Terms & Definitions

Anti-racism

Actively identifying, undoing and unlearning centuries of racial discrimination woven into the fabric of society, from the structural to individual level, with the aim to redistribute power and centre equity instead of hierarchical power and separation.

Caste systems Caste systems create hierarchies which determine access to resources and opportunities under the reasoning of ‘innate superiority’. [1] Caste systems are categorisations whereby people are stratified according to hereditary groups linked to occupations with no room for social mobility. Core features of the caste system are: [2] a) it is a social order wherein civil, cultural and economic rights of each individual castes are pre-determined, ascribed by birth and made hereditary; b) the castes are placed in a vertical plane with entitlement to economic and social rights, unequal and hierarchical – access to rights reduces as one moves down the caste hierarchy from the higher caste to the lower castes, with the type of rights denied varying, depending on the social location of the group in the caste hierarchy; and, c) it provides a regulatory mechanism through the instruments of social ostracism, continuation of separation of castes groups through the custom of endogamy and reinforced with justification from philosophical elements in the Hindu religion. Intertwined with notions of purity and pollution, the ‘purest’ caste in India are the Brahmins, the socially dominant group consisting of priests, teachers, doctors for example, and the ‘impure untouchable’ being the Scheduled castes (also known as Dalits) who tend to be manual workers and servants. [3] Scheduled castes were considered impure and polluting, and unfit for social association and inter-relations with the castes ‘above’ them. As a result of the stigma of untouchability, they suffer from physical isolation and social segregation. [4]

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Colourism

Prejudice or discrimination against those with darker skin tones, including within the same ethnic or racial group. Colourism favours the same hierarchy upheld by racism; lighter skin colours and Eurocentric features are deemed more valuable and desirable. Colourism is intertwined with how structural and internalised racism operate. [5]

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Critical Race Theory

[6,7] Critical Race Theory (CRT) began as a legal area of study in the 1970s established by US legal scholars such as Derreck Bell, Kimberlé Crenshaw and Richard Delgado and has evolved into a multi-disciplinary intellectual movement working towards racial justice. There is much variation in the work and beliefs and principles of CRT scholars may differ. The principles of CRT that have guided the conceptual framework underpinning this series:

1. Racism is commonplace - “ordinary not aberrational”

2. Race is socially constructed without biological basis

3. Racism goes beyond individual beliefs, existing across institutions and systems

4. Those at the top of hierarchies benefit from racism

5. Racism exists across institutions and within systems that can appear on the surface to be ‘equal’ or ‘neutral’ but in fact maintain an unequal order of society

6. Racially minoritised groups undergo processes of racialisation which based on time and context, results in specific stereotypes that reinforce racially and ethnically minoritised people’s position in society

7. Bell’s theory of interest convergence, that “the interests of Blacks in achieving racial equality will be accommodated only when it converges with the interests of Whites.” [8]

8. Power is a central concept to understanding societal interaction.

 

Decolonisation

Active efforts recognising, examining and undoing the legacies of colonialism, across all domains of society including the social, political and epistemological.

 

Discrimination

Discrimination is differential treatment or outcomes that are unfavourable towards a group or an individual based on some aspect of their actual or perceived identity, such as race, religion, nationality, physical ability, gender, sexual orientation, class or social status. Discrimination can be intentional and explicit, but it can also be indirect, where the negative consequences of certain facially neutral policies, protocols or regulations disproportionately affect particular groups of people. [9] Racial discrimination: Racial discrimination is unfavorable treatment or outcomes that a group or individual is subjected to because of their actual or perceived racial categorisation or identity. Racial discrimination also operationalises racist ideology because this discrimination differentially allocates opportunities and resources based on hierarchical racial categorisations. Differential allocation of opportunities and resources based on racial categorisation, disempowers some, empowers others, furthering inequalities in human existence and maintaining existing power hierarchies.

 

International human rights law defines prohibited racial discrimination as ‘any distinction, exclusion, restriction or preference based on race, colour, descent, or national or ethnic origin which has the purpose or effect of nullifying or impairing the recognition, enjoyment or exercise, on an equal footing, of human rights and fundamental freedoms in the political, economic, social, cultural or any other field of public life.’ [10] Religious discrimination: Religious discrimination is much like racial discrimination, but on the basis of religion and religious belief. Examples of religious discrimination include discrimination based on Islamophobic or antisemitic views.

