Race, racism, whiteness, white privilege and anti-racism
Mary-Claire Balnaves; Annabel Ahuriri-Driscoll; Jennie Briese; Deb Duthie; Lana Elliott; Shelley Hopkins; Kate Murray; and Lydia Roberts
Preface
Similarly to Chapter 4, this chapter provides an overview of large and multifaceted concepts related to race and racism. While providing a basis for understanding these ideas, continuing to develop and challenge your understanding through further reading, reflection, and critical inquiry is key to ensuring culturally safe practice. We acknowledge that what is discussed could be unfortunately familiar and lived experiences for many people reading this chapter. Whilst the chapter captures the theoretical side of racism, the lived experience of this form of discrimination is extremely real, current and pervasive.
Introduction
Sometimes, when discussing Cultural Safety, students and staff within health care and the academy ask, ‘Why do we need to talk about race and racism with Cultural Safety?’ This question is usually followed by a series of different remarks, such as ‘I treat everyone equally regardless of their race,’ ‘I am person-centred,’ or ‘I respect every person.’ These seemingly simple statements are often considered caring by the people making them. However, these statements negate that power is central to Cultural Safety and that race and racism remain pervasive and harmful to non-dominant cultures or groups in our society as a direct result of current power structures. An individual’s social position may alter their awareness of these dominant structures, including dominant ways of knowing, being and doing. Whether we realise it or not, these implicit power structures within our society socialise us to race and racism, meaning we learn to look at the world in terms of race (often known as racialised logic), which goes on to influence our personal and professional lives. Adopting Cultural Safety in spaces such as health care and tertiary education demands that we seek to understand, examine and interrogate current power structures that normalise racism and that we work collectively to challenge and dismantle these structures that stand in the way of equitable person-centred and respectful care.
What is race?
Race is not biological (Cox et al., 2021; Watego et al., 2021). The idea of race is socially constructed, meaning that it does not tangibly exist. Instead, it is a concept based solely on the collective consensus of dominant people or groups. The concept of race has been used by groups of people, framing some groups as superior and others as inferior. Pseudo-scientific evidence has often underpinned the entrenchment and proliferation of race-based thinking, which has been used to:
- Group and categorise people based on specific social or physical features (Watego et al., 2021);
- Discriminate against certain groups of people and justify macroaggressions and microaggressions, including colonialism and perpetuated racial violence (Cox et al., 2021; Watego et al., 2021).
The idea of categorising people by ‘race’ is a form of power and control (Dudgeon et al., 2010). Whilst it has been scientifically disproven, the influence of pseudo-scientific ideas such as social Darwinism, an evolutionary theory used to dehumanise certain groups of people and create social, economic and political inequity, remains pervasive (Dudgeon et al., 2010). Racism continues to be used socially and culturally to reinforce a particular group’s supposed superiority or inferiority relative to others (Dudgeon et al., 2010; Watego et al., 2021).
Racialisation is naming or categorising a person or group into a distinct racial category to create or sustain a social hierarchy (Watego et al., 2021). Although race is socially constructed, racialisation transforms the idea of race into a tangible reality. Racialisation is an active process. It involves prejudice-based actions that categorise individuals into groups with a particular distribution of social wins and losses. The disparate treatment of groups and unequal distribution of social wins and losses extends to all forms of social being, including (but not limited to) social, economic, and political areas of life (Watego et al., 2021). This is significantly evident with the ongoing disproportionate inequity and injustice experienced by First Nation’s people in all aspects of their lives within Australia and Aotearoa (New Zealand).
Critical Self-Reflection Exercises 1
Race is a social construct. Reflect on:
- What is your understanding of race?
- What has constructed your understanding of race? For example, where did you learn about race? Was it at home, at school, in your workplace, through the media?
- What is your understanding of the history of race as a social construct?
- When do you hear race discussed in your everyday life? And in what context?
Race or ethnicity? There is a difference.
Ethnicity and race are often confused and used synonymously, yet they are two distinctly different terms. Ethnicity refers to a group/s that people identify with or feel they belong to (Cox et al., 2021). A person’s ethnicity is determined by their sense of identity, with groups they feel share common traits such as beliefs, ideas, languages, geographical origins or ancestry (Cox et al., 2021; Smedley et al., 2023). The term ‘cultural group’ is often used interchangeably with ‘ethnic group’. Culture refers to the ideas, beliefs, customs, and traditions a group shares, whereas ethnicity refers to the people who share this culture. A person can belong to more than one cultural (ethnic) group and may feel a sense of belonging to varying degrees. Ethnicity is not connected to biology. Like culture, ethnicity is dynamic and can be developed, enhanced, and even changed throughout a person’s life (Cox et al., 2021; Smedley et al., 2023). Whilst culture can be self-ascribed, race is often externally ascribed to a person.
Racism and ethnocentrism are also different and distinct terms. Ethnocentrism is the belief that your cultural group is not only different from the cultural group of others but is in some way better (Hammond & Axelrod, 2006). Ethnocentrism means that your cultural lens may feel ‘right’ or the only way to think, feel, or understand the world. This belief can occur consciously or subconsciously, but regardless, it can create power differentials between cultures. For certain cultural groups, ethnocentrism creates a level of dominance, positioning anyone outside of the ‘superior’ group as inferior or lesser than (Cox et al., 2021; Smedley et al., 2023). For example, biomedical culture is a dominant ethnocentric culture that holds power within health care. It often reinforces the idea that objective, physical, and scientific measurements of health care are superior, and often ignores or excludes the social, relational and humanistic aspects of health.
