Strategies for Developing an Inclusive Geriatric Physician Workforce for Older Adults in the U.S

The “geriatric imperative” has been part of the aging discourse for more than 30 years but neither geriatric practice nor older adults are homogenous. As the U.S. population ages, elders will become more racially and ethnically diverse; and, their health outcomes will be shaped by lifetime experiences with systemic discrimination and racism. Already, COVID-19 has made clear that older adults and non-Whites, particularly African Americans and Hispanics, disproportionately bear the burden of disease and illness. Research suggests health disparities will continue unless there is change within the health care system. The Institute of Medicine (2001) reported on the problematic nature of the stark contrast between the diversity of patients and the physicians caring for them, including issues with patient trust and communication, yet no significant movement has been made to diversify the physician workforce. Despite being 13% and 16% of the U.S. population, respectively, African Americans and Hispanics make up just 5% and 6% of the practicing physician workforce. Further, practicing geriatricians represent less than 1% of physicians with very few physicians of color. There is a need for more African American and Hispanic geriatricians. In this systematic review, we examine recruitment and retention efforts targeting students of color, and curricula of geriatric medical programs in the U.S. We offer recommendations toward incentivizing physicians of color to enter geriatrics, strategies to support decolonization of geriatric medical curricula in undergraduate medical education programs, and the development of mentorship and pipeline programs to increase diversity in the geriatric physician workforce.

Diversity matters: the other doctor within the Dutch academic healthcare system

IntroductionOver the past year, there has been a worldwide increase in the focus on systemic discrimination and inequitable practices within different societies, particularly concerning race and ethnicity. The inherent (experience of) inequity in racism is notonly limited to individuals but also found in different domains of societal structures, including healthcare and academia. In academia and healthcare organisations, junior Black and Minority Ethnic (BAME) doctors and students regularly find themselves caught between the leaky pipeline phenomenon and hierarchically dependent positions in academic healthcare settings. Voicing their experiences after such encounters is neither an option nor a choice they can do without repercussions. The prejudices, stigmas, implicit biases present within these environments result in segregated practices, where BAME doctors become the ‘other’ doctor (otherism), and based on their religion, ethnicity, migrant background or physical features are boxed into a specific group or category.Reflections & recommendationsThe outcome of this exercise (re-) emphasised that more improvement in the Dutch healthcare systems concerning stigmas and biases towards race and ethnicity are needed to promote the inclusion of future BAME doctors and students. A pivotal turn is urgently needed to repair the racial stigmas and biases that have distorted the image of BAME doctors/students, limiting their academic and professional progress. By structurally implementing focused strategies to promote inclusivity, the current gap within healthcare and the participation between non- BAME and BAME-doctors/students can be bridged, inevitably leading to better healthcare services, safer learning environments and a balanced representation of our multicultural societies in healthcare.We argue that increased self-reflection from such critical inquiry will ultimately result in clear and objective understandings of (pre) existent inequitable practices in our societies.

Views and Experiences of LGBTQ+ People in Prison Regarding Their Psychosocial Needs: A Systematic Review of the Qualitative Research Evidence

People who identify as LGBTQ+ and are in prison often experience many additional challenges. Once in prison, there is systemic discrimination against imprisoned LGBTQ+ people and a lack of understanding and concern regarding their care, treatment and support needs. While there is growing interest in their protection and that of other vulnerable populations in prison settings, little is known about their views and experiences regarding their distinct psychosocial needs. The aim of this systematic review is to critically evaluate and synthesize the existing research evidence relating to the unique psychological and social experiences of LGBTQ+ people in prison and identify aspects that may help or hinder access to appropriate psychosocial interventions and supports. The PRISMA procedure was utilized. A search of relevant databases from January 2010 to March 2021 was undertaken. Studies were identified that involved LGBTQ+ people, and addressed their views and experiences regarding their psychosocial needs whilst in prison. The search yielded 858 papers in total. Following the application of rigorous inclusion and exclusion criteria a total of 12 papers were considered suitable for the systematic review. Quality was assessed using the CASP instrument. Following analysis, three themes were identified: (i) interpersonal factors (ii) intrapersonal factors and (iii) institutional factors. The policy, education and practice development implications are highlighted and discussed. Future research opportunities have been identified that will add significantly to the body of evidence that may further the development of appropriate health interventions and supports specific to the LGBTQ+ population in prison.

Women’s Participation in Governance and Political Processes in Kenya: Threats and Proposed Remedies

The most recent studies on women’s political participation demonstrate that women are consistently denied adequate space and a level playing field to participate in politics and governance, especially in many global south countries, unlike their male counterparts. These studies’ most dominant claim is that these contexts’ patriarchal cultural norms mainly limit women’s central involvement in such nations’ political processes. Based on this impediment system, it follows that these environments become more unpropitious, hostile, and insecure for women in politics, which opens up and perpetuates possibilities for all manner of harm to them. Because of such threats, several scholars, religious leaders, and women activists decry the underrepresentation of women in politics, which in their understanding, has contributed to prolonged systemic discrimination through a legacy of insufficient woman-centric legislation and policy interventions. There is a consensus-based claim among the majority of these actors that this kind of inadequacy continues unabated due to a siloed thinking that inhibits a joined-up approach in tackling such discrimination. This paper seeks to further explore this claim through a broad stroke integrated review of literature that deals with women’s political participation in Kenya, where the concept of traditional gender role beliefs provides a vital backdrop for conducting it. Based on this concept’s valuable terms of reference, it is concluded that women need to be accorded a more enabling environment to participate in politics and, in this way, ensure that their ascension to leadership positions in governance becomes tenable. It is anticipated that such an assumption will increase legislation, policy and other interventions geared towards safeguarding women’s general participation in politics. In light of such conclusion, it is proposed that groundswell support is needed to ensure that the creation of a conducive environment for women to be involved in politics is realized, and in this way, their disenfranchisement based on their limited participation in politics is tackled.

