Chapter 9: Race, Culture & Health Equity

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Welcome back to the Deep Dive.

Today we are stripping away the polite veneer of a topic that often gets treated with kid gloves and nursing education.

We're talking about culture, and I know exactly what we're thinking because I thought it too back in the day.

Oh great, a lecture on different food choices,

religious holidays, and making sure we don't accidentally offend someone.

Exactly, that is the common trap.

We often reduce culture to a checklist of beliefs, foods, and holidays.

It's what we colloquially call the sari and samosa approach.

Right, food and festivals version of cults.

It's comfortable, it's colorful, and it's completely utterly insufficient for modern nursing practice.

But today, we are going completely beyond the surface.

We are digging into Chapter 9 of Community Health Nursing, a Canadian perspective, the fifth edition.

The chapter is titled Race, Culture, and Health, and it's written by Elizabeth McGiven and Joyce Mbukwa.

And I have to say, having read this chapter cover to cover, this text does not pull any punches at all.

It argues that the reality of culture and nursing isn't just about traditions.

It's a complex web of power, history, and these invisible structures.

It is a heavy read, but an essential one.

The mission for this deep dive is to guide us, and you, through this specific chapter, step by step.

We need to clarify a major shift that is happening in the profession,

moving from the old, comfortable idea of cultural competence.

Which we've all heard a million times.

To the necessary, challenging reality of anti -racist practice.

We need to understand how systemic forces, things we often don't see, impact health right here in Canada.

So let's dive right in.

Section 1 of the chapter starts by, well, really by challenging our assumptions.

I think a lot of us, when asked to define culture, would say it's, I don't know, language, gestures, maybe the tools we use, the stuff you can see.

And those are parts of it.

The text acknowledges that culture includes language, gestures, tools, customs, and traditions.

But the authors immediately pivot to a much more critical perspective.

They specifically cite the Aboriginal Nurses Association of Canada, or ANA.

And the ANA argues that culture is about more than just a list of beliefs.

It's about how culture is defined, and the power dynamics involved in that definition.

That's a key distinction right off the bat.

It's not just this is my culture, it's who gets to say what my culture is.

Precisely.

It's about the power and privilege of defining others.

If I am in the dominant group, I get to define what is normal and what is exotic or cultural.

My culture is just the default, and yours is the interesting one.

That's it, exactly.

And the text breaks down several key characteristics of culture that move us away from that static checklist.

The first one, and perhaps the most important to grasp because it underpins everything else we'll talk about, is that culture is a social construction.

Okay, let's unpack this.

Social construction sounds like a sociology buzzword that gets thrown around a lot.

What does it actually mean in the context of this textbook?

For a nursing student, what do they need to know?

Right, it's a huge term.

But think of it this way.

Culture isn't just something natural that sprouts from the ground like a tree.

It is an idea that has been constructed, built, or made up over time by society.

Made up?

Specifically, it's shaped by dominant systems.

Government, education, health care.

We aren't born knowing our culture.

We learn these norms through socialization.

So we aren't born with culture.

We are socialized into it.

Like, I'm not born knowing that a handshake is a greeting.

I'm taught that.

Exactly.

It's learned behavior that feels innate.

And because it's constructed, it's also fluid and dynamic.

That's the next characteristic the book mentions.

It changes.

It changes.

It's not a museum piece sitting under glass.

The text gives the example of how technology and global migration shift culture.

Think about how Canadian culture has shifted just in the last 20 years due to the internet or the different waves of immigration.

Sure.

Absolutely.

The text also mentions that culture is implicit and tacit.

That feels like a fancy way of saying we don't realize we're doing it.

That is it.

Exactly.

It shapes us at an unconscious level.

Think of it like water to a fish.

Right.

The fish doesn't know it's in water.

It's just the environment.

We don't stop to think about the assumptions that ground our decisions.

We just think that's common sense when really it's cultural conditioning.

Can you give me an example of that of implicit culture in a hospital setting?

Sure.

Think about the concept of time.

In our Western biomedical culture, time is linear and rigid.

An appointment is at 2 p .m.

If you are 15 minutes late, you missed your appointment.

That feels like a hard fact to us.

A rule.

A very clear rule.

Yes.

But in many other cultures, time is relational.

You arrive when the previous responsibility is finished.