Why talk about race and racism?
Given racism’s widespread consequences, calls continue to demand its recognition as a social determinant of health (Kairuz et al., 2021; Selvarajah et al., 2022). In terms of social structures, racism is not isolated to health care settings but impacts all determinants of health, including education, housing, and access to justice. The negative impacts of racism on a person, their family, community, and society have been experienced disproportionately by people of colour and, in particular, First Nations people, including Aboriginal and Torres Strait Islander peoples and Māori peoples (Thurber et al., 2022). The systemic nature of racism and its impacts can be seen to have significantly contributed to health inequalities. Health inequities experienced by Aboriginal and Torres Strait Islander peoples are a result of ‘the historical and ongoing effects of settler colonisation and racism’ (Thurber et al., 2022). With emerging research now showcasing the neural and inflammatory responses of racism on the body and brain leading to adverse health outcomes (Muscatall et al., 2022), there is unmistakable evidence of psychological changes that can lead to acute or chronic health conditions (Kairuz et al., 2021). That is, there are direct links between interpersonal discrimination, psychological distress, and poor health (Thurber et al., 2022).
In Australia and Aotearoa (New Zealand), the impacts of racism on health are seen through experiences of mental health, self-harm, and suicide. The Aboriginal and Torres Strait Islander Health Performance Framework (2024) identified that Indigenous Australians are hospitalised at three times the rate of non-Indigenous Australians for intentional self-harm, at 3.6 per 1,000 population compared to 1.2 per 1,000 population for non-Indigenous Australians. Suicide and self-inflicted injuries are the third leading cause of death for Indigenous Australians, with the overall death rates due to suicide two (2) times the rate of non-Indigenous Australians (Australian Institute of Health and Welfare, 2024, p.36). In Aotearoa (New Zealand), suicide rates for rangatahi (young people) between 10-24 years increased sharply from 18.8 per 100,000 in 2002 to 38.4 per 100,000 in 2012 and remained disproportionately high at 2 – 2.5 times compared to that of non-Māori, non-Pacific children and young people (Ngā Pou Arawhenua, Child and Youth Mortality Review Committee & Suicide Mortality Review Committee, 2020). In addition to rates of suicide, disparities are evident across a broad range of health behaviours and outcomes for First Nations peoples around the world and are linked to their experiences of racism (Paradies, 2018). These outcomes on health reflect that the trauma of racism is both historic and contemporary, and not limited to an individual, but affects communities and groups of people more broadly.
The anatomy of racism
Racism has its own anatomy that permeates society. It includes actions, thoughts, and ideas (conscious or unconscious) that create inequity and perpetuate violence against certain groups based on race. Racism, in all its forms, and the impacts are not just terms, definitions or ideas that exist in the abstract. Instead, racism remains an authentic, lived experience of many people. Like culture, racism is dynamic and is perpetuated through characteristics shared by people in particular times and places. Racism can be:
- Overt racism is explicit and can be more easily discerned with apparent harmful attitudes that are publicly expressed (Elias, 2015). Overt racism is often connected to interpersonal racism (see definitions below for an example). By contrast, research suggests that covert racism is in fact far more common (Coates, 2011). Covert racism is subtle, not obvious, and often concealed (Coates, 2011). Unlike overt racism, covert forms of racism could include the absence of behaviours or inaction. It is often connected to forms of racism such as institutional racism (Ahuriri-Driscoll et al., 2022);
- Direct or Indirect. Direct racial discrimination is seen when a person is treated not only differently but lesser than based on their ‘race, colour, descent, national or ethnic origin or immigrant status’ (Australian Human Rights Commission [AHRC], n.d.). Indirect racism, more often seen in forms of institutionalised racism, is where there are rules or policies that apply to everyone but are indirectly unfair to a group of people with a particular attribute (AHRC, n.d.). A recent example includes a report investigating the Queensland Health system [PDF] which found that racism was pervasive in the health care system, and a significant barrier to Aboriginal and Torres Strait Islander peoples’ health and wellbeing.
Defining forms of racism
‘Definitions are vital starting points for the imagination. What we cannot imagine cannot come into being. A good definition marks our starting point and lets us know where we want to end up (Hooks, 2000, p.20).
To be able to understand the anatomy of racism and how it functions – we need to start with definitions of racism. While we have begun to consider racism at the macro level, it is through defining forms of racism that we can begin to dissect its anatomy. Defining forms of racism in proximity to power is necessary to acknowledge its multifaceted existence within society.
Forms of racism include (but are not limited to):
- Individual/Interpersonal Racism;
- Institutional/Systemic Racism;
- Structural Racism;
- Microaggressions;
- Internalised Racism.
Before discussing these definitions of racism, we would like to acknowledge that unfortunately, there are countless examples of what these different types of racism look like and how these actions contribute to systemic racism and inequality. These types of racial harassment, abuse and violence are likely not to be understood or universally felt by all readers. Yet, for many groups, particularly First Nations peoples worldwide, these are not just figurative examples but literal, lived experiences of their own, their families, and their community’s reality.
