Anti-Black discrimination in primary health care: a qualitative study exploring internalized racism in a Canadian context.

OBJECTIVES: A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients' attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care. DESIGN: This qualitative study employed purposive maximal variation and snowball sampling to recruit and interview self-identified Black persons aged 18 years and older who: (1) lived in Montréal during the COVID-19 pandemic, (2) could speak English or French, and (3) were registered with the Québec health insurance program. Adopting a phenomenological approach, in-depth interviews took place from October 2021 to July 2022. Following transcription, data were analyzed thematically. RESULTS: Thirty-two participants were interviewed spanning an age range from 22 years to 79 years (mean: 42 years). Fifty-nine percent of the sample identified as women, 38% identified as men, and 3% identified as non-binary. Diversity was also reflected in terms of immigration experience, financial situation, and educational attainment. We identified three major themes that describe mechanisms through which internalized racism may manifest in health care to impact experiences: (1) the internalization of anti-Black racism by Black providers and patients, (2) the expression of anti-Black prejudice and discrimination by non-Black racialized minority providers, and (3) an insensitivity towards racial discrimination. CONCLUSION: Our study suggests that multiple levels of racism, including internalized racism, must be addressed in efforts to promote health and health care equity among racialized minority groups, and particularly within Black communities.

Appropriated racial oppression: Implications for mental health in Whites and Blacks.

Racism has been examined in its many forms. Scholarship regarding how individuals personally experience, cope with, and manage racial oppression is still developing. The term "appropriated racial oppression" reframes the construct "internalized racism" as a process whereby members of a group appropriate a dominant group's ideology, adapt their behavior, and perceive a subordinate status as deserved, natural, and inevitable. The expression of appropriated racial oppression is based on a variety of complicated and interacting processes, such as incentivized societal norms, critical consciousness, and racial socialization. We conceptualize appropriated racial oppression as a mediated process that yields both direct and indirect health outcomes for both non-dominant and dominant groups. The latter is critical because little research examines how racism affects dominant groups and their health. In this commentary, we examine two examples where appropriating racial oppression may confer both negative and adaptive outcomes. Although we highlight examples rooted in White and Black racial experiences, we briefly consider implications for intersectional and multiple marginalized identities as well. Future research recommendations for psychology, public health and interdisciplinary research are discussed.