ZAINICHI KOREANS, AFRICAN AMERICANS, AND THE RACIAL POLITICS OF COMPARISON

Zainichi Koreans are the descendants of colonial subjects who migrated to Japan from 1910 to 1945, when Korea was part of the Japanese empire. In 1952, the Japanese state stripped them of their nationality status and left them stateless. Like racial minority groups in other societies, Korean descendants still face systemic discrimination in contemporary Japan. Although they were colonized by a non-European power and are not physically distinct from the dominant Japanese population, their situation is often compared to that of African Americans. Yet, for scholars who think that race is necessarily based on “phenotype,” anti-Korean oppression cannot qualify as an instance of racism in Japan and the comparison with Black Americans is misguided. This article explores the intellectual and political issues at stake in debates over the use of racial comparisons—what I call the “racial politics of comparison.” Examining the views of scholars and Zainichi Korean activists, I show how the latter have drawn inspiration from the Black liberation struggle and built alliances with African Americans in order to resist oppression. I argue that their unique situation forces us to revise the role attributed to phenotype in current definitions of race and racism.

Enacting Border Governance through Multi-scalar Violence: Exclusion and discrimination of Rohingya people in Rakhine state

While international focus has been on armed violence and Rohingya refugee flows from Rakhine state, this article pays attention to the myriad forms of ‘everyday discrimination’ that Muslim Rohingya people have experienced over a prolonged time. These forms of discrimination were observed by the author and reported by Rohingya informants in three areas of Rakhine state during research conducted in 2015. The article argues that systemic discrimination against Rohingya people can be understood as the violent enactment of bordering processes by both state and non-state actors at multiple scales, thus contributing to border governance. Bordering processes can be observed at the national level through the construction of citizenship in law and documentation; at the sub-national level through the restriction of travel and mobility at the township and village levels in Rakhine state; at the household level through household registrations and the control of births, marriages, and family relationships; as well as at the individual level through arrests, detention, and acts of violence. The border is enacted through such processes, with Rohingya people treated as an embodiment of both a political boundary between Myanmar and Bangladesh, and a social boundary constructing the Muslims as ‘fearsome and disgusting others’ by the country's non-Rohingya groups, particularly by the majority Bamar Buddhist population.

Exploring Intersectionality: Theoretical Concept and Potential Methodological Efficacy in the Context of Nepal

This article engages in theoretical discussions of intersectionality on such issues as: how does Kimberle Crenshaw's intersectionality theory function in various forms of social divisions, and how do various scholars respond to it? Why is intersectionality theoretically and methodologically critical to examining Nepali political and social contexts, especially on women and Dalit's issues? This article examines the overview of intersectional theoretical standpoints explicitly based on Crenshaw's ideas and how it problematizes political practices of domination and discrimination against minority groups in societies today. Rather than providing an empirical and positivist approach to findings, this write-up offers a theoretical framework that helps conceptualize and utilize it in examining power exercise and politics in the Nepali context. It emphasizes discourse analysis to explore the systemic discrimination and the genealogy of structural violence to moot debates about central and marginal subjects concerning women and Dalit issues in Nepal.

Retheorising distributed leadership through epistemic injustice

Existing distributed leadership (DL) theories tend to focus on distributing financial, material and human resources in order to enhance school performance. However, their impact appears controversial. Critical scholars assert that using DL to promote trust and democracy can be a self-fulfilling prophecy orchestrated by few formal leaders. When being misused as a managerial tool, DL can reinforce epistemic injustice in school. In this conceptual paper, we retheorise DL through the lens of epistemic injustice. Drawing on the concepts of testimonial, hermeneutical and systemic injustice, we analyse how DL practices potentially marginalise, silence, and reject individuals as knowledge contributors due to their deflated credibility, the lack of concepts or language, and systemic discrimination. To build epistemic justice and reciprocity into DL, we propose three moves: building trust and self-trust; re-distributing epistemic resources; and reconfiguring relational justice. This paper makes a theoretical contribution by explicating why and how epistemic injustice is done to disadvantaged individuals in DL. It also serves as the theoretical foundation for future empirical investigations.

The Underutilization Of International Medical Graduates In Ontario and Canada: A Selective Review Of The Existing Literature On The Experiences Of International Medical Graduates In The Context Of Canadian Health Care Policies

This paper will examine the phenomenon of the underutilization of IMGs in Canada and Ontario. Using the existing literature selectively as it relates to the key research questions, it will be argued that health policy initiatives have contributed in diverse ways to the underutilization of IMGs in the health care system, with significant negative impact upon the life experiences of the IMGs and their families. As will be seen, we need to consider how these health policies have been influenced by other factors – such as systemic discrimination, an issue whose importance is suggested in some of the scholarly literature on this topic – that have contributed to this problem as well as to its resistance to policy remediation.