exclusion of certain groups (e.g., ethnic and racial minorities, immigrants, LGBTQ individuals, individuals with a disability, and individuals who are economically disadvantaged, etc.) from full participation in a society’s mainstream social, economic, cultural, and political structures (Cook, 2008). As a result of this exclusion, these 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. Marginalization is an essential concept in the delivery of patient care. Marginalization is the “act of placing a person or group in positions of lesser importance, influence, or power” (Dictionary.com., 2021). Examples of groups that have been and are being marginalized include ethnic and racial minorities, immigrants, the LGBTQ population, persons who are disabled, and the economically dis- advantaged. Some experts have identified the following three themes of marginalization (Baah et al., 2019): 1. 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 social interactions. Enforcement and maintenance of boundaries divide the political and socioeconomic resources unevenly. 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). 2. Living between cultures: Living between cultures is another factor that links marginalization to SDH. Although the boundary or margin separates the dominant and peripheralized group, 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 to bond with the dominant society but cannot do so. Examples of living between cultures are the ways of life of most immigrants, migrant farm workers, and other vulnerable groups. People between cultures tend to live in areas characterized by limited employment and educational opportunities (Baah et al., 2019). within a cultural humility framework. Because Whiteness is presented as the cultural norm, many White people have difficulty understanding that they are part of a culture. The term “White” usually describes a group of people and refers to light-skinned people of European descent. More importantly, being unaware of their racial identity makes Whites unaware of their role in perpetuating racism. Lacking White Identity White identity is essential to discuss when practicing awareness of Whiteness, however, also hinders White people from interacting with people of color (Kirkpatrick, 2020). If their racial identity development is stunted, White people typically retreat to a position of comfort that usually involves identifying with White culture and avoiding issues of race. White individuals who successfully manage their emotional reactions typically continue to progress in their racial identity development (Kirkpatrick, 2020). White individuals often do not see themselves as a visible racial group, whereas people of color are very aware of
3. Creation of vulnerabilities: Vulnerabilities are created as the cumulative impact of the creation margins and living between cultures. Vulnerability is 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 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 nondisabled individuals control access to social, economic, and political power. Let us examine the educational system in the U.S. to think about how marginalization works. Most of the best K–12 public schools in this country are in middle- or upper- middle-class districts. This means that the students able to receive education and graduate from these schools must come from families who identify as middle or upper class. Students from working-class or lower-class families do not have an equal opportunity to receive education in these schools. Let us also look at how marginalization was apparent in the 2020 elections for the president of the U.S. Numerous stories shed light on difficulties that voters faced in certain states. Stories were told about long lines of voters, voting locations closing early, and voters who were given misinformation at polling locations. Thus, the opportunity to vote in locations with longer hours, sufficient staffing, and working machines was often unavailable to working- class individuals. 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 nondisabled individuals control access to social, economic, and political power. Counselors should recognize the power imbalances resulting from oppression, privilege, and marginalization and work to correct them within the counseling sessions and their institutional and societal context. Healthcare Professional Consideration: Healthcare professionals should recognize the power imbalances resulting from oppression, privilege, and marginalization and work to correct the imbalances within healthcare services and the broader institutional and societal context. White people’s racial identity. Thus, it is likely that White counselors will have a hard time recognizing the power and privilege that they possess as White counselors. One of the foundational tools of cultural competence is self-awareness. Hence, White counselors must reflect on various facets of their identity and understand their White racial identity. White identity theory was first developed by Janet Helms in the 1980s and 1990s as a tool for White counselors to “create meaning about their identities as Caucasians, particularly in terms of how they think about, respond to, react to and interact with clients from different racial/ethnic groups” (Chung & Bemak, 2012, p. 67). In other words, the theory’s formation was based on the idea that White people are so immersed in the dominant culture that they are unaware of the influence of the dominant culture’s ethnocentric images and ideals. Being White makes it easier to assimilate into the dominant culture and to partake in unearned privileges many White people enjoy but do not acknowledge. Most White people perceive themselves as
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Book Code: PYTX1226
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