg 25). Question - What are examples of the healthcare industrial complex?
Now for recognize we can: 1) Understand how white supremacist ideas have shaped the definitions of health and (dis)ease, (2) Identify examples of how white supremacy culture manifests in everyday healthcare delivery, and 3) Identify examples of how healthcare industrial complex causes harm to minoritized people and communities.
RESPOND & RESIST
If we actually want to make a dent in inequality/equity … we need to use different tools.
Image ID: on the left a photo of Audre Lorde. On the right her quote "The master's tools will never dismantle the master's house. They may allow us temporarily to beat him at his own game, but they will never allow us to bring about genuine change."
We discussed that there are both “Big R” and “little r” ways to respond and resist, but all ways take critical consciousness, courage, and envisioning a different path. Healthcare and public health are inherently political and economic, so it’s important that we consider, work in, and try to influence these domains. We can use our power and privilege to be productive agents of change. Use that power productively rather than repressively.
With white supremacy being infused in all levels of the socioecological model (culture, policies, community/organizations/institutions, interpersonal, and individual levels) then a health care system for the common good requires culture change.
“A common good healthcare culture…
Values people & places before profits and productivity
Honors and embraces multiple ways of knowing and being healthy
Focuses on care as much, sometimes more, than cure
Moves at the speed of trust, not at the speed of the agenda
Harnesses productive, not repressive, power dynamics
Repairs past harms”
Now for respond and resist we can: 1) Identify the change you can create within your spheres of influence (starting with yourself), 2) Create an intention on how to use your power productively, 3) Connect to create solidarity and accountability.
Noriko then leaves us with this powerful closing reflection, to continue our own self work outside of this discussion, which you can reflect on too!
Image ID: PowerPoint slide reading: Closing Reflection - healthcare for the common good requires community and solidarity, healthcare for the common good requires cycles of change. Closing reflection questions - How have you internalized white supremacy and systems of oppression? Where are your spheres of influence? How can you use your power and privilege productively? Who is part of your common good community to create and sustain solidarity and accountability?
Complete slides from Noriko's presentation:
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