Integrating Social Justice in Health Care Curriculum: Antiracist Approaches for Nursing
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Integrating social justice in health care curriculum: Drawing on antiracist approaches
toward a critical antidiscriminatory pedagogy for nursing
Blanchet Garneau, A., Browne, A.J., Varcoe, C.
Suggested citation: Blanchet Garneau, A., Browne, A.J., Varcoe, C. (2016). Integrating social
justice in health care curriculum: Drawing on antiracist approaches toward a critical
antidiscriminatory pedagogy for nursing. 2nd International Critical Perspectives in Nursing and
Healthcare, Sydney, Australia.
Abstract
Nursing as a discipline has a unique contribution to advancing the social justice agenda in
healthcare practices and education. However, even if social justice is claimed to be a core value
of the profession, researchers, practicing nurses, educators, and students are continually
challenged to understand how social justice could be enacted in caring practices. In this paper, we
discuss the place and relevance of a critical antidiscriminatory pedagogy for nursing (CADP). We
argue that, because discrimination is inherent to the production and maintenance of inequities and
injustices, adopting a CADP offers opportunities for nurses and future nurses to develop their
capacity to counteract racism and other forms of individual and systemic discrimination in health
care. Grounded in critical theories and pedagogies, this approach involves an explicit
examination of structural conditions and power dynamics, and a praxis informed by critical
consciousness that can positively impact caring practices and change conditions of social
injustice. A CADP challenges the liberal individualist paradigm, as well as culturalist and
racializing processes prevalent in nursing education and situates nursing practice as responsive to
health inequities. Thus, a CADP is a promising way to translate social justice into nursing
education through transformative learning.
Integrating social justice in health care curriculum: Drawing on antiracist approaches
toward a critical antidiscriminatory pedagogy for nursing
Blanchet Garneau, A., Browne, A.J., Varcoe, C.
Suggested citation: Blanchet Garneau, A., Browne, A.J., Varcoe, C. (2016). Integrating social
justice in health care curriculum: Drawing on antiracist approaches toward a critical
antidiscriminatory pedagogy for nursing. 2nd International Critical Perspectives in Nursing and
Healthcare, Sydney, Australia.
Abstract
Nursing as a discipline has a unique contribution to advancing the social justice agenda in
healthcare practices and education. However, even if social justice is claimed to be a core value
of the profession, researchers, practicing nurses, educators, and students are continually
challenged to understand how social justice could be enacted in caring practices. In this paper, we
discuss the place and relevance of a critical antidiscriminatory pedagogy for nursing (CADP). We
argue that, because discrimination is inherent to the production and maintenance of inequities and
injustices, adopting a CADP offers opportunities for nurses and future nurses to develop their
capacity to counteract racism and other forms of individual and systemic discrimination in health
care. Grounded in critical theories and pedagogies, this approach involves an explicit
examination of structural conditions and power dynamics, and a praxis informed by critical
consciousness that can positively impact caring practices and change conditions of social
injustice. A CADP challenges the liberal individualist paradigm, as well as culturalist and
racializing processes prevalent in nursing education and situates nursing practice as responsive to
health inequities. Thus, a CADP is a promising way to translate social justice into nursing
education through transformative learning.
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Background
A growing body of research continues to demonstrate the profound effects of health and social
inequities on peoples’ health, access to care and overall well-being. Knowing that race and
racism are key determinants of health inequities (Krieger, 2014; Solar & Irwin, 2010), racializing
and discriminatory processes are primary targets for social justice interventions. However, racial
discrimination rarely operates in isolation from other social dynamics. For example, experiences
of discrimination have been shown to be amplified by issues of poverty, substance use, or
stigmatizing chronic conditions such as HIV or mental health issues (Varcoe, Browne, & Ponic,
2013). Varcoe et al. (2013) argue that while the impacts of discrimination may be interpersonal
and obvious, they are more likely to be systematic, built into the structures of society, and often
invisible. Discrimination then refers to “all means of expressing and institutionalizing social
relationships of dominance and oppression” (Krieger, 2014, p. 250).
In this paper, we focus attention on the value-added of focusing on multiple, intersecting forms of
discrimination, including for example, the stigma of poverty, the impact of racialization, ageism,
and gendered inequities, among others, and how these are often co-constituted determinants of
health and well-being for individuals, communities, and populations. We pay particular attention
to systemic discrimination as inherent to the production and maintenance of health and social
inequities and injustices (Krieger, 2014; Marmot, Friel, Bell, Houweling, & Taylor, 2008), and
the potential of a critical antidiscriminatory pedagogy (CADP) to enhance the capacity for
nursing to address key social justice issues. We argue that integrating CADP in nursing education
holds promise for moving social justice as a professional value into transformative learning and
action.
Approaches to Addressing Social Justice and Heath Inequities in Nursing
To address health and healthcare inequities, scholars and nursing educators have advocated for
curricular changes based on the principles of social justice (Chinn, 2014; Hardy, 2011). As
Thorne (2014) argues, even if some scholars have operated from a stance of liberal individualism,
social justice “has been a dominant normative position for nursing for as long as we have been
Background
A growing body of research continues to demonstrate the profound effects of health and social
inequities on peoples’ health, access to care and overall well-being. Knowing that race and
racism are key determinants of health inequities (Krieger, 2014; Solar & Irwin, 2010), racializing
and discriminatory processes are primary targets for social justice interventions. However, racial
discrimination rarely operates in isolation from other social dynamics. For example, experiences
of discrimination have been shown to be amplified by issues of poverty, substance use, or
stigmatizing chronic conditions such as HIV or mental health issues (Varcoe, Browne, & Ponic,
2013). Varcoe et al. (2013) argue that while the impacts of discrimination may be interpersonal
and obvious, they are more likely to be systematic, built into the structures of society, and often
invisible. Discrimination then refers to “all means of expressing and institutionalizing social
relationships of dominance and oppression” (Krieger, 2014, p. 250).