It's about respecting the person you're with, not the clock on the wall.

So if a nurse views a patient being late as a moral failing, as them being non -compliant.

Instead of just operating on a different clock.

That's that implicit bias at work.

The nurse's cultural value of linear time is seen as the only correct one.

That makes a lot of sense.

The authors also list intersectionality as a key characteristic.

Yes.

And this is so critical.

Culture doesn't exist in a vacuum.

It overlaps or intersects with race, gender, class, ability, sexual orientation, everything.

It's all layered together.

Right.

The text gives the example of deaf culture.

A person isn't just deaf.

They might be a deaf black woman living in poverty.

All those identities intersect to create a unique cultural experience.

And importantly,

unique experiences of power and oppression within the health care system.

The book also mentions Quebec here.

It does.

It highlights the importance of French language rights.

That's a cultural identity that intersects with law and geography and history.

It's not just a language.

It's a protected cultural identity.

No, the authors throw a bit of a flag on the play regarding nursing specifically.

They talk about a Eurocentric barrier in our profession.

Yes.

This is a critique of what they call the biomedical Eurocentric foundation of nursing.

Let's break that down.

Eurocentrism.

It refers to the dominance of white European ways of thinking, to the point where they're seen as universal truths rather than just one cultural perspective.

In nursing, this often manifests as an almost exclusive focus on the individual.

Which is very Western, right?

You are responsible for your health.

You know, pull yourself up by your bootstraps.

Correct.

It's the idea that health is a personal project.

You eat right, you exercise, you take your pills.

But the text argues that this individual focus completely fails to address community obligations or structural issues.

So if I'm a community health nurse and I'm only looking at the individual patient in front of me, I'm missing the forest for the trees.

You're missing the forest, the soil quality, and the climate.

If the structure, the politics, the economy is making the community sick, treating the individual without addressing the structure is just, well, it's just putting a bandaid on a gaping wound.

It's not sustainable and it's not effective.

Speaking of the forest, let's look at who is actually in the forest.

Section 2 of the chapter dives into the data on cultural diversity in Canada.

And the numbers are shifting fast.

If you're operating off demographics from 20 years ago, you are way behind.

They are shifting dramatically.

Let's start with the First Nations, Metis, and Inuit populations, often referred to collectively as FNMI.

Statistics Canada estimates that in the next two decades, these populations are likely to exceed two and a half million people.

And the growth rates are just.

They're staggering compared to the general population.

They really are.

Between 2006 and 2016, the First Nations population grew by nearly 40 percent.

The Metis population grew by over 50 percent.

Fifty.

Five zero.

Fifty.

And the Inuit population by nearly 30 percent.

So these are young, rapidly growing communities.

But what's really critical for nurses to note, and the text practically bolds this, is the age difference.

Right.

The median age of FNMI peoples is 10 years younger than the general Canadian population.

Ten years.

That's a massive demographic gap.

So if I'm working in a community with a large indigenous population, what does that age gap mean for me on a practical level?

It means your practice needs to be heavily skewed toward pediatrics, maternal health, youth mental health, and early prevention.

You aren't dealing with a geriatric boom in the same way you might be in a predominantly white suburb.

Your entire focus of care has to shift younger.

Okay.

That's a really clear clinical takeaway.

Then we look at Black Canadians.

The census reported over a million people identifying as Black Canadians, but the text emphasizes, well, it says this is not a monolith.

This is a crucial point and a mistake that's often made.

Black is a racial category, not a single culture.

Right.

The text notes this group includes African Canadians who have been here for generations, Caribbean Canadians, and recent immigrants from dozens of different countries in Africa and elsewhere.

We cannot treat this group as having a single uniform culture.

A Somali refugee has a very different cultural context and set of health needs than a Jamaican Canadian born in Toronto.

And immigration patterns in general are changing too.

I think historically a lot of Canadians assume immigration to Canada means people coming from Europe.

That is no longer the case.

For the first time recently, Africa ranked second ahead of Europe as a source continent for recent immigrants.

Asia remains the top source with over 60 % of newcomers born in Asia.

I'm looking at figure 9 .1 in the text right now.

It's a bar chart showing where permanent residents settle.

And for those listening, you can just imagine a bar chart where three bars tower over everything else.

Yes, the big three, Toronto, Vancouver, and Montreal.

They attract the majority of newcomers.

