For about two decades, social inequalities have been discussed in the context of social determinants of health in Public Health, for example in the context of the Commission of Social Determinants of Health of the World Health Organization (WHO) or the ‚Social Determination of the Health-disease Process‘ approach of the Latin American Social Medicine and Collective Health (LASM-CH). Eurocentric perspectives clearly predominate in the international discourse. A large number of studies have shown that social inequalities can lead to poorer health. These inequalities relate, for example, to categories such as gender, socioeconomic status, education, and migration. Intersectional perspectives, power-critical approaches and the explicit naming of the topic of „racism“ have only occurred sporadically and only in recent years in the discourse of health and nursing science in Germany. More common here are also subjects of investigation in the context of social inequality or barriers in access to and in care.
Looking at the program of the recent European Conference of Public Health in Berlin, it becomes clear that a very heterogeneous wording and different concepts continue to be used to describe disadvantage and racial discrimination in health care. Only three of approximately 1500 papers and posters presented focused on racial discrimination in the title, and only one of these papers explicitly focused on care. Terms and concepts used to target populations in studies ranged from „immigrants“, „migrants“, „ethnicity“, „of (country of) origin“, „foreign-born“ to „foreign background“ within one session on „Providing services to diverse populations“ alone. These papers all aimed to highlight disparities in care or health outcomes, with only one explicitly identifying racial discrimination as such. This highlights the problem that inequalities and barriers continue to be made visible in national and international public health contexts, but in which people's racial realities and intersectional effects rarely find visibility.
In 2022, the DeZIM Institute conducted and published the first major study on „Racial Realities“ in Germany. Racism is understood here as a structural and overall societal problem that is primarily related to socially handed-down power structures. This is reflected in the results: 22% of the respondents are directly affected by racism, 58% of the potentially racialized persons state that they have already experienced racism. Indirectly affected by racism is a large part of the population: 49% know a racialized person and 45% have already observed a racist incident. Only 35% of the population say they have never been directly or indirectly affected by racism. Furthermore, almost every second person surveyed is aware that racism is not only an individual problem, but also an institutional or structural one.
(...) the explicit naming of the topic „racism“ occurs only sporadically (...)in the health and nursing science discourse in Germany.
The first specific data on racism in health care in Germany is provided by the Afrozensus, which reveals from an intersectional perspective that 50.3% of cis men and 67.1% of cis women surveyed have experienced discrimination in the field of care and health, and black, trans*, inter*, and non-binary people report experiencing the most discrimination in this field at 81.7% (Aikins et al. 2021).
Two of our own secondary data analyses on „Intersectional Perspectives on Experiences of Racism by Family Caregivers of People of Turkish Descent with Dementia“ and „Experiences of Racism by Older People of Turkish Descent with Chronic Illness in Office-Based Medical and Medication Care“ explicitly elaborated on experiences of racism that had already been identified in the primary data analysis and subsumed under categories such as „language barriers“, „access“, and „negative experiences“. Secondary data analysis of the material from an intersectional perspective revealed the many levels on which the experience has a lasting impact on those affected. The results of the second study will be published in 2023 in the anthology „Alltagsrassismus“ (Editors: Joseph-Magwood & Polat).
In order to address the extensive research desideratum in German-speaking countries, the project „Racisms in Health Care“ will be funded by the German Federal Ministry of Education and Research (BMBF) from January 1, 2023 for a period of three years in the funding line „Current and Historical Dynamics of Right-Wing Extremism and Racism“, which we will carry out as a consortium at ASH Berlin (Prof. Dr. Dr. Hürrem Tezcan-Güntekin), the University of Witten/Herdecke (Prof. Dr. Patrick Brzoska) and the University of Applied Sciences Fulda (Prof. Dr. Regina Brunnett). The interdisciplinary joint project examines racism in health care institutions with a focus on hospitals and inpatient rehabilitation facilities. Patients and their relatives, health professionals and managers of the facilities will be interviewed in order to make empirically sound statements about experiences, situations and interpretations of racist discrimination in health care institutions and to identify starting points for developing racism-critical professionalism of health professionals and organizations.
Further information: Prof. Dr. Hürrem Tezcan-Güntekin and the project
Tezcan-Güntekin, H., Joseph-Magwood, A., Polat, A. (eds.): Alltagsrassismus. Kohlhammer Publishing House 2023