Individual/interpersonal racism
Individual/interpersonal racism includes expressions of racism played out between individuals in everyday life (Dudgeon et al., 2010). Expressions of individual or interpersonal racism often occur in everyday settings (Australian Human Rights Commission [AHRC], 2017) and can range from a ‘casual’ joke, remark or comment to violent acts against a person. The types of jokes and actions are on a spectrum, from subtle (covert) acts to obvious (overt) acts, whether intentionally or not, all lead to diminishing, demeaning and disempowering a person or group. This spectrum of actions against a person is enacted based on perceived characteristics such as ethnicity or race (Watego et al., 2021). Regardless of the degree of severity or frequency of interpersonal racism, it is a significant stressor to a person, which can lead to poor physical, mental, and spiritual health and inequity in society (Dudgeon et al., 2010). Individual/interpersonal racism is often overt, in explicit, demonstrable verbal or physical acts. Interpersonal racism can also be covert, in more subtle acts or the absence of actions such as forms of social exclusion. Individual/interpersonal racism is not a standalone act but a manifestation of the deep-rooted, disconnected system that maintains and perpetuates power based on racial dominance reflected in institutional/systemic forms of racism (Watego et al., 2021). As such, the connection between ‘everyday racism’ and systemic racial inequality between people and groups within society are deeply intertwined (AHRC, 2017).
Structural racism
Structural racism is interrelated with institutionalised racism, and often the terms are used interchangeably (Thurber, 2022). Structural racism starts to consider the ways systems (or institutions) regulate everyday life. In structural racism, regulation or ‘the rules, official acts or ways of controlling people’ (Cambridge Dictionary, 2019) are often based on race or racialised biases that differentiate between groups of people and lead to oppression of a particular group. These rules or forms of control impact many areas of a person’s life or group of people’s lives, including (but not limited to) education, housing, justice, banking, the media, health and health care (Thurber, 2022). Systemic racism shows there are forms of power in society that can directly impact, positively or negatively, a person’s human rights (AHRC, 2017).
Microaggressions
Like interpersonal racism, microaggressions are everyday remarks that ‘other’ a person or group of people (AHRC, 2017). Microaggressions can be verbal, nonverbal or behavioural actions on a day-to-day basis that are demeaning to a racialised group of people. These can be casual, ordinary, and momentary, conveying a message that may belittle, insult, or invalidate their existence. Intentional or unintentional, the impact can be equally detrimental (Sue et al., 2007). Microaggressions may not be obvious or apparent to those making the remark and may seem unimportant. However, the nature and frequency of these microaggressions to the recipient can have a cumulative and compounding effect on physical and mental health. Some examples of microaggressions include asking a person of colour, ‘Where are you from?’ followed by ‘Where are you really from?’ These are questions too frequently asked of people of colour, which reinforce an outsider or ‘other’ status that infers a person does not belong (AHRC, 2017).
Internalised racism
Internalised racism is defined by the American Psychology Association (APA, 2019) as the adoption or internalisation of ‘racist attitudes, beliefs, or stereotypes, resulting in negative beliefs about one’s own racial and ethnic group or identity.’ The idea of internalised racism means people who experience racism are at risk of taking on the negative and violent racist beliefs expressed within society. Consciously or unconsciously, this acceptance of racist beliefs, stereotypes and negative beliefs by a person or group of people experiencing racism is a manifestation of the pervasive nature of racism within society (APA, 2019; Hwang, 2021).
Critical Self-Reflection Exercise 2
Read through the following reflective questions, and choose three (3) to answer:
- After reading through the definitions of racism, what are your initial thoughts, feelings, and observations about forms of racism within society?
- How has racism been talked about in your family and social circles?
- Reflecting on your experience with health care (for example accessing and receiving care, learning about health care, or working in health care);
- What are the dominant groups or dominant ideas that influence health care?
- What types of discrimination, including racism, exist in health care?
- Is there a relationship between certain forms of discrimination in health care and dominant groups/ideas in health care? If so, why? If not, why not? What are some examples of each type of racism within health care in Australia and Aotearoa (New Zealand)?
- How do forms of racism in society directly impact, positively or negatively, a person’s human rights? For example, how does it impact housing, education, health, media etc.
- In the place you call home, have you ever asked someone, ‘Where are you from?’ or have you been asked, ‘Where are you from?’. Reflect on what prompted you to ask this question and the experience of this. For example, what was the context? What was intended by this question? How did the other person receive the question? Could it have been perceived differently than you had intended? If so, was there any evidence of this?
Further reading
Ministry of Health (2022). Position statement and working definitions for racism and anti-racism in the Aotearoa, New Zealand health system. Wellington: Ministry of Health.
Watego, C., Singh, D. & Macoun, A. (2021). Partnership for Justice in Health: Scoping Paper on Race, Racism and the Australian Health System [Discussion Paper]. The Lowitja Institute, Melbourne. https://www.lowitja.org.au/wp-content/uploads/2023/05/Lowitja_PJH_170521_D10-1.pdf [PDF]
The pathophysiology of racism
Despite the reality of racism, First Nations peoples and people of colour continue to demonstrate ongoing resistance, survival, activism and sovereignty against all forms of racial power and domination. These self-determined acts, amidst the pervasiveness of racism, are poignant reminders of the sovereignty of First Nations peoples.