No surprise there.

But if you look closer at the chart, there are nuances.

The book points out, for instance, that Quebec attracts a higher proportion of immigrants from Africa and the Middle East compared to the rest of Canada.

Why is that?

Is it just preference?

It's policy and language.

Quebec's immigration policy actively favors francophones to preserve the French language.

So it attracts people from French -speaking countries in West Africa, North Africa, and the Middle East.

This is important for community health nurses to understand.

Diversity looks different depending on which province you're in.

Now, there's a concept in this section that always blows my mind, and honestly, it's kind of tragic.

It's called the healthy immigrant effect.

It is a paradox, and it is disturbing.

The data shows that when newcomers arrive in Canada, they are often healthier than the Canadian -born population.

Which makes sense, right?

I mean, there's strict medical screening to get a visa.

You can't migrate if you have certain communicable diseases or conditions that would be an excessive burden on the system.

That's part of it.

The other part is that, generally, people who have the resilience, youth, and resources to uproot their entire lives and move across the world are a self -selected, healthier group to begin with.

Okay, so they are a self -selected, screened, healthy group.

But here's the decline.

Their health status drops quickly after arrival.

And the text points out that foreign -born, visible minority women, in particular,

report the greatest health decline after 10 years in Canada.

Okay, I need to stop you there because this feels completely counterintuitive.

We pride ourselves on having a universal healthcare system in Canada.

You're telling me that someone arrives here, usually in peak physical condition, and then, despite our world -class healthcare, their health nosedives.

What is physically happening to them?

It is a bitter pill to swallow.

But yes, the text is very specific here.

It's not that they catch a Canadian virus.

It's that they catch Canadian society, if you will.

We have to look at the social determinants of health.

Give me a concrete example.

Is it just that the winters are cold and people stop exercising?

I wish it were just the weather.

Let's talk about credentialism and income.

Imagine you were a qualified nurse or a surgeon in your home country.

You arrive in Canada, excited to work.

And suddenly, your degree is recognized as nothing.

Not recognized.

You are told you need years of expensive retraining, exams and a new language.

So you are driving a taxi or cleaning offices to survive.

So you take a massive hit to your socioeconomic status.

You go from middle -class to working poor almost overnight.

You go from professional respect and financial stability to income insecurity and poverty.

That brings chronic stress.

Your cortisol levels spike and stay spiked.

That has real physical consequences on the body, cardiovascular disease, diabetes.

And that's just the income part.

Right.

Then add in the housing crisis, living in substandard, perhaps moldy or overcrowded apartments, because that's all you can afford.

Add in food insecurity.

Add in the loss of your social support network.

And on top of all that, the text mentions the unwelcoming system.

Right.

This is the discrimination piece.

Imagine navigating a health care system where you sense the provider doesn't respect you or dismisses your pain or where you can't communicate your symptoms effectively because there's no professional interpreter available.

You'd stop going.

You'd avoid it.

You would stop going.

You'd delay care until it's an absolute emergency.

That is how the healthy immigrant effect turns into a health crisis.

It's a structural failure, not a biological one.

And part of that unwelcoming atmosphere comes from how immigrants are portrayed in our society.

The chapter has a research box.

It's a 9 .1 that talks about critical discourse analysis.

This is a really powerful study.

It was titled Immigrants Can Be Deadly.

And the researchers analyzed 10 years of major Canadian newspaper headlines.

10 years is a big sample size.

What did they find?

The findings were disturbing.

They found that the press consistently framed immigrants using three main metaphors as disease breeders, as imposters, or as scroungers.

Disease breeders.

That is incredibly dehumanizing language.

Sounds like we're talking about livestock, not people.

It is.

It creates this image of outsiders bringing pestilence.

Then you have imposters suggesting they're lying about their refugee claims, trying to cheat the system.

And scroungers, the narrative that they're just here to abuse health benefits and welfare.

The argument in the text is that this rhetoric has real world impact.

A huge impact.

It's not just words.

It creates a permission structure for bad policy.

It creates a public opinion that sees refugees as threats rather than as people in need of help.

It jeopardizes their mental health and justifies treating them poorly.

We see that play out in actual government policy.

Figure 9 .2 in the text tracks attitudes toward immigration, showing a hardening of attitudes over time.

And that leads directly to things like the cuts to the Interim Federal Health Program, or IFH.

