Why Race Matters: A Letter from the Dean
By Angela Amar, Dean (PhD., RN, FAAN, Dean of UNLV School of Nursing)
I remember talking to a group of students of color about their experiences in a school of nursing. One said, “I know my classmates are glad they’re not black. Every time we learn about a disease, being black is always a risk factor. That and Native American.” Another added how grateful she was for the public health nursing course because finally there was an explanation – social determinants of health. They all wished that the explanation came sooner in the curriculum. The other thing that was beneficial to learn was the link between the colonial history of hierarchy and supremacy in the United States and the evolution of racism. Discriminatory practices in housing, education, healthcare, employment and criminal justice helped to institutionalize and engrain racism into the core of our society. It created a system of privilege based on historical supremacy. Those whose ancestors controlled the narrative received advantage or privilege. Other voices are excluded from the narrative and were disadvantaged.
An abundance of research identifies racism, not race, as the reason for disparities in health outcomes. Racism is preventable. Therefore, racism is a public health problem. Nurses, then, have a role in preventing racism.
In order to prevent racism, we have to first name it. We have to see it, identify it, and work to eliminate it. Nurses, historically, have been remiss in discussions of race. You will hear nurses say that they “don’t see color”. If you do not see color then you will not see racism. How can you help to solve a problem if you do not see it? Colorblindness ignores the ways that racism has existed and continues to exist for individuals and systemically.
Racism does not result from merely seeing race or color. The problems arise because of the stereotypical beliefs and actions that race evokes. For example, recently Chinese people were associated with COVID-19. Non-Asian people responded with aggression and hostility toward not just people of Chinese descent but toward Asian people of multiple nationalities. The race of the person is not the problem; it is the associations we make based on race. Implicit bias is the unconscious beliefs and stereotypes that affect our actions and decisions. (To learn more, see https://implicit.harvard.edu/implicit/takeatest.html)
Recognizing and understanding our biases is a first step to eliminating them. To deconstruct this system of racism and bias requires self-reflection, deep conversation and learning. It requires listening to the voices of those outside of the dominant narrative. It involves challenging the status quo. Many nursing textbooks are filled with stereotypical behavior. Students should question this content. Faculty should use these examples as teachable moments. Questioning, reflection, and listening are all part of learning. Once we understand our underlying biases then we work on controlling our instinctual responses and not acting on preconceived ideas. We all have to learn to check our assumptions and search for alternate explanations.
Second, nurses often build on not seeing color by adding that they treat everyone the same. This well-intentioned response does not assure that people are given what they need. Equality - treating everybody the same, is important when basic rights are denied. In the history of this country, equality was the impetus for separate but equal. This meant that black individuals could ride the bus, but had to sit in the back and give up their seat if a white person was standing. It meant having white schools and black schools, but the funding was significantly less for the black schools. Can you imagine being a child who never had a new book or one that wasn’t written in? The white schools got new books; black schools got the hand me downs. So, it becomes apparent that equal does not always work beyond basic rights.
An equity lens that gives people what they need is required. For example, as nursing students we all learn about the pathophysiology of sickle cell anemia, historically viewed in healthcare as a black person disease. We learn that this genetic disorder results in misshaped blood cells that causes great pain. However, research shows that the pain of patients with sickle cell anemia is routinely undermedicated and treated with skepticism. More people suffer with sickle cell anemia than cystic fibrosis (common genetic disease affecting primarily white persons), yet the funding is almost four times greater for cystic fibrosis research than for sickle cell anemia. Another example involves patient education and materials. We do not give blind persons pamphlets or printed materials. It is not that we are treating them differently. We are responding to their unique needs. Ableism, discrimination against persons with disabilities, is just as damaging to a person as racism.
As nurses, we have a responsibility to meet the needs of our patients and to create welcoming environments. Once we understand racism as a public health problem, we work to eradicate it. That requires listening to others and learning. It means that we examine our own biases and work to correct them. We look for the voices that are missing from the story and work to make those voices heard. Our patients deserve a nurse who sees each patient for the unique individual they are and tailors the approach accordingly. As the most trusted profession nurses must work for equity and justice.