Race and racism have been central to establishing and maintaining settler colonial societies in Australia and Aotearoa (New Zealand) (Sherwood, 2013; Lipscombe et al., 2019; Elkin, 2022). While Aotearoa (New Zealand) and Australia have had different colonial experiences (Sherwood, 2013; Lipscombe et al., 2019), both processes of colonisation have had devastating and long-term impacts on First Nations peoples, including the loss of economic resources, the creation of structural inequality, and widespread institutional racism in each context (Cox et al., 2021).
Racism extends beyond interpersonal forms of race-based discrimination. It includes systemic and structural racism whereby laws, policies, ideologies and social barriers challenge or prevent people from experiencing justice, dignity, and equity because of their racial identity. Over time and in different historical moments, racism can manifest, adapt, and intensify in different ways. As an example, there was a noted spike in racism directed towards Asian and Asian-Australian people during the COVID-19 pandemic (Ballantyne & Giarrusso, 2023). More overt forms of racism can come in the form of harassment, abuse or humiliation, violence, or intimidating behaviour. However, less overt forms of racism also remain embedded in our systems and institutions, operating in ways that lead to inequity and injustice.
Aligning with the pathophysiology of racism, there are many misconceptions about race and racism. The following sections work through a series of misconceptions about race and racism.
‘I do not see race or colour.’
People often say they do not ‘see’ the colour of a person’s skin. This ‘colour-blind’ orientation is commonly raised in conversations about race and racism. The assumption is that by not seeing or naming ‘colour’ or race, the potential for racism is minimised. For example, this statement could be used to ‘reassure’ someone, including ourselves to convey that the person will not experience discrimination based on their colour. Yet, in saying this, it also ignores important aspects of culture for a person and the historical and contemporary injustice a person may be experiencing. This reinforces that racialisation is an active process that occurs irrespective of whether it is made explicit. Whilst race has been scientifically disproven, racialisation continues to be entrenched and proliferated to sustain prevailing social hierarchies. (Dudgeon et al., 2010; Watego et al., 2021).
‘It is not a race thing.’
People often argue that when a person is discriminated against, it is not because of that person’s race. It is instead often put down to ‘miscommunication or misunderstanding.’ However, this over-simplification of a person’s experience ‘not being a race thing’ ignores the socialisation of individuals to hold prejudices based on race and downplays the harm, ignoring the occurrence or frequency of such experiences. For example, microaggressions could be seen as ‘one off’ or ‘unintentional’ miscommunication from one person to another person of colour. However, for the person of colour, experiencing those microaggressions is not a ‘one off’ event, but a frequent occurrence that has a compounding effect. The minimising of a person’s experience of racism coupled with ongoing and often unconscious prejudices contribute to the complex, pervasive and violent nature of race and racism.
‘I have not contributed to racism.’
As previously discussed, racism is heavily intertwined with ideas of power. Collective prejudice and discrimination do not seep into broad public consciousness unless harboured by individuals or social groups who hold considerable power in shaping social norms and institutions. As articulated by Kauanui (2016), racism is a structure of society rather than a one-off event. Racist structures and practices also function as a reminder of the origins and aims of racism, which have been central to the development of colonial societies and systems, and the erasure of First Nations peoples’ ways of knowing, being and doing.
While critical race theory gained formal recognition in academia in the 1970s, racism and the distribution of power that underpins it has long been understood by racialised peoples. Some argue that the innate need for humans to organise and categorise the world extends to the value-laden categorisation of people. When orchestrated by those with power, for example, the imperial and colonial structures of Britain (Elkin, 2022), this ‘social ordering’ is thought to explain why such forms of racial violence against groups of people remain pervasive (Bolaffi et al., 2003).
Racism is reinforced through silence, particularly silence by those who align with society’s dominant norms or cultures. In this sense, silence, or a failure to call out forms of racism, is in itself a form of racial violence, as it continues to reinforce and allow systems and policies to discriminate against people (Watego et al., 2021). In providing a detailed account of racism, this chapter hence aims to contribute to anti-racist conversation and action; one of many steps required to untwine racism from our society and social structures and seek necessary equality (Watego et al., 2021). But what is it about racism that invites or even permits people to remain silent? The first step to answering this question is to build your understanding of racism and the way it functions in all aspects of society.
‘Racism is a thing of the past.’
Racism is a contemporary issue as well as a historical one. Racism is a current and significant form of discrimination that is prevalent across all countries. A historical example of covert, institutionalised racism in the Australian context is the Immigration Restriction Act 1901, otherwise known as the ‘White Australia Policy.’ This act was one of the very first pieces of legislation passed after Australia claimed united statehood in 1901. The White Australia Policy aimed to restrict the number of non-white people entering the nation and was designed to help keep Australia ‘British’ (Atkinson, 2015).
Australia’s first Prime Minister, Edward Barton, stated that this legislation would ensure the sanctity of the Commonwealth’s future generations but also for the welfare of the world’s “white races”. The enactment and perpetuation of laws, policies, and systems within a colonial settler nation like Australia against First Nations peoples shows the pervasiveness of racism and how it is entwined within the fabric of our society. Centuries later, these acts of racism continue to underpin many social institutions, entrenching social divides that continue to marginalise Aboriginal and Torres Strait Islander peoples. Ramifications are still felt extensively in domains as varied as health access and outcomes; access to justice and legal representation; education attainment; engagement and representation in sports; employment, workplace conditions and relations; within neighbourhoods and communities; in accessing public transport; and in portrayal in the media (AHRC, n.d.).
