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Cultures of Power and Privilege

If you have not done so already, prepare yourself for the topic of power and privilege by reading from the Recommended Readings for this section.

What do people's experiences of colonization and health, as described in Module 1, have to do with power and privilege? In brief, systems of power and privilege at the level of the individual, community, and wider society sustain the ability of some people, at the expense of others, to have more opportunities for making choices in their lives and to be able to participate more fully in society.

Can you see yourself or others reflected in McIntosh's article, White privilege: Unpacking the Invisible Knapsack? What connections are there to your nursing practice? Take a few minutes here for some private reflection.  

Many people are unaware that they have privilege and that their privilege is sustained by those without it. People have learned not to be aware of their privilege and, indeed, are not even aware they have learned to be ignorant of it. Being unaware is part of what sustains power and privilege, and it is embedded in the dominant culture of Canada, which is based largely on male-dominated European values. However, the focus in this discussion is "dominance and uncritical acceptance of white privilege, not whiteness per se".1 In the "Chilcotin Wars" clip, Roger John talks about the taken-for-granted power of the colonizers.

Roger John, Chilcotin Wars [Text Transcript]

Many believe that Canada is now a multicultural nation and that everyone has, or should have, access to all they need in life. But many people, including Aboriginal peoples, have been marginalized by the powerful processes of colonization and colonialist policies that have reinforced privileges for some at the expense of others. Listen to what Sheila Dick has to say about sending her young children off to school for the first time.

Sheila Dick, Preparing Children for School [Text Transcript]

In this video clip, Sheila remembers sending her children to school and being re-traumatized by the experience as it causes her to reflect on her residential school experience and to fear that her children may be stereotyped and judged in the mainstream K-12 system. Most parents do not have this concern because they did not experience residential school. In Sheila's case, her fear is justified based on her experience. This example illustrates that although Aboriginal parents may be able to protect their children from racism while they are very young, they must eventually participate in an education system from which "there is no escape".2 Sheila fears that her children will face racist teachers who may make assumptions about how her children learn. Underlying this fear is her own fear of failing, so entrenched from residential school, layered with the knowledge of the competitive nature of mainstream school, as opposed to traditional ways of learning and teaching that focus on family involvement and co-operation.3

Sheila also experienced the fear of racism while looking for an apartment. Those with privilege, in particular, white privilege, will probably never have to be concerned about an apartment "being rented" as soon as the apartment manager sees the colour of their skin. If your social location includes being a member of a racialized minority, your experience may be similar to Sheila's. When people engage in racism, they explain everything about an individual or a group in terms of their racial or ethnic background. It is only when they become conscious of their actions that they will factor other aspects of the individual or group's experience into their analysis of them.

Sheila Dick, Looking for an Apartment [Text Transcript]

The marginalizing, or "othering" processes is one major way that privilege is sustained. If you have not done so already, read Canales' article on exclusionary and inclusionary othering. Canales describes how people who are different from the dominant, or mainstream, culture, are "othered" and how their difference is considered to be a problem.

As long as "othered" individuals and groups are expected to conform to the dominant culture, they will continue to be marginalized. Many of those in the mainstream have yet to understand that demanding that everyone conform to one way of being, living, or experiencing life disrespects difference.

Experiencing the festivals, art, music, and food of people from different backgrounds, while enjoyable, does not help people in the mainstream fully understand the issue of power and privilege. In her article, Canales asks us to think about inclusionary othering, that is, to put ourselves in others' roles and connect with them through difference. This provides an opportunity to consider, or confirm, that difference is a good thing, rather than something bad that needs to be changed. Above all, it creates some space to reflect on our commonalities as human beings and celebrate, not fear, our differences.

Culture

Have you noticed that health care has a dominant culture? What have you noticed about it? In the recommended article by Stephenson, there are many important examples of how the dominant medical culture can create ethical dilemmas not only for marginalized people and groups, but also for health providers, including nurses.

After reading Stephenson's article, take a few minutes to reflect on the concept of "culture." You may come up with a list of examples such as ethnic heritage, religion, values, beliefs, dances, songs, and artifacts. What culture do you think is dominant in Canada? How do you define Canadian culture? Do you consider yourself a member of this culture? Now, go to the Glossary on this website to read a more detailed discussion of how culture relates to this discussion.