That was a major event in 2012.

The federal government at the time drastically cut health coverage for refugees.

The public logic was cost saving and fairness.

Why should refugees get better dental or vision care than Canadians on welfare?

I remember that argument.

But the reality was that it created a tiered system.

It treated them as temporary residents who didn't deserve comprehensive care unless they were a danger to public health.

So we'll treat you if you have tuberculosis because we don't want to catch it.

But if you have diabetes or a heart condition, you're on your own.

Essentially, yes.

It was a policy based on this idea of the deserving versus undeserving poor.

And there's a huge backlash from health professionals, doctors and nurses protesting in the streets.

Yeah, I remember that.

The courts eventually reversed some of it, calling it cruel and unusual.

But it highlights how political ideology, fueled by that media discourse,

directly determines who is deserving of health care.

For a nurse on the ground, this creates massive confusion and moral distress.

And the text makes a point here about a key nursing action.

Yes, the importance of using professional interpreters, not family members, not a child who has to translate a devastating diagnosis for their parent.

But policies often make accessing those professional resources very difficult.

We absolutely need to get into the definitions.

Section four is titled deconstructing race, racism and racialization.

I feel like these terms get thrown around interchangeably on social media, but the authors are very, very specific about what they mean.

They are.

And for good reason.

Precision matters here.

Let's start with race, which is in table 9 .1.

The text states clearly, unequivocally, race has no biological basis.

Zero.

Because I think a lot of people still think, well, there are clearly genetic differences between a white person and a black person.

Practically zero.

The text cites the human genome project.

There is only a 0 .1 % variation in the human genome between any two people on the planet.

We are 99 .9 % identical biologically.

So the differences we see are?

They are literally skin deep, physical differences like skin tone, hair texture, their adaptations to geography,

largely sun exposure.

They are surface level.

There's more genetic diversity within a so -called racial group than between two different ones.

So if race isn't biological, why do we use it?

Why does it exist?

Because it is a social construction.

That's the key.

It was created, invented to categorize people, and it was invented to justify treating certain groups as inferior.

If I can convince society that someone is biologically different and lesser, then I can justify enslaving them or taking their land.

It's a tool of power.

It is a political tool, not a biological reality.

So if that's race, what is racism?

The table defines it very specifically.

Racism is defined as an ideology of inferiority combined with systemic power.

This is so important.

It is not just an individual person being mean or calling someone a slur.

That's prejudice or bigotry.

Okay, so it's more than just individual acts.

Much more.

It's a system of discrimination involving social institutions, schools, hospitals, the justice system, laws that denies entire groups of people access to resources, power, and opportunity based on those artificial racial categories.

That brings us to racialization.

This is a term I hear more and more often now, especially in academic circles.

How is it different from race?

Racialization is the process.

It's the verb.

It's the act of assigning race to people, usually non -white people, as their primary defining characteristic.

It's the process through which we are all taught to see and judge people through a racial lens.

So it's something that is done to people.

Exactly.

The text gives a really painful anecdote about this regarding nurses.

Yes, I remember reading this.

It mentions minority registered nurses, highly trained professionals, reporting that when they enter a patient's room, family members often assume they are dietary staff or housekeeping.

Ouch,

that must be so infuriating.

That is racialization in action.

The family sees skin color and immediately assigns a lower status role, ignoring the professional uniform, the ID badge, the entire context.

They are racing the nurse.

It's a form of racial profiling within the profession itself.

And this connects directly to poverty, too.

The text talks about the racialization of poverty.

The statistics here are stark.

Racialized persons have double the poverty rate of non -racialized persons in Canada.

Double.

And it's even worse when you layer gender on top of that, the feminization of poverty.

Exactly.

Women make up the majority of the poor in Canada, and Indigenous women face staggering rates.

The text cites a rate of approximately 47 % for those living on reserve.

That's nearly one in two.

So poverty isn't random.

It follows these racial and gendered lines.

It's color -coded and gender -coded.

Precisely.

And the text references the community health nursing standards of practice.

It says we have a professional and ethical responsibility to understand these root causes, colonialism and racism, because they are determinants of health, just as much as a virus or a genetic condition is.

You cannot treat the patient without understanding the poverty that is making them sick.

That leads us perfectly into what I think is the core theoretical model of this chapter.