Critical Self-Reflection Exercise 3
Cultural Safety requires self-reflection on your cultural identities, including your previous understanding of racism. Reflect and consider:
- Were there any misconceptions of race and racism you were aware of before reading this section?
- What could the impact of holding these misconceptions be when delivering health care?
- What was a key insight/learning for your cultural awareness that would be important to understanding race and racism more deeply?
- What areas do you feel you still need to learn more about?
Whiteness
Understanding race and racism also requires an understanding of whiteness. While it will likely depend on who you ask, a typical response to the question of ‘what is whiteness?’ is ‘the colour of a person’s skin being white.’ This seems like a logical connection, knowing that race is connected to categorising people based on race (often connected to the colour of a person’s skin or certain groups’ cultural traits). However, whiteness as a social theory is more deeply related to structures and systems than skin colour on its own.
Whiteness as the ‘norm’
Like race and racism, whiteness is not biological but a social construct (Puzan, 2003). Moreton-Robinson (2004) describes the Western construct of whiteness as ‘the norm’ or the default position. These norms include specific ways of being, doing and knowing that are often visible to those who do not meet the norms of whiteness but are invisible to someone who meets or fits these social parameters (Olcon, 2023). Can you think of an example of this?
One example is when young children are learning to colour in pictures with pens and pencils. It is common for children at a young age to learn colours. When they draw, often we ask them what colour the pens or pencils are. Blue, green, red and so on. There are times, when there is a beige coloured pencil. Some children will not say ‘beige’ as the colour of the pen or pencil, but to refer to this as ‘skin colour’. Where did they learn this from? The skin colour of whom? And why is the black or brown pencil not referred to as skin colour? This example demonstrates that whiteness as the norm can permeate, knowingly or unknowingly, aspects of lives from even from a young age. Parter et al. (2021) outline that whiteness, therefore, is a system of power relations and privileges that involves:
- Knowledge, actions, and ways of life that are considered superior to those of other groups or people;
- Maintaining power structures that support the idea that not all people are considered equal;
- Maintaining dominance over groups of people.
People who fit the whiteness norm can ‘escape such [racial] designation and occupy positions which allow them to carry on as if what they say is neutral, rather than historically and ideologically situated’ (Puzan, 2003, p. 193). At the same time, racially designated people who do not fit the norms of whiteness will likely experience forms of discrimination, including racism (Puzan, 2003). Systemic power relations are not unique to Western culture and do not guarantee that every person who may fit the ‘norm’ will hold power or benefit from these structures. However, whiteness, and the asymmetrical power dynamics associated with it, survive, and are perpetuated based on forms of discrimination and oppression of people and groups who are made to feel marginalised (Moreton-Robinson, 2004; Parter et al., 2021). Whiteness (consciously and unconsciously) leads to a dehumanising process that then leads to treating certain groups of people as ‘less than human beings’ (Moreton-Robinson, 2004, p. 76).
Critical Self-Reflection Exercise 4
When reflecting on concepts such as racism and whiteness, it is essential to be curious about what thoughts, feelings and ideas are coming up. Write these down and consider where these may originate from. Some reflective questions may include:
- Before reading this chapter, what was your understanding of the concept of whiteness?
- After reading this chapter, what is your response to the concept of whiteness?
- Are there aspects of whiteness within your lived experience? For example, have you benefitted from the norms of whiteness that allow you to stay ‘neutral’ or have you been made to mask parts of yourself to fit the white norm?
- What could be some barriers to understanding whiteness?
- What is a key takeaway for you about whiteness, particularly as it related to health care?
Further reading
Olcoń, K. (2023). Key Concepts in Critical Whiteness Studies. In: Ravulo, J., Olcoń, K., Dune, T., Workman, A., Liamputtong, P. (eds) Handbook of Critical Whiteness. Springer, Singapore. https://doi.org/10.1007/978-981-19-1612-0_2-1
White privilege
‘White privilege’ is a way in which whiteness plays out in power structures in society. It refers to certain benefits, advantages and privileges that a person who fits the ‘dominant norms’ of whiteness will receive (Casey et al., 2013; Smith et al., 2014). McIntosh (2003; 2020) provides the analogy of white privilege as an invisible knapsack. It is an unseen, weightless bag that often contains unearned, unacknowledged, and invisible privileges to the person carrying it. The presence of this invisible knapsack does not exclude a person from experiencing other forms of disadvantage, discrimination or adversity. However, it highlights one aspect of society that unknowingly works to that person’s benefit.
Like racism, which discriminates based on a person’s complexion or cultural identity when it does not fit the dominant norm, the benefits of whiteness are connected to people with related physical appearances, complexions, attitudes, and behaviours of European ancestry (Casey et al., 2013; Smith et al., 2014). Puzan (2003, p. 194) states that ‘white skin is emblematic of systemic white privilege, conferring certain indelible and undeniable advantages to those who have it, and to a lesser extent, to those non-whites who can pass as white, either by actually appearing white or by adopting the accoutrements of white culture.’