Have you ever described someone as having cultural attributes, or being "cultured," or explained that something is due to culture? Members of the dominant culture who attribute culture only to others fail to acknowledge that they, too, are creators of culture. Conversely, members of the dominant culture may see only their culture as "true," "normal," or "high." Both situations illustrate how privilege obscures the way that power works in society and leads to power-over behaviour that views difference as something to be fixed or changed. In the "Know Yourself" clip, Roger describes the importance of acknowledging your culture and yourself.

Roger John, Know Yourself [Text Transcript]

Take a few minutes now to do Activity 2, What is This Thing Called Culture?  

Culture is complex and not an "object" or "group" to be studied. All of us create culture constantly and, in doing so, create and sustain power relations. Cultural safety demands the recognition that all people are bearers of culture. Problems arise when culture is objectified or behaviour or health is explained in terms of culture.

For example, Aboriginal peoples are commonly assumed to experience a higher incidence of diabetes due to poor lifestyle and diet choice, caused, in part, by their culture. Missing from this analysis is the recognition, in terms of cultural safety, that life choice or life opportunity is closely linked to historical, social, political, and economic factors relating to our experiences. Mainstream analysis ignores the colonial legacy that informs health, as well as the fact that choice for Aboriginal peoples may mean something very different than that for members of the dominant culture. Thus, in this example, explaining health only in terms of culture objectifies culture, making it something that can be seen, studied, or judged. In a similar way, when the dominant culture objectifies individuals or groups based on certain characteristics, these individuals or groups may then be labelled or stereotyped in negative ways, thus becoming the "other."

Culture is not restricted to an individual or group's ethnic background, skin colour, beliefs, diet, country of origin, and so on. Culture is also created and experienced in terms of age, ability, sexual orientation, physical size, education, and income, among many other things. The many intersections of our experiences, based on these characteristics, are helpful when thinking about our social location.

Reflect on your social location. What characteristics come to mind?

Culture is the medium through which all of these factors are experienced and created and through which we experience and make meaning of our lives.⁴

Think about the culture of your workplace. What happens when you want to do something different from the norm? What happens when patients/clients ask for something that is not included in official procedures or policies? Now is a good time to read the article by McGibbon, which is about the power of the knowledge you have as a nurse and how your power and knowledge can help you, your colleagues, and your clients.

After reading McGibbon's article, do Activity 3, "Flower of Power."

To conclude this section, read Chapter 2 by Papps, in Wepa's Cultural Safety in Aotearoa New Zealand. In the late 1980s, Maori people in Aotearoa were not satisfied with the quality of their health services. The dominant health care culture left no room for their voice, and they felt excluded from and overpowered by the system. They subsequently worked to change the system so that, today, all nurses in Aotearoa must meet cultural safety competencies. This means nurses must be able to reflect on their own culture, as well as respect difference and the knowledge of Maori people.

When you look at health services or individual experiences through the lens of cultural safety, you can appreciate the ways in which colonization, power, and privilege come together to affect how people experience health. Think about how power has affected the lives of Joan Morrison (who you met in Module 1) and her mother while you watch and listen to Joan's video clip.

Click to watch video clips/read text transcripts.
Joan Morris, Mom's life after Nanaimo Indian Hospital [Text Transcript]		After being released from Nanaimo Indian Hospital, Joan's mother expected to have her meals served to her in bed at home. She had learned to be waited on and Joan's role in relation to her mother changed — Joan was now expected to take care of her mother. This is an example of how power relations enacted in a hospital setting can affect family members. It is also an example of how a previously independent and capable adult internalized the oppression of the Indian Hospital and became "helpless." Joan had to look after her mother and was not able to finish her education as a direct result of her family's experience of colonialist health policy and the racism of the Indian Act.
Sheila Dick, Proud 11 Year-old Boy [Text Transcript]		Sheila describes her own similar experience.
Click here to read how Jenefer, a non-Aboriginal nursing student, became aware of her power and privilege and how it connected with, and transformed, her nursing practice.

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