bring essential knowledge to the relationship (Sue & Sue, 2021). As part of practicing with cultural humility, mental and behavioral health professionals are called on to take an active role in addressing issues of oppression outside the office on institutional levels and to make efforts to reduce any power differentials that affect the client within the service environment or other areas within the client’s life. Privilege is a central concept for mental and behavioral healthcare professions in their work to address oppression and marginalization of certain groups and the resulting privileging of other groups. The concept of White privilege and male privilege were clearly articulated and widely disseminated through McIntosh’s work in the 1980s. McIntosh articulated White male privilege as “an invisible package of unearned assets which he can count on cashing in each day, but about which he was ‘meant’ to remain oblivious. White privilege is like an invisible weightless knapsack of special provisions, assurance, tools, maps, guides, codebooks, passports, visas, clothes, compass, emergency gear, and blank checks” (McIntosh, 1998, p. 1). Privileging is “a process where chances or odds of being offered an opportunity are altered or skewed to the advantage of members of certain groups” (Minarik, 2017, p. 55). Essentially, privilege functions by providing some groups of individuals (e.g., White, male, heterosexual, abled, middle class) with preferred treatment in the form of special opportunities and advantages, while withholding that preference from other individuals (e.g., African American, female, LGBTQ, disabled). Privilege can include many advantages, including being given the benefit of the doubt and feeling a sense of belongingness (Minarik, 2017). Individuals who are not privileged experience the opposite—such as being an automatic suspect or having to prove belonging (Minarik, 2017). Privilege is not a guarantee of success for those groups who receive it; however, it is an advantage that other groups do not receive and allows for opportunities that others are denied (Minarik, 2017). A final key aspect regarding privilege is that it is not necessarily visible to those who receive it. The invisibility of privilege is the key component that allows it to continue. More simply, when those who receive privilege do not recognize it, they are unable to take actions to change it. Once people become aware of privilege, they may choose to use the benefits of privilege to advocate for marginalized populations. Self-Assessment Quiz Question #5 When discussing oppression and privilege, healthcare professionals should know that: a. Privilege is the commission of an unjust or cruel exercise of authority or power. b. Privilege is a guarantee of success for groups receiving it. c. Oppression’s foundation is in the “me too” movement. d. Oppression leads to a condition of privilege for the person or the group that is the oppressor(s). Marginalization is an important concept in the delivery of patient care. In the context of oppression, privilege, cultural humility, and social justice, marginalization is the pushing aside and exclusion of certain groups (e.g., ethnic and racial minorities, immigrants, LGBTQ population, individuals with disability, and individuals who are
economically disadvantaged) from full participation in a society’s mainstream social, economic, cultural, and political structures (Cooke-Jackson, et al., 2021). Some experts have identified the following three themes of marginalization (Baah et al., 2019): ● Creation of margins : Margins act as barriers and connections between a person and the environment. Margins construct physical, emotional, and psychological boundaries that people experience during interactions with society. Enforcement and maintenance of boundaries divide political and socioeconomic resources in an uneven fashion. This also facilitates the unbalanced distribution of critical resources such as healthcare (Baah et al., 2019). This illustrates the concept of social determinants of health (SDH), which is defined as “the circumstances in which people are born, live, work and age and the systems put in place to deal with illness” (World Health Organization [WHO], 2010). ● Living between cultures : Living between cultures is another factor that links marginalization to SDH. Although the boundary or margin separates the dominant and peripheralized groups, incomplete integration leads to a person or group that lives between cultures. Incomplete integration creates a situation where a person or group relinquishes characteristics of the marginalized group in order to bond with the dominant society, but is unable to do so. Examples of living between cultures are the ways of life of most immigrants, migrant farm workers, and other vulnerable groups. People living between cultures tend to live in areas characterized by limited employment and educational opportunities (Baah et al., 2019). ● Creation of vulnerabilities : Vulnerabilities are created by the cumulative impact of the creation of margins and living between cultures. Vulnerability is defined as a state of being exposed to and unprotected from health- damaging environments (Baah et al., 2019). Marginalized groups often do not receive the same access to societal resources such as high-quality education, healthcare, housing, or equal access to voting as those groups that are not marginalized. The marginalization of oppressed groups prevents them from having a voice and helps to sustain the status quo in the U.S. in which White, economically well-off, and able-bodied individuals control access to social, economic, and political power. Healthcare Consideration : Healthcare professionals should recognize the power imbalances that result from oppression, privilege, and marginalization and work to correct the imbalances within the delivery of mental and behavioral healthcare services and within the broader institutional and societal context. Self-Assessment Quiz Question #6 When discussing themes related to marginalization, the concept of being exposed to and unprotected from health-damaging environments is referred to as: a. Creation of margins. b. Living between cultures.
c. Vulnerability. d. Boundaries.
Book Code: SWUS1525
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