Historical and Continued Colonial Impacts on Heart Health of Indigenous Peoples in Canada: What’s Reconciliation Got to Do With It?

Box 1: Defining the many faces of racismRacism is experienced as differential treatment, such as prejudice or discrimination, based on being a member of a racial group, which is commonly experienced by members of a minority racial group.Although multiple forms of racism have been identified, below we discuss 4 types, with the intent of illustrating diverse forms.The choices draw on Allan and Smylie's report First People, Second Class Treatment 16 (p.5).Interpersonal Racism: Acts that occur between individuals; this is the most commonly talked about form of racism.Examples of these acts include discriminatory treatment in employment, healthcare delivery, and educational settings; they also include prejudice or demeaning acts that occur within any day-to-day interactions among 2 or more people.The severity of these acts can vary from ignoring or shunning, to poor treatment, to more overt and harsh acts such as name calling and physical or sexual violence.Raced-based "microaggressions" are also examples of interpersonal racism, which is defined as "brief or commonplace daily verbal, behavior and environmental indignities, whether intentional or unintentional, that communicates hostile derogatory, or negative racial slights and insults to the target person or groups."17 Systemic Racism: race-based differential enactments through social systems, structures, and institutions, which can include stated criteria or conditions for an individual to be eligible or not.Although experienced by individuals within a group, evidence of systemic racism is found when reviewing practices, policies, and processes that reveal underlying, avoidable, and unfair inequalities across ethnic/racial groups.Systemic racism can serve to produce racialized inequality, but also be re/enacted when those in power (ie, policymakers, funders) fail to redress such inequalities.Systemic racism is often experienced as social exclusion and isolation, which also limits or prevents political and economic participation, or access to and participation in other social systems such as education or health.Epistemic Racism: racialized acts that occur within the realms of knowledgedthat is, asking whose knowledge and way of knowing is held up as superior and valid, vs the silencing and judging of another groups' knowledge and ways of knowing as inferior, not to be considered valuable, and dismissed.In the context of Indigenous health, an example of epistemic racism (Sinclaire at al.) 18 is that imposition of Western knowledge systems (biomedical science) has intentionally and unintentionally produced evidence to suggest inferiority of Indigenous people and their science (ways of knowing).Ongoing marginalization of Indigenous ways of knowing and practices within healthcare is a clear example of epistemic racism.Internalized Racism: when an individual or group internalizes and accepts negative, stereotypical beliefs, attitudes, and ideologies about their inferiority.Adapted from Allan and Smylie.16