Critical Self-Reflection Exercise 5
Read the following chapter:
- McIntosh, P. (1989). White Privilege: Unpacking the Invisible Knapsack. Chapter 2 In McIntosh, P., On Privilege, Fraudulence, and Teaching As Learning: Selected Essays 1981–2019. Routledge. https://doi.org/10.4324/ 9781351133791
Reflect on the following:
- What were the critical points of McIntosh’s paper?
- What was one new thing you learned about white privilege that could be helpful when learning, teaching and working in health care?
- Is there another analogy you know of or could use to describe white privilege?
- From your understanding, why do you think understanding white privilege is related to Cultural Safety?
- How does understanding white privilege help you become a better health practitioner and educator?
White fragility
What is white fragility?
White fragility is a phenomenon coined by DiAngelo (2011) in referring to a person’s response to even minimal racial stress, which can lead to counterproductive reactions to racial justice (Liebow & Glazer, 2023). Common attributes of white fragility include reactions similar to the sympathetic nervous system’s response to threat such as feelings of anger, guilt, or shame as well as behaviours like debating, silence and avoidance when racial stresses are observed, raised or discussed (Di Angelo, 2011; Liebow & Glazer, 2023).
Why does white fragility occur?
Due to the nature of whiteness and white privilege, some individuals or groups of people who fit ‘the norm’ or ‘default’ appearance, attitudes and beliefs may have different experiences about being racialised (Liebow & Glazer, 2023). If you are not used to being racialised or experiencing racism, then any amount of racial stress, even minimal, ‘can be intolerable, triggering a range of defensive moves’ (Di Angelo, 2011).
Reflections from the Authors
There are a small group of emboldened people, who would find pride in being called a racist, and bask in being connected to dehumanising acts against people from a different ethnic background. This is not white fragility, rather another example of racism. The majority of people, do not connect with or undertake these extreme and overt acts of racism. This positions people to feel immune from being racist, and not part of the problem. When there is even an inch of potential they could be seen as ‘racist’ or have been told their actions were racist they will immediately feel defensive. This defensiveness often leads to uncomfortable feelings of anger, shame and guilt for just ‘being who they are’ or ‘not intentionally doing anything’.
Race and racism are often more readily understood than white fragility. But why? This chapter is an introduction to the harms of racism to peoples’ health and wellbeing. These harms are often caused by systems and structures that have been reinforced over time. The way racism works, means it has been embedded in society to be ‘part of life’. White fragility is the polar opposite, to reflect that there are parts of society immune to being discriminated against based on their race.
People who experience racism and white fragility will experience similar feelings of anger, shame and guilt. However, what elicits these feelings, and the way each group are permitted to express these feelings are extremely different.
People who experience racism, are often not permitted the time or space to process these feelings and are expected to just ‘get on with life’. People who experience white fragility, have most likely not had to deal with being racialised before, are able to respond immediately and have permission to share their dissent with these feelings.
Critical Self-Reflection Exercise 6
White fragility highlights the nature of a person’s reactions and encourages critical self-reflection and curiosity about what thoughts, feelings, and ideas emerge when considering how racism operates around us. Write down and consider where your responses to white privilege may originate. Some reflective questions include:
- Did you have a previous understanding of the term white fragility? If so, what was it, and how does it compare to this explanation?
- How could these feelings and reactions associate with white fragility hinder power sharing in health?
Further reading
Liebow, N. & Glazer, T. (2023). White tears: Emotion regulation and white fragility. Inquiry, 66(1), 122–142. https://doi.org/10.1080/0020174X.2019.1610048
Where to from here? Anti-racism
An anti-racist approach directly aligns with the principles of Cultural Safety in terms of examining and addressing power structures to create culturally safe spaces. The Ministry of Health in Aotearoa (New Zealand) (2022) working definition of anti-racism that includes active opposition to and addressing all forms of racism through addressing power differentials and imbalances. Anti-racism requires:
- The examination of power and privilege.
- Accepting the need to redistribute current forms of power and privilege.
The idea of a ‘working’ definition itself represents that anti-racism is an evolving and ongoing process to address and oppose forms of racism.
Critical Self-Reflection Exercise 7
Cultural Safety requires an understanding of the current power structures that normalise racism within spaces such as health care and tertiary education and methods to challenge these structures through anti-racist practices (Cox et al., 2021). This chapter is only one starting point and perspective for understanding and talking about race and racism, which is a part of anti-racism.
Reflect on this chapter and review the Australian Human Rights Commission’s (2017) campaign, ‘Racism. It Stops With Me.’. It provides an initial starting point to learn about anti-racism and anti-racist practices:
- Australian Human Rights Commission. (2017). Racism. It Stops With Me. https://itstopswithme.humanrights.gov.au/
- Australian Human Rights Commission. (2019). Let’s talk race:: a guide on how to conduct a conversation about racism. https://humanrights.gov.au/our-work/race-discrimination/publications/lets-talk-race-guide-how-conduct-conversations-about
From your current understanding of Cultural Safety, race and racism, consider: How can racism stop with you, today?
References
Ahuriri-Driscoll, A., Williams, M., Vakalalabure-Wragg, U. (2022). Evolution of Racism and Anti-racism – Lessons for the Aotearoa New Zealand Health System (Stage One Literature Review). Wellington: Ministry of Health.
