All individuals are products of the system into which they have been socialised; a system that has taught people how to think about themselves and others, how to interact, how to know what is expected and what happens if we deviate from what is expected. Socialisation is ongoing, complex and often invisible. Intentional and continuing critical self-reflection is required to understand and influence the process of socialisation. Power, in this context refers to the capacity that a person has to exercise control over others, deciding what is best for them, deciding who will have access to resources, etc.1
It is important that health professional students understand their place – individually, and as members of the health professional groups they are socialised into – within the institutional or ‘colonised’ health system, and the impact this has on palliative care service provision.
Engaging in regular and ongoing self-reflection regarding health professional knowledge, skills, attitudes, behaviours and power differentials is required to be able to deliver culturally-responsive healthcare.2 This toolkit activity aims to provide students with an overview of these key issues and encourage critical self-reflection.
In the context of the healthcare system, when referring to a person as having privilege, it is about the access they have to resources. Those with more power have unearned access to things that those without power, typically members of marginalised groups, do not have access to. The idea of unearned access is where the inequity lies because access is based on an identity someone holds that has traditionally been associated with power.
For example, in the context of white privilege, people who are white have unearned access to resources that work in their favour as opposed to people of colour who experience a multitude of barriers to gaining access to the same resources. These barriers, which are rooted in historical inequity, include systems, policies, and laws that disenfranchise and impoverish people of colour. White people are not forced to question their behaviours because the system is set up with them at the centre or as ‘normal’ (eg, white children are not usually taught that they might be discriminated against because of the colour of their skin, whereas children of colour often are).1
Bias refers to prejudice that is in favour of or against one thing, person or group, usually in an unfair way. These learned associations, which develop over time, prompt feelings and attitudes about other people based on characteristics such as racial group, ethnicity, age, gender, sexual orientation, and socioeconomic status.
Biases can be:
- Implicit – attitudes based on stereotypes people have learned that affect their understanding, actions and decisions in an unconscious manner, or
- Explicit – attitudes and beliefs that people hold at a conscious level that are formed and acted on with deliberate thought.
Everyone has biases as part of the natural way the brain categorises things. It is important to become aware of our biases to mitigate the impact that these beliefs and attitudes have on our behaviour towards specific groups of people.
A learning experience that can help you understand more about your own implicit biases is the Harvard’s Project Implicit Association Test.3
- In her 2016 blog post, ‘What I said when my white friend asked for my black opinion on white privilege’, Lori Lakin-Hutcherson describes a number of experiences with racism across her lifetime that help to illustrate how white privilege can be understood:
- If you’ve never had a defining moment in your life where you realise that skin colour alone makes other people hate you, you have white privilege
- If you’ve never been ‘the only one’ of your racial group or colour in a class, at a party, in a workplace etc and it’s been pointed out in a ‘playful’ fashion by the authority figure in the situation, you have white privilege
- If you’ve never been on the receiving end of the assumption that when you’ve achieved something, it’s only because it was taken away from a white person who ‘deserved it’ – that is white privilege
- If no one has ever questioned your intellectual capabilities or attendance at an elite institution based solely on your skin colour – that’s white privilege
- If you have never experienced or considered how damaging it could be to grow up without myriad role models and images in school that reflect you in your required reading material or in the mainstream media – that is white privilege. [Excerpt].4
Take a moment to think about these points and reflect on the influence of privilege in your day-to-day life.
- Take one of the Harvard Project’s Implicit Association Tests to help you understand more about your own implicit biases.
- University of Colorado. Diversity, Equity and Inclusion 101. 2021; Available from: https://www1.ucdenver.edu/offices/equity/education-training/self-guided-learning/diversity-equity-and-inclusion-101.
- AHPRA and National Boards, The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025. 2020.
- Project Implicit. Harvard Project’s Implicit Association Test. 2011; Available from: https://implicit.harvard.edu/implicit/index.jsp.
- Lakin-Hutcherson, L., Editorial: What I said when my white friend asked for my black opinion on white privilege, in Good Black News. 2016: https://goodblacknews.org/.