The cycle of oppression.

There's a diagram, figure 9 .3.

I want to pause on this diagram because this is where the rubber meets the road.

We hear these words all the time.

Stereotype, prejudice, discrimination, oppression.

But this text suggests they're actually steps in a machine.

They're gears.

One turns the next.

And you cannot understand the endpoint oppression without seeing where it starts.

It's a predictable, mechanical process.

So walk me through the gears.

Where does it begin?

It starts in the head.

The first gear is stereotype.

This is an exaggerated, fixed image, a caricature.

The book gives examples like girls are bad at math or indigenous people get everything for free.

We all absorb these from media, from jokes, from our upbringing.

OK, so that's just the image floating around in our culture, in our heads.

I haven't done anything yet.

I just have the thought.

Right.

It's the raw material.

But if you don't check that thought, if you don't critically examine it, it hardens into prejudice.

This is step two.

The image becomes a belief,

a prejudgment.

So it goes from a saying to a truth.

Exactly.

You aren't just seeing a caricature.

You believe it to be true about the person standing in front of you.

You think this person in my ER is an addict because they are indigenous.

That's a terrifying shift.

You've prejudged them before they've spoken a single word.

And that belief, that prejudice dictates your action or your inaction.

That is step three, discrimination.

So discrimination is the verb.

It's the doing part.

Prejudice is the feeling.

Discrimination is the doing.

It's the behavior.

It could be an action, like calling security on someone.

Or often, as the book points out, it's the not doing.

The not doing.

Not offering the pain medication, not checking on the patient in the waiting room, not believing someone's reported symptoms.

That inaction is a discriminatory act.

And finally,

the last gear in the machine.

Oppression.

This is the biggest gear.

This is when discrimination is backed by systemic power policies, laws, institutional culture, health systems.

It makes the discrimination official, widespread, and self -perpetuating.

It becomes just the way things are.

The text uses a devastating case study to illustrate this cycle in action.

The story of Mr.

Brian Sinclair.

I think the story is the anchor for this entire chapter.

This is a story every Canadian nurse must know.

It's a national tragedy.

I want to take us back to that waiting room in Winnipeg's Health Sciences Center.

It's September 2008.

Brian Sinclair is a 45 -year -old First Nations man.

He's a double amputee in a wheelchair.

Why was he there?

What was his presenting complaint?

He had a blocked catheter, a common, treatable condition.

He was in pain.

He had an infection.

He needed a catheter change and some antibiotics, not complex care.

He went to the ER.

He spoke to the triage aide.

And he wheeled himself into the waiting room to wait to be seen.

So he did everything right.

He identified a problem.

He sought care.

He did.

But here's where the cycle of oppression stops being a diagram and becomes a weapon.

The staff looked at him, a middle -aged indigenous man, double amputee, sitting in a waiting room, and the stereotype kicked in immediately.

The stereotype of the drunken Indian, the homeless person just looking for a place to sleep.

Precisely.

Witnesses testified that they thought he was just sleeping it off or looking for a warm place to stay.

That is the prejudice.

The stereotype became a belief.

They believed he wasn't there for health care.

He was there for loitering.

And because they believed that, because of that prejudice, they enacted discrimination, the most brutal form of it.

They ignored him for 34 hours.

34 hours in an emergency room waiting room.

Nurses, security guards, cleaning staff, other patients, they walked past him.

Some reported later they saw him vomiting.

One person tried to tell a security guard he was concerned and was told Sinclair had already been seen and discharged and was just waiting for a ride.

He hadn't been triaged at all.

They just made that up.

They made it up because the prejudice was so strong, it acted as a blinder.

They didn't see a patient in distress.

They saw a stereotype confirming their bias.

The infection from his blocked catheter turned to sepsis.

And he died.

Rigor mortis actually sat in while he was still sitting in the waiting room chair.

That is horrifying.

It's almost impossible to comprehend.

And the final gear,

oppression.

How does that fit in?

This is the part that, for me, is the most enraging.

When the inquest happened, the institution, the Winnipeg Regional Health Authority, didn't say, we were racist.

Our staff's racism killed this man.

They said the ER was crowded.

It was a patient flow issue.

They blamed the bureaucracy.

It was a systems error.

That is oppression.