Australian Human Rights Commission. (n.d.) Complaints under the Racial Discrimination Act. https://humanrights.gov.au/sites/default/files/Complaints%20Under%20the%20RDA%20April%202017_2.pdf?_ga=2.267546507.442700569.1686617224-2098652412.1683505440
Australian Human Rights Commission. (2017). Racism. It Stops With Me. https://itstopswithme.humanrights.gov.au/
Australian Human Rights Commission. (2021). Indirect Discrimination, Australian Human Rights Commission. https://humanrights.gov.au/quick-guide/12049
Australian Institute of Health and Welfare (2024). Aboriginal and Torres Strait Islander Health Performance Framework: summary report March 2024. AIHW: Australian Government.
APA Task Force on Race and Ethnicity Guidelines in Psychology. (2019). APA Guidelines on Race and Ethnicity Guidelines in Psychology: Promoting Responsiveness and Equity. Retrieved from https://www.apa.org/about/policy/guidelines-race-ethnicity.pdf [PDF]
Atkinson, D. (2015). The White Australia Policy, the British Empire, and the World. Department of History Faculty Publications. Paper 4. http://dx.doi.org/10.3366/brw.2015.0191
Ballantyne, G., Giarrusso, V. (2023). Asian Australian Experiences of Racism During the COVID-19 Pandemic in Victoria: a Preliminary Analysis. Journal of International Migration and Integration, 24, 1437–1453. https://doi.org/10.1007/s12134-023-01018-8
Bates, K. A., & Ng, E. S. (2021). Whiteness in academia, time to listen, and moving beyond White fragility. Equality, Diversity and Inclusion: An International Journal, 40(1), 1–7. https://doi.org/10.1108/edi-02-2021-300
Bolaffi, G. (2003). Dictionary of race, ethnicity and culture. SAGE. https://ebookcentral.proquest.com/lib/qut/reader.action?docID=334373
Cambridge Dictionary. (2019). REGULATION | meaning in the Cambridge English Dictionary. https://dictionary.cambridge.org/dictionary/english/regulation
Charles, B. (2023). Institutional racism is at work in Australia. How does it affect Indigenous people? https://www.sbs.com.au/nitv/article/institutional-racism-is-at-work-in-australia-how-does-it-affect-indigenous-people/ds4mvd3ft
Casey, Z., et al. (2013). Whiteness and white privilege. In P. L. Mason (Ed.), Encyclopedia of race and racism (2nd ed.). Farmington, MI: Gale.
Coates, R. D. (2011). Covert racism theories, institutions, and experiences. Brill.
Coates, T. (2015). Between the world and me. Spiegel & Grau.
Cox, L., Taua, C., Drummond, A., & Kidd, J. (2021). Enabling Cultural Safety. In J. Crisp, J. Crisp, C. Douglas, G. Rebeiro, & D. Waters (Eds.), Potter & Perry’s fundamentals of nursing (6th ed., Australia and New Zealand edition, pp. 49–83). Elsevier Australia
DiAngelo, R. (2018). White Fragility: Why it’s so hard for White people to talk about racism. Beacon Press.
Dudgeon, P., Wright, M., Paradies, Y., Garvey, D., & Walker, I. (2010). The social, cultural and historical contexts. In P. Dudgeon, H. Milroy and R. Walker (Eds.) Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, pp. 3-24. https://www.thekids.org.au/globalassets/media/documents/aboriginal-health/working-together-second-edition/working-together-aboriginal-and-wellbeing-2014.pdf [PDF]
Dudgeon, P., & Walker, R. (2022). An urgent call to address interpersonal and structural racism and social inequities in Australia. The Lancet, 400(10368), 2014-2016. https://doi.org/10.1016/S0140-6736(22)02491-6
Elias, S. (2015). Racism, Overt. In The Wiley Blackwell Encyclopedia of Race, Ethnicity, and Nationalism (eds A.D. Smith, X. Hou, J. Stone, R. Dennis and P. Rizova). https://doi.org/10.1002/9781118663202.wberen398
Elkins, C. M. (2022). Legacy of Violence: A History of the British Empire. New York, NY: Alfred A. Knopf.
Gatwiri, K., Rotumah, D., Rix, E. (2021). BlackLivesMatter in Healthcare: Racism and Implications for Health Inequity among Aboriginal and Torres Strait Islander Peoples in Australia. International Journal of Environmental Research and Public Health. 18(9):4399. https://doi.org/10.3390/ijerph18094399
Hammond, R. A., & Axelrod, R. (2006). The evolution of ethnocentrism. Journal of Conflict Resolution, 50(6), 926-936.
Hooks, B. (2000). All about love: new visions. New York: William Morrow.
Hwang, W.-C. (2021). Demystifying and Addressing Internalized Racism and Oppression Among Asian Americans. https://www.apa.org/pubs/journals/releases/amp-amp0000798.pdf [PDF]
Kauanui, J. K. (2016). “A structure, not an event”: Settler colonialism and enduring indigeneity. Lateral: Journal of the Cultural Studies Association, 5(1). https://doi.org/10.25158/L5.1.7
Kairuz, C.A., Casanelia, L.M., Bennett-Brook, K. et al. (2021). Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait Islander peoples living in Australia: a systematic scoping review. BMC Public Health, 21(1), 1302. https://doi.org/10.1186/s12889-021-11363-x
Liebow, N. & Glazer, T. (2023). White tears: emotion regulation and white fragility. Inquiry, 66(1), 122–142. https://doi.org/10.1080/0020174X.2019.1610048
Lipscombe, T. A., Dzidic, P. L., & Garvey, D. C. (2019). Coloniser control and the art of disremembering a “dark history”: Duality in Australia Day and Australian history. Journal of Community & Applied Social Psychology, 30(3), 322–335. https://doi.org/10.1002/casp.2444
McIntosh, P. (2003). White privilege: Unpacking the invisible knapsack. In S. Plous (Ed.), Understanding prejudice and discrimination (pp. 191–196). McGraw-Hill.
