Health professionals need to embody an anti-racist approach to communication. To do so, you must first understand the concepts of race and racism.

Race has been systemically and historically constructed as a variable of difference, whereby people are ascribed to designated groups based on biology, culture, or other characteristics (Bakan & Dua, 2014). Racism is the ideology and practice of sustaining, maintaining, and reinforcing differences based on race (Bakan & Dua, 2014). It results in racialised persons being excluded from everyday access points because of their race.

Anti-racism is the active process of changing attitudes, beliefs, practices, and policies to dismantle systemic hierarchy and oppressive power (Alberta Civil Liberties Centre, 2021). An anti-racism approach involves:

• identifying and challenging racism within institutions
• taking specific and directed action toward eliminating racism
• recognising self as an agent for change toward equity.

Anti-racism focuses on acknowledging and working to address racial inequities, the unequal distribution of resources, power and economic opportunity and systemic bias predicated on race and unearned privilege afforded to non-racialised people. Linked with racism is the concept of white privilege, which refers to the advantage afforded to those who are non-racialised over persons of other racial backgrounds. It does not mean every white person is rich, healthy, or lavish. In Peggy McIntosh’s (1989) groundbreaking essay “White Privilege: Unpacking the Invisible Knapsack,” she lists several daily occurrences that are privileged based on race. For example, when applying for a mortgage, skin colour will not bias financial credibility when non-racialised people apply. Still, it can be a significant determining factor for those of other races. Recognising white privilege can often be conflated with feeling guilty about race, but this is not the aim.  A focus on individual guilt deviates from the conversation and intent of anti-racism, which is to ultimately dismantle racist structures that subjugate and discriminate against racialised people.

Healthcare experts have a critical responsibility to integrate and exemplify anti-racist behaviours in their fields of practice. It’s imperative for you, as a healthcare practitioner, to adopt an anti-racist stance and champion the rights of your clients and peers against racial injustices. Effective communication is key in showcasing anti-racist principles. This process usually starts with introspection and understanding the viewpoints of others. See Case Study 3 for an example of an anti-racist approach to communication related to a racialised client.

Case Study 3 (An example of an anti-racist approach to communication)

A nurse (RN1) receives a report from a colleague (RN2). During the night shift, a client was admitted for generalised abdominal pain, elevated blood pressure, and heart rate. At this time, the etiology is undetermined, but the client is scheduled for a CT scan shortly.

RN 2: Hi Rita, it was a pretty quiet night. We just admitted a patient; I cannot pronounce her name, in bed 2, for generalised pain. She says the pain is in her abdomen, but who knows what is happening? She gives me a lot of attitude; you know how it can be. We should have sent her home and told her to return if things worsened.

RN1: Why is that?

Rationale: RN1 recognises that there may be some underlying racist attitudes and attempts to open the conversation.

RN2: Well, you know how these people are… they come to emergency for every little complaint, over-dramatising everything. They do not care about the costs of a visit to the emergency room.

RN1: Lorna, I am uncomfortable with you referring to this patient as “these people.” Your tone and choice of words insinuate that we should dismiss their pain complaints because of how the client looks and their culture.

Rationale: RN1 states how they feel using “I” statements and refers explicitly to the racist language that RN2 uses. RN1 also uses direct language to identify the passive actions of RN2.

RN2: Oh no, that is not what I meant; I am not a racist; I was not trying to say it like that. I just meant that some people are likelier to take advantage of free healthcare than others.

RN1: I know this might be a difficult conversation, but referring to a client as “these people” and “taking advantage of the system” is racist, especially since you have attached it to the patient’s race and culture.

RN2: But that is not what I meant.

RN1: It might not be what you meant, but the words you chose and the meaning are racist and unacceptable. Considering our conversation, it would be good to request our manager to organise a workshop for all of us about racism and language. Additional training will illuminate how language and beliefs like “taking advantage” are pervasive micro-aggressions that ultimately lead to poorer treatment and access to healthcare for racialised clients. We must reflect on our communication skills and ensure we are not using oppressive language in our workplace.

Rationale:  RN1 is very clear in identifying the communication as racist but also doing so in a respectful way. Even RN1’s language is inclusive regarding group responsibility when referring to “our” workplace.

References

Alberta Civil Liberties Research Centre. (2021). Anti-racism. https://www.aclrc.com/antiracism

Bakan, A., & Dua, E. (2014). Theorizing anti-racism. Linkages in Marxism and critical race theories. University of Toronto Press.

McIntosh, P. (1989, July/August). Unpacking the invisible knapsack. Peace and Freedom Magazine, pp. 10-12. https://nationalseedproject.org/Key-SEED-Texts/white-privilege-and-male-privilege