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Epistemic Injustice

Epistemic Injustice, coined by Fricker, [11] has been defined as having two aspects - (1) Testimonial injustice whereby there is a perceived deficit in the credibility of the person who is expressing their thoughts or being and (2) hermeneutical injustice, which has been referred to as interpretative injustice by Bhakuni and Abimbola for ease of accessibility, ‘occurs if individuals or groups struggle to make sense of and share their experience of the world, owing to a gap in available legitimised collective interpretive (or sensemaking) resources.’ [12] In other words, knowledge and knowledge production is also shaped by racism and discrimination, leading to epistemic injustice, where there is weight and credibility afforded to those at the top of the established power hierarchies, for example those in high-income countries, and there are distinct and deliberate gaps in knowledge or collective resources which contribute to minoritised populations not being able to articulate their existence and experience. Testimonial injustice plays out in health systems when aspects of a patient’s identity affect their perceived credibility [13,14] and when healthcare workers are discriminated against based on their identity. Interpretive epistemic injustice plays out across health systems for example when ‘evidence’ based medicine is utilised without acknowledging its lack of objectivity and sometimes problematic nature is perpetuating and upholding racial hierarchies.

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Ethnicity

Ethnicity is a social construct that categorises people based on characteristics like language spoken, values, cultural factors, behaviours, ancestral geography locations. [15] There is overlap between racial and ethnic categories and structures of exclusion, given how groups of people who share ancestry, language and culture for example are also likely to share physical phenotypes.

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Health

We conform to the World Health Organization 1948 definition of health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’.

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Hierarchical power

Hierarchical power is a system whereby there is a stratification of society according to categories whereby those at the top are actively afforded privilege, capabilities, and capital across all domains of life, whilst those towards the bottom are actively disadvantaged.

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Indigeneity

The United Nations Declaration of the Rights of Indigenous Peoples (article 33) provides that Indigenous people themselves define their own identities, however the following is a working definition of Indigenous communities, peoples and nations by Martinez Cobo:   “Indigenous communities, peoples and nations are those which, having a historical continuity with pre-invasion and pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the societies now prevailing on those territories, or parts of them. They form at present non-dominant sectors of society and are determined to preserve, develop and transmit to future generations their ancestral territories, and their ethnic identity, as the basis of their continued existence as peoples, in accordance with their own cultural patterns, social institutions and legal system.” [16,17]

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Intergenerational drag

The process by which “Ethnic or racial groups pass social assets and liabilities on to their descendants”. [18] Differences and disadvantages in health can be related back to historical reasons that can accumulate over generations and present today. [19]

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Internalisation

When those who are minoritised believe in negative stereotypes that uphold power hierarchies and maintain the status quo, which can include negative thoughts about themselves, their own communities and their place in society. For example, this could include those belonging to an ‘unscheduled caste’ believing they cannot work in professions usually associated with ‘higher castes’ or marry those of ‘higher castes’. Or it could be racially minoritised individuals believing they are not capable or worthy of being in higher positions of power in their respective workplaces. When racially minoritised individuals believe in colourism, they are internalising White supremacist ideology. In medicine, we see internalisation in racially minoritised populations and healthcare professionals who believe there to be genetic differences based on race.

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Intersectionality

A term coined by Kimberlé Crenshaw, refers to the interplay between social categorisations often thought of in silos, such as race, gender or class, as well as associated systems of oppression, such as White supremacy, patriarchy and ableism, overlap and deepen interdependent systems of oppression and disadvantage. The UN’s metaphor of a traffic junction, summarises the effects and mechanisms of structures of intersecting subordination, whereby ‘race, gender, class and other forms of discrimination or subordination are the roads that structure the social, economic or political terrain. It is through these thoroughfares that dynamics of disempowerment travel.’ [20]

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Migrant

(International Organization for Migration) A person who moves away from their place of usual residence, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons. International migrants do not hold citizenship status in the countries to which they have migrated.

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Minoritised

Minoritised is defined as ‘individuals and populations, including numerical majorities, whose collective cultural, economic, political and social power has been eroded through the targeting of identity in active processes that sustain structures of hegemony’. [21]

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Neocolonialism

Processes that preserve the power dynamics of colonialism, with Eurocentrism and domination of previously colonising countries. [22]

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Race

Race is a socially constructed classification that relies on someone’s actual or perceived physical appearance and ancestry, and the social, economic and political meaning that is imbued in these. [23] Race was constructed and functions as an essential tool of racism, to separate and create racial hierarchy. The modern history of race, centrally features its use as a mechanism for assigning superiority and inferiority, and determining access to resources and human rights, [9,24] despite racial hierarchies being morally and biologically baseless. Racial categories are fluid non-discrete variables, and the meaning of race can change over time, location and context. [15,25] These social racial categories are embedded in and function as tools of broader intersecting networks of oppression (such as patriarchy) - operating through social, legal, economic, political and health structures to differentially allocate privilege and power. [26]