When the system uses its power, its lawyers, its policies, its PR department, to shield itself and normalize the death of a marginalized person, they tried to frame his death as an unfortunate clerical error, a man who fell through the cracks, rather than the predictable tragic result of unchecked racism.

It was racism disguised as access block.

That is heavy.

But it clearly, brutally shows that this isn't just about being nice.

This is life or death.

The text explicitly states, and this is a quote worth remembering,

inequity and racism are disease equivalents.

The disease equivalents.

Yes.

They contribute to complexity and poor outcomes, just like diabetes or hypertension do.

Racism is a pathogen.

And we have data to back that up, too, beyond this one horrific story.

The chapter cites the Park et al study on avoidable mortality.

Yes, a 2015 study.

And avoidable mortality is a really specific measure.

It refers to deaths that could have been prevented with timely and adequate health care.

So things like burst appendices or infections that get out of control.

Exactly.

And they found that First Nations women have 2 .5 times the rate of avoidable mortality compared to non -First Nations women in Canada.

Two and a half times.

That is a massive discrepancy.

And it links back to this idea of cultural safety, or rather the lack of it.

The text mentions a report where Indigenous patients were refused painkillers because of a provider bias.

That stereotype that Indigenous people are more prone to addiction or have a higher pain tolerance.

If your doctor doesn't believe your pain, you don't get care.

It's a direct barrier.

So we know the problem.

The chapter lays it out in grim detail.

What's the solution?

This next section talks about three different frameworks.

Cultural competence, cultural safety, and cultural humility.

And I feel like in school we hear cultural competence the most.

We do.

But the text frames cultural competence as just the start.

It's the first step on the ladder.

This is Madeleine Leininger's model.

It focuses on gaining knowledge, changing attitudes, and learning skills.

Like knowing that a certain culture doesn't eat pork.

Or knowing how to wrap a body after death according to a specific religious tradition.

Yes.

And that knowledge isn't bad.

It's helpful.

But the critique is that it can be reductive.

It becomes a checklist.

Right, the sari and samosa thing again.

Exactly.

It can also other people treating them as exotic specimens to be studied.

And critically,

it often lacks a focus on power dynamics.

It assumes if I know your customs, I can treat you without acknowledging that I hold institutional power over you in the healthcare system.

So how is cultural safety different?

The book calls it the goal.

Cultural safety is the goal.

And its focus is completely different.

It analyzes power imbalances and institutional discrimination.

It asks what is making this encounter unsafe for this patient.

The key distinction here, and this is vital, is that the recipient of care determines if the encounter was culturally safe.

Oh, that's a flip.

So I, as the nurse, can't say I practice culturally safe nursing today.

You cannot.

You can't award yourself that medal.

Only the patient can say I felt safe and respected in my identity during that encounter.

It takes the power of definition away from the provider and gives it to the patient.

It forces us to be accountable to them.

And cultural humility.

The text calls this the process.

That is the process.

It's a commitment to self -reflection and a critique of your own power.

It's admitting you don't know everything.

It's about lifelong learning and understanding your own personal and systemic biases.

It shifts the focus from learning about them to learning about me and my impact on them.

Which brings us to the uncomfortable part for a lot of people.

Looking at ourselves.

Section 8 is about racism and white settler privilege in nursing.

And this section really challenges the history of our profession.

We're taught that nursing is a noble, neutral, caring profession.

But the text argues that nursing education is steeped in Eurocentric history.

They mention Florence Nightingale.

She's the icon, the lady with the lamp, the founder of modern nursing.

She is.

But the text contrasts her with Mary Seacole.

Mary Seacole was a Jamaican nurse who also served in the Crimean War.

She was an expert in treating cholera.

She even funded her own way there because the British authorities rejected her help, likely because she was black.

And she was on the front lines.

Right on the front lines, treating soldiers under fire.

But I'll bet most nursing students have barely heard of her.

If at all.

I didn't hear about her in my intro to nursing class.

Exactly.

She has been largely erased from the history, while Nightingale, a white upper -class woman, is celebrated.

It's an example of the erasure of non -white contributions to our own profession.

The text also notes that our grand theories of nursing aurum, pars, roi, the big names we have to memorize, they often ignore this entire sociopolitical context.

They do.

They tend to assume a neutral, deraced, usually white patient.

They don't talk about racism or colonialism or poverty as core nursing concepts.

