Broadening the Conversation About Intersectionality in Clinical Medicine

"Discrimination is always intersectional" - understanding structural racism and teaching intersectionality in medical education in Germany

BACKGROUND

Racism in medicine represents a global problem. It takes place on the individual, institutional and structural level. Especially structural racism can have serious effects on the health of individual people. Furthermore, racist discrimination is not always based on race solemnly but frequently intersects with other social categories such as gender, class or religion. To describe this multidimensional form of discrimination the term intersectionality has been coined. However, the understanding of structural intersectional racism in medicine is still fragmented, especially in the German context. Yet, medical students need to be trained in understanding structural and intersectional racism to see the impact of racist structures on the patient's health.

METHOD

We conducted a qualitative study to explore the knowledge, awareness and perception of racism in medicine and health care of medical students in Germany. Our research questions are how do medical student understand structural racism and its effects on health in Germany? Do students see interrelations with other forms of discrimination and in this context to what extent are they familiar with the concept of intersectionality? Which categories intersect from their point of views with race in context of medicine and health care? We conducted focus groups with medical students (n = 32) in Germany.

RESULTS

Our results demonstrate that students have a wide spectrum of knowledge, awareness and perceptions about racism from being rather elaborate to very little knowledge about it. The students have particular problems to understand and situate structural racism in Germany. Some raised doubts about the relevance. Yet, other students are aware of the concept of intersectionality and are convinced that racism must be looked at from an intersectional perspective.

CONCLUSIONS

The diverse knowledge, awareness and perceptions of medical students about structural racism and intersectionality hints to a lack of systematic education of medical students about these issues in Germany. Yet, in context of diversifying societies an understanding about racism and its impact on health is imminent for future medical doctors to provide good care for their patients. Therefore, this knowledge gap must be systematically filled by the medical education.

A holistic health determinants model for public health nursing education and practice

Baccalaureate nursing graduates (BSNs) in the 21st century need to be prepared to manage the population health needs of diverse populations across the lifespan and take actions to improve health equity. A need for a Holistic Health Determinants Model that included the Social Determinants of Health was identified. A model incorporating the Healthy People 2020 Health Determinants Model and the Healthy People 2030 Social Determinants of Health Model was developed. Two theoretical approaches provided a foundation for the model. Social ecological theory stresses the lived experience in an ever-changing environment from the micro to the macro biological, behavioral, social and physical environmental levels. Public health intersectionality added the construct of constant interactions among the health determinants that resulted in different levels of health status among individuals and groups. This Holistic Health Determinants Model is a tool to use in teaching nursing students how to address the needs of individuals/families, diverse populations, and communities. It also facilitates integration of the new AACN Population Health Competencies across the curriculum. The model facilitates the preparation of BSN graduates to address the factors that shape health status and to take actions to improve health equity.

Intersectionality and heart failure: what clinicians and researchers should know and do

PURPOSE OF REVIEW

To review the application of intersectionality to heart failure. Intersectionality refers to the complex ways in which disenfranchisement and privilege intersect to reproduce and influence health and social outcomes.

RECENT FINDINGS

Intersectionality challenges approaches that focus on a single or small number of socio-demographic characteristics, such as sex or age. Instead, approaches should take account of the nature and effects of a full range of socio-demographic factors linked to privilege, including: race and ethnicity, social class, income, age, gender identity, disability, geography, and immigration status. Although credible and well established across many fields - there is limited recognition of the effects of intersectionality in research into heart disease, including heart failure. This deficiency is important because heart failure remains a common and burdensome syndrome that requires complex pharmacological and nonpharmacological care and collaboration between health professionals, patients and caregivers during and at the end-of-life.

SUMMARY

Approaches to heart failure clinical care should recognize more fully the nature and impact of patients' intersectionality- and how multiple factors interact and compound to influence patients and their caregivers' behaviours and health outcomes. Future research should explicate the ways in which multiple factors interact to influence health outcomes.

HIV and stigma in the healthcare setting

People living with HIV (PLHIV) continue to endure stigma and discrimination in the context of health care despite global improvements in health outcomes. HIV stigma persists within healthcare settings, including dental settings, manifesting itself in myriad, intersecting ways, and has been shown to be damaging in the healthcare setting. Stigmatising practices may include excessive personal protective equipment, delaying the provision of care or unnecessary referral of PLHIV to specialist services in order to access care. The workshop entitled "HIV and Stigma in the Healthcare Setting" provided an overview of the concept and manifestation of HIV stigma and explored the disproportionate burden it places on groups that face additional disadvantages in accessing care. The final part of the workshop concluded with a review of institutional and community-based interventions that worked to reduce HIV stigma and group discussion of the ways in which these strategies might be adapted to the dental workforce.