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Racial capitalism

Racial capitalism is another key structural process contributing to how racism, xenophobia and discrimination determine health. Racial Capitalism, coined by Robinson, is an exploitative process, where economic and social value is extracted based on the racial identity of a person. Where there was formation of a capitalist society with winners and losers, it “pursued essentially racial directions, so too did social ideology”. [27] Even when we look at the historical context of slavery and colonialism prior to modern capitalist societies, the presence of racial capitalism is clear. In the aftermath of the global uprising against racism in 2020, there is more of a movement in some communities towards ‘anti-racism’, leading to a multiplication of efforts and initiatives for ‘diversity and inclusion.’ It can now be seen as beneficial for those who are not minoritised to be aligned with advancing racial equity in the wake of these movements, ie. there is a convergence in interests. [8,27] This can however result in newer mutations of racial capitalism, where on the surface organisations and communities are appearing to be more inclusive, or anti-racist, through various ‘diversity and inclusion’ initiatives, or even through the hiring of more diverse workforce. However, changing things only at a superficial and public-facing level, without changing the deeper, historically entrenched power structures that perpetuate racism, xenophobia and discrimination is insufficient to dismantle such structures, resulting in tokenism, performatism, or as we call it, the modern face of racial capitalism.

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Racism

Racism is an organised system affording power and privilege in accordance with an established racial hierarchy, [28,29] where the social construction of racial categories and thus racialisation is used to maintain this hierarchy. [6,7] Racism operates to protect the rights, power and livelihoods of those at the top of this created hierarchy whilst placing those towards the lower rungs in closer proximity to death. Using the model of Nazroo et al, we subcategorise racism into: interpersonal, institutional and structural. [30] Interpersonal, or individual racism, occurs between individuals, whereas institutional racism occurs where institutional policies and practices result in discrimination based on race. It has been defined as “the collective failure of an organization to provide an appropriate professional service to people because of their colour, culture or ethnic origin”. [31]

Spatial determination Spatial determination encompasses a proximal set of factors and processes that determine health, related to location and geopolitical factors. When discrimination interacts with spatial determination, ie spatial discrimination, it demonstrates how minoritisation and oppression can manifest in certain geopolitical areas, placing minoritised people in closer proximity to unhealthy environments. For example, it can relate to the use of enforced borders and bureaucracy to assign rights to some categorisations of people and separate them from others who are deemed to be below them or less worthy in a hierarchical system of power.

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Structural racism

Structural racism is at the core of other forms of racism, [32] centring separation and hierarchical power, and describing the socioecological macro level processes and systems in which people and institutions exist. This maintains and perpetuates racial inequity, including through facially race-neutral means. Structural racism need not be a conscious decision of people or institutions, but instead is an entrenched way of how we exist, continually evolving so as to not become obsolete. [19,29,33] On the surface, policies and structures that appear ‘racially-neutral’ and non-discriminatory may disproportionately affect already minoritised groups negatively, upholding existing power imbalances, therefore being structurally racist.

Structural violence Coined by Galtung, structural violence refers to societal institutions and structures which cause harm by preventing some people from living healthy lives and meeting their basic needs. [34]

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Whiteness

Whiteness is a form of domination, which is often afforded power at the top of many hierarchies. For example, in Europe, former European colonies, and European settler colonial nations, White supremacy privileges ‘Whiteness’ and disadvantages ‘non-whiteness’. [19] Whiteness during the time of slavery and colonialism determined the freedom and liberation of a human being and it remains at the core of intersecting structures of privilege today. Whiteness is deeply embedded as a form of domination, steeped in power, privilege, and hegemony, that in becoming the norm and the backdrop, remains unacknowledged and unconfronted because it is presumed to be non-existent. [35] Whiteness tends to exist at the top of the hierarchy due to its financial and historical dominance. In those settings, recognising and identifying Whiteness as a key property that is valued, is essential to dismantling the existing structures of oppression. [35-37] Similar structures exist in non-White societies and where one group, religion or caste controls another.

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Xenophobia

Fear or hatred of, or discrimination against those who are considered to be foreigners. [9] The targets of xenophobia are often groups or individuals perceived as outsiders to the nation and undeserving of the benefits associated with citizenship or national membership. In this sense, xenophobia is undeniably political. Xenophobic discrimination is often underpinned by xenophobic anxiety, and the sense that those deemed as foreigners are a threat to those who do hold citizenship.38 Xenophobic discrimination can be enacted through acts and measures that are explicitly motivated by hostility, but it can also be enacted structurally through policies and practices that are facially neutral. [39]

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Xenoracism

“It is a racism that is not just directed at those with darker skins, from the former colonial territories, but at the newer categories of the displaced, the dispossessed and the uprooted, who are beating at western Europe’s doors, the Europe that helped to displace them in the first place. It is a racism, that is, that cannot be colour-coded, directed as it is at poor whites as well, and is therefore passed off as xenophobia, a “natural” fear of strangers. But in the way it denigrates and reifies people before segregating and/or expelling them, it is a xenophobia that bears all the marks of the old racism. It is racism in substance, but “xeno” in form. It is a racism that is meted out to impoverished strangers even if they are white.” [40]

 

References

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