They act as if health happens in a social and political bubble.

Then there is Table 9 .2, which unpacks privilege.

And it makes an important distinction between white privilege and settler privilege.

Right.

White privilege refers to unearned advantages that someone gets, simply because their race is seen as neutral or the norm.

It's not about having an easy life.

It's about not having certain obstacles in your path because of your skin color.

And settler privilege.

I feel like this is a term that confuses people, especially if they are new immigrants.

You know, if I just arrived from Poland or the Philippines, how am I a settler?

I didn't colonize anyone.

That is a common and understandable question.

Settler privilege is specific to the context of countries like Canada, Australia, the US.

It refers to the advantages derived from the dispossession of indigenous lands.

So even if you just arrived?

Even if you just arrived, you are living on land that was taken from indigenous peoples.

You are benefiting from a legal and economic system established by that dispossession.

You get to buy a house, use the hospital, send your kids to school on that land, all within a system that was built on and continues to benefit from that original colonial relationship.

That is the privilege.

The examples on the table really hit home.

Can we read a couple to make it concrete for the listener?

Certainly.

Here's one for you to think about.

If I need pain meds, I won't be refused because of a stereotype about my race having high pain tolerance or being drug seeking.

That is a privilege you expect to be believed.

Here's one that hit me as a student.

My textbooks and professors mostly look like me.

That sends a powerful message about who belongs in the profession.

Or this one from a practice perspective.

If I advocate for a patient, I am likely speaking to a manager of my own race.

That is a huge professional advantage.

You don't have to bridge a cultural or racial power gap just to do your job.

You're seen as insiders together.

So we see the privilege.

We see the oppression.

What is the way forward?

The final section talks about decolonization.

And the text views decolonization as a shared endeavor.

It quotes another scholar, Donald, saying that indigenous peoples and Canadians must face this history together.

It's not just an indigenous issue to fix.

It's a relationship issue.

We are all treaty people.

So how do we do that?

They present an anti -oppressive practice framework in Figure 9 .4.

It has three parts.

What is step one?

Step one is seeing.

You have to actively identify stereotypes and privilege in your daily life and practice.

You have to take the blinders off.

You have to notice when that family member assumes the black nurse is the cleaner.

You have to notice when a patient is labeled difficult or non -compliant and ask if race or culture is playing a role in that label.

So it's about developing a critical awareness.

Step two is understanding and mapping.

This is tracing the root causes.

How does a prejudice lead to a policy?

It's asking why is this policy this way?

Who does it benefit?

Who does it harm?

It's seeing the machinery of the cycle of oppression at work in your own workplace.

And step three?

Acting for change.

This is the hard part.

It's confronting your own participation in oppression even when it's passive.

It's being an ally.

It's speaking up when you see the cycle in motion.

It's advocating for professional interpreters instead of just using a patient's seven -year -old child.

It's about taking a risk to disrupt the status quo.

The text ends with some very practical exercises like relational inquiry.

It does.

It encourages students to ask different questions.

Instead of just what are their symptoms,

it pushes you to ask what historical forces influence this community.

And importantly,

how am I similar or different from this person and how does that power dynamic affect this interaction?

It breaks down the professional barrier between us, the experts, and them, the patients.

This has been a lot.

A really heavy but necessary deep dive.

I think that's the point.

We started by saying culture isn't just a checklist, and we've journeyed from understanding that simple definition all the way to seeing the deadly impacts of the cycle of oppression, like in the tragic case of Brian Sinclair.

It is a journey from surface -level politeness to deep structural analysis.

It is not an easy chapter to read, but it is the foundation of ethical nursing in a country like Canada.

You can't practice safely without it.

And as we wrap up, I want to leave you with a thought based on this chapter.

We often value niceness in nursing.

We want to be kind, compassionate people.

But the text suggests that sometimes our niceness can mask complicity with racism.

If we are too polite to call out the stereotype, too nice to disrupt a discriminatory process, we are part of the cycle.

That is the crucial takeaway.

Cultural safety isn't about being nice.

It's about disrupting power to create justice.

So here is our question for you to take into your next shift or your next class.

What invisible knapsack of privilege are you carrying with you?

And how might it be weighing down the very person you're trying to help?

Thank you for listening.

This has been the Deep Dive with the Last Minute Lecture Team.

See you next time.