BHA 3002 Health Care Management

Racism is a complex social phenomenon to study, given the variations in historical and geographical contexts as well as non-availability of data especially in the European context which is the main focus in this review. We discuss in this paper the modalities of racism entangled with the enslavement of the African people and colonialism in the context of capitalist development and European modernization. Furthermore, since the focus of the paper is healthcare as part of welfare provision, we follow Paradies et al. (2015) who view racism as an organized system within societies that causes avoidable and unfair inequalities in power, resources, capacities, and opportunities across racial or ethnic groups, which manifests through beliefs, stereotypes, prejudices, or discrimination. Racism can moreover, be internalized, throughincorporating racist attitudes, beliefs, and ideologies in one's worldview; this can be interpersonal through interaction between individuals or systemic forexample, through lack of control of and access to labor, material, and symbolic resources within a society. This implies that racial inequalities in healthcare can be understood as lack of access to socioeconomic opportunities and resources, within contexts of negative images, stereotypes, prejudice, and discrimination against certain minority groups.

Priest and Williams (2018) for example, describe how pervasive global health inequalities exist among what they describe as “stigmatized and disenfranchised ethnic groups (p. 1)” in a wide variety of health conditions including: “earlier onset of illness, increased severity, and progression of disease, higher levels of comorbidity, mortality rates, and poor access to healthcare (p. 1).” Similarly, Arora et al. (2001), show that compared to white populations in the UK, black and minority ethnic populations carry a heavier burden of poor health, premature death and long-term chronic ill health, while refugees, and asylum seekers constitute a high-risk group for mental ill health.

Research in Canada suggests that some diseases, including cardiovascular disease, certain cancers, diabetes, and HIV/AIDS, have specific racial/ethnic profiles that disadvantage minority racialized groups (Nestel,2012). In Sweden, according to Alexander (2009), people who are not ethnically Swedish are more likely to suffer from poor mental and physical health. Hjern (2012) reports that immigrants of non-European background are three to four times more likely than Swedish people to suffer from poor or very poor health. Essén et al. (2000) observe that women with a foreign background, especially those from sub-Saharan Africa, have a higher risk of perinatal mortality than native Swedish women. These perinatal mortality differences could not be explained by existing risk factors and the authors suggest that more intense surveillance should be given to women and newborns from sub-Saharan Africa as a way of reducing perinatal mortality.

Racism, as stressed by Priest and Williams and conceptualized by Paradies et al. (2015) is a critical determinant and fundamental cause of inequalities inhealth, as underlined by Mulinari and Neergaard (2017) in the case of Sweden.Yet, in spite of such disparities, racism, as is becoming clear from a newly initiated research inSweden by the authors of this review, is difficult to discuss in healthcare encounters (Bradby et al., 2019), largely because it manifests in very subtle ways.

The aim of this review article is therefore to investigate how racism has beenrendered invisible in the context of global neoliberalism the political doctrine concerned with how to manage capitalism as an economic system that according to Nkansah-Amankra et al. (2013) shapes social policy, including public health. The role of global neoliberalism is however understood as encompassing other historical events for example, the end of the second worldwar, the human rights movement in USA and the liberation or anti-colonial movements. Contextualizing racism in healthcare within this broad global neoliberalism will, we argue, enable us to understand, not just how racism is rendered invisible but more significantly, also the marginalization, vulnerabilities and suffering created in the process. This is particularly important because the inability to identify the historical, social, economic, and ideological structuring of racism within social institutions such as healthcare today, seem to result in attributing responsibility for the effects of racism to those individuals and groups who may also be its casualties (Mueller, 2017; Waldman, 2018).

In the section below, we discuss how racism has become unspeakablealthough nonetheless experienced. We first explore the historical genealogies of racism, after which we examine how neoliberalism has shaped and contributed to the silencing of racism. We conclude the paper by brieflyreflecting on the role of academia and advocating for the application of participatory or collaborative research methodologies in order to help create spaces for promoting open discussion of racism in healthcare settings.

As a phenomenon entangled with the history of European modernization, racism arguably goes back to the renaissance. According to Earle and Lowe (2005), Europe was already receiving black Africans regularly and insignificant numbers ever since the mid fifteenth century, when they were employed as entertainers, dancers, and other categories of workers, but also as slaves, in the cosmopolitan courts. Having black slaves was at the time a sign of social prestige and distinction in these courts. The presence of black people moreover played a necessary counter-image in the construction of European whiteness and civilization (Earle and Lowe, 2005). While being an essential part of European modernization, racism, has in different historical periods assumed different forms including: biblical argument grounded in perceived Christian superiority, biological argument based on science and finallycultural argument (Blaut, 1992; Rogers and Moira, 2005; Cole, 2018).

In its most conspicuous and violent form, racism was manifested in the European capitalist development when large numbers of Africans were shipped to the Americas as slave labor in mines and in sugar, tobacco, and cotton plantations. During this time, public lynching of slaves by slave owners  was commonplace (Young, 2005). Direct colonization that entailed, for example, the scramble for Africa during the Berlin Conference in 1884 (Nilsson, 2013), appropriating land and forcibly moving indigenous people to reserves, promoting exploitation, segregation and exclusion of peoples andgroups considered inferior or uncivilized then followed. Colonial interventionswere justified through a discourse of civilizing mission (Rodney, 1966; Eltis and Richardson, 1997; Baptist, 2014; Salem and Thompson, 2016).

After these conspicuously violent historical moments, but more specifically after the holocaust and genocide during the Second World War, the civil rights movement in the USA, and the liberation or anti-colonial movements in thecolonies, racism has seemingly, been forced into obscurity and invisibility (Lentin, 2008).

Following the Second World War and as a response to the Holocaust, UNESCO issued statements in 1951 and 1952, concluding that there are no innate biological differences between different human groups. Race as a biological category was abandoned in science, at least politically (Shapiro, 1952). The focus on race and consequently racism as based on a biologicalnotion meant that racism was viewed as originating in science rather than as apolitical idea. Therefore, when race was deemed unscientific, racism was consequently seen as done away with: Europe was regarded by some to have gone back to its original nature–as a non-racist society.

As argued by Goldberg (2009), the Holocaust became the “reference point of race” and Europe's colonial history was brushed away and seen as distinct from European identity and modernity. Mulinari and Neergaard (2017) too argue that the focus on the holocaust explicitly obliterates European colonial history, with annihilation as an extreme form of exclusionary racism, whereas exploitative racism still needs black workers. In addition, the shift of the discourse to cultural forms of racism in many European countries has, as argued by Salem and Thompson (2016), managed to obliterate the biologicalnotion of race from the public sphere therefore making it difficult to bring discussion of racism into public arena.