McIntosh, P. (2019). On Privilege, Fraudulence, and Teaching As Learning: Selected Essays 1981–2019. Routledge. https://doi.org/10.4324/9781351133791
Moreton-Robinson. (2004). Whitening Race: Essays in social and cultural criticism. Aboriginal Studies Press. https://ebookcentral.proquest.com/lib/qut/reader.action?docID=287025
Muscatell, K. A., Alvarez, G. M., Bonar, A. S., Cardenas, M. N., Galvan, M. J., Merritt, C. C., & Starks, M. D. (2022). Brain–body pathways linking racism and health. American Psychologist, 77(9), 1049–1060. https://doi.org/10.1037/amp0001084
Ministry of Health (2022). Position statement and working definitions for racism and anti-racism in the health system in Aotearoa, New Zealand. Wellington: Ministry of Health.
Ngā Pou Arawhenua, Child and Youth Mortality Review Committee & Suicide Mortality Review Committee. (2020). Te Mauri—The life force. Rangatahi suicide report | Te pūrongo mō te mate whakamomori o te rangatahi. Health Quality and Safety Commission.
Olcoń, K. (2023). Key Concepts in Critical Whiteness Studies. In: Ravulo, J., Olcoń, K., Dune, T., Workman, A., Liamputtong, P. (eds) Handbook of Critical Whiteness. (pp. 1-17) Springer, Singapore. https://doi.org/10.1007/978-981-19-1612-0_2-1
Paradies, Y. (2018). Racism and Indigenous health. In Oxford Research Encyclopedia of Global Public Health. Oxford University Press. https://doi.org/10.1093/acrefore/9780190632366.013.86
Parter, C., Rambaldini, B., Wilson, S., Gwynn, J., C Skinner, J., & Calma AO, T. (2023). Heal country, heal our nation: Talking up racism. Australian and New Zealand Journal of Public Health, 47(2), 100037. https://doi.org/10.1016/j.anzjph.2023.100037
Puzan, E. (2003). The unbearable whiteness of being (in nursing). Nursing Inquiry, 10(3), 193–200.Sherwood, J. (2013). Colonisation – It’s bad for your health: The context of Aboriginal health. Contemporary Nurse, 46(1), 28–40. https://doi.org/10.5172/conu.2013.46.1.28
Regulation (2019). In Cambridge English Dictionary. Cambridge University Press. https://dictionary.cambridge.org/dictionary/english/regulation
Smedley, A. , Wade, . Peter and Takezawa, . Yasuko I. (2023, June 22). Race. Encyclopedia Britannica. https://www.britannica.com/topic/race-human
Smith, A., Crosthwaite, J., & Clark, C. (2014). White privilege. In S. Thompson (Ed.), Encyclopedia of diversity and social justice. Lanham, MD: Rowman & Littlefield Publishers.
Smith, H., Le Grice, J., Fonua, S., & Mayeda, D. T. (2022). Coloniality, institutional racism and white fragility: A wero to higher education. The Australian Journal of Indigenous Education, 51(2). https://doi.org/10.55146/ajie.v51i2.34
Sweet, M. (2019). Calls to address the public health threat of racism in healthcare – #JusticeForNaomi. Croakey Media, retrieved from https://www.croakey.org/calls-to-address-the-public-health-threat-of-racism-in-healthcare-justicefornaomi/
Sue, D. W., Calle, C., Mendez, N., Alsaidi, S. & Glaeser, E. (2021). Microintervention strategies: what you can do to disarm and dismantle individual and systemic racism and bias. John Wiley & Sons, Inc. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/qut/detail.action?docID=6437585
Watego, C., Singh, D. & Macoun, A. (2021). Partnership for Justice in Health: Scoping Paper on Race, Racism and the Australian Health System, Discussion Paper, The Lowitja Institute, Melbourne, https://www.lowitja.org.au/wp-content/uploads/2023/05/Lowitja_PJH_170521_D10-1.pdf [PDF]
Thurber, K. A., Brinkley, M. M., Jones, R., Evans, O., Nichols, K., Priest, N., Guo, S., Williams, D. R., Gee, G. C., Joshy, G., Banks, E., Thandrayen, J., Baffour, B., Mohamed, J., Calma, T., & Lovett, R. (2022). Population-level contribution of interpersonal discrimination to psychological distress among Australian Aboriginal and Torres Strait Islander adults, and to Indigenous-non- Indigenous inequities: a cross-sectional analysis of a community- controlled First Nations cohort study. The Lancet, 400(10368), 2084–2094. https://doi.org/10.1016/S0140-6736(22)01639-7
Racialisation is the process of categorising people as being of assumed races.