Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.
University of Minnesota Medical School, Minneapolis, MN.
Ethn Dis. 2018 Aug 9;28(Suppl 1):235-240. doi: 10.18865/ed.28.S1.235. eCollection 2018.
Race consciousness serves as the foundation for Critical Race Theory (CRT) methodology. Colorblindness minimizes racism as a determinant of outcomes. To achieve the emancipatory intent of CRT and to reduce health care disparities, we must understand: 1) how colorblindness "shows up" when health care professionals aim to promote equity; 2) how their colorblindness informs (and is informed by) clinical practice; and 3) ways to overcome colorblindness through strategies grounded in CRT.
DESIGN/SETTING/PARTICIPANTS: We conducted 21 semi-structured interviews with key informants and seven focus groups with personnel employed by a large Minnesota health care system. We coded transcripts inductively and deductively for themes using the constant comparative method. We used a race-conscious approach to examine how respondents' accounts align or diverge from colorblindness.
Evading race, respondents considered socioeconomic status, cultural differences, and patients' choices to be the main contributors to health disparities. Few criticized the behavior of coworkers or that of the organization or acknowledged structural racism. Respondents strongly believed that all patients were treated equally by providers and staff, in part due to race-neutral care processes and guidelines. Respondents also used several semantic moves common to colorblindness to refute suggestions of racial inequality.
Colorblindness upholds the racial status quo and inhibits efforts to promote health equity. Drawing on CRT to guide them, health care leaders will need to develop strategies to counter personnel's tendency to focus on axes of inequality other than race, to decontextualize patients' health behaviors and choices, and to depend heavily on race-neutral care processes to produce equitable outcomes.
种族意识是批判种族理论（CRT）方法论的基础。色盲将种族视为决定结果的因素最小化。为了实现 CRT 的解放意图并减少医疗保健差距，我们必须理解：1）当医疗保健专业人员旨在促进公平时，色盲如何“表现出来”；2）他们的色盲如何影响（并受到）临床实践的影响；3）通过基于 CRT 的策略克服色盲的方法。
设计/设置/参与者：我们对一家大型明尼苏达州医疗保健系统的关键信息员进行了 21 次半结构化访谈，并对 7 个员工焦点小组进行了访谈。我们使用恒定性比较方法，通过归纳和演绎对转录本进行主题编码。我们采用种族意识方法来检查受访者的叙述如何与色盲一致或背离。
受访者回避种族问题，认为社会经济地位、文化差异和患者的选择是造成健康差距的主要原因。很少有人批评同事的行为或组织的行为，也没有人承认结构性种族主义。受访者强烈认为，所有患者都受到提供者和工作人员的平等对待，部分原因是由于种族中立的护理流程和指南。受访者还使用了几种常见的色盲语义手段来反驳种族不平等的建议。
色盲维持种族现状，阻碍促进健康公平的努力。医疗保健领导者需要借鉴 CRT 来指导他们，制定策略来应对人员倾向于关注不平等的其他轴，而不是种族，去情境化患者的健康行为和选择，并严重依赖种族中立的护理流程来产生公平的结果。