In this paper, we focus attention on the value-added of focusing on multiple, intersecting forms of
discrimination, including for example, the stigma of poverty, the impact of racialization, ageism,
and gendered inequities, among others, and how these are often co-constituted determinants of
health and well-being for individuals, communities, and populations. We pay particular attention
to systemic discrimination as inherent to the production and maintenance of health and social
inequities and injustices (Krieger, 2014; Marmot, Friel, Bell, Houweling, & Taylor, 2008), and
the potential of a critical antidiscriminatory pedagogy (CADP) to enhance the capacity for
nursing to address key social justice issues. We argue that integrating CADP in nursing education
holds promise for moving social justice as a professional value into transformative learning and
action.
Approaches to Addressing Social Justice and Heath Inequities in Nursing
To address health and healthcare inequities, scholars and nursing educators have advocated for
curricular changes based on the principles of social justice (Chinn, 2014; Hardy, 2011). As
Thorne (2014) argues, even if some scholars have operated from a stance of liberal individualism,
social justice “has been a dominant normative position for nursing for as long as we have been
3
professionalized” (p.79). However, Canales and Drevdahl (2014) argue that even if social justice
is at the core of the nursing discipline, it is generally absent or may operate as mere rhetoric in
the nursing curriculum.
Culturally congruent care and multicultural approaches
Because inequities and injustices are hypervisible for racialized groups, the translation of social
justice in nursing practice and education has been dominated by attention to cultural sensitivity,
drawing on a plethora of theories and models orienting nursing practice and education towards
culturally congruent care (Andrews & Boyle, 2002; Campinha-Bacote, 1998; Leininger, 1991;
Papadopoulos, Tilki, & Taylor, 1998; Purnell & Paulanka, 2008). These theories and models
have been developed from a cultural diversity and multiculturalist perspective, often founded in
culturalist ideology, which is prominent in nursing and promoted by a majority of schools,
universities, and other public institutions (Vandenberg & Kalischuk, 2014). In such approaches,
health behaviors, for example, are seen as primarily determined by an individual's presumed
ethnocultural, and often racialized identity. As a consequence, and in concert with the long
recognized dominance of liberal individualism in nursing (Browne, 2001), racialism and
culturalism are frequently used to explain behaviors and health issues (Browne & Reimer-
Kirkham, 2014; Varcoe et al., 2013). This can lead to practices that separate culture from its
social, economic and political context and reinforce racializing and intersecting culturalist
processes (Blanchet Garneau, 2016; Downing & Kowal, 2011). Recent empirical studies have
highlighted that educational approaches focusing on culture alone are not sufficient to address
discrimination and racism issues in healthcare (Allen, Brown, Duff, Nesbitt, & Hepner, 2013;
Hardy, 2011). Thus, even with the best intention of providing culturally congruent care,
multicultural approaches have failed to challenge racism and discrimination at the level of
clinical practice, as well as at the organizational and systemic levels.
Racial discrimination and anti-racist approaches
In concert with the critiques of individualistic and multicultural approaches in nursing education,
some authors have argued for a critical turn cultural competence and toward the inclusion of
concepts related to racism and other individual and systemic forms of discrimination in its
conceptualization and in health professionals’ education (Almutairi & Rodney, 2013; Blanchet
professionalized” (p.79). However, Canales and Drevdahl (2014) argue that even if social justice
is at the core of the nursing discipline, it is generally absent or may operate as mere rhetoric in
the nursing curriculum.
Culturally congruent care and multicultural approaches
Because inequities and injustices are hypervisible for racialized groups, the translation of social
justice in nursing practice and education has been dominated by attention to cultural sensitivity,
drawing on a plethora of theories and models orienting nursing practice and education towards
culturally congruent care (Andrews & Boyle, 2002; Campinha-Bacote, 1998; Leininger, 1991;
Papadopoulos, Tilki, & Taylor, 1998; Purnell & Paulanka, 2008). These theories and models
have been developed from a cultural diversity and multiculturalist perspective, often founded in
culturalist ideology, which is prominent in nursing and promoted by a majority of schools,
universities, and other public institutions (Vandenberg & Kalischuk, 2014). In such approaches,
health behaviors, for example, are seen as primarily determined by an individual's presumed
ethnocultural, and often racialized identity. As a consequence, and in concert with the long
recognized dominance of liberal individualism in nursing (Browne, 2001), racialism and
culturalism are frequently used to explain behaviors and health issues (Browne & Reimer-
Kirkham, 2014; Varcoe et al., 2013). This can lead to practices that separate culture from its
social, economic and political context and reinforce racializing and intersecting culturalist
processes (Blanchet Garneau, 2016; Downing & Kowal, 2011). Recent empirical studies have
highlighted that educational approaches focusing on culture alone are not sufficient to address
discrimination and racism issues in healthcare (Allen, Brown, Duff, Nesbitt, & Hepner, 2013;
Hardy, 2011). Thus, even with the best intention of providing culturally congruent care,
multicultural approaches have failed to challenge racism and discrimination at the level of
clinical practice, as well as at the organizational and systemic levels.
Racial discrimination and anti-racist approaches
In concert with the critiques of individualistic and multicultural approaches in nursing education,
some authors have argued for a critical turn cultural competence and toward the inclusion of
concepts related to racism and other individual and systemic forms of discrimination in its
conceptualization and in health professionals’ education (Almutairi & Rodney, 2013; Blanchet
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Garneau & Pepin, 2015; Herring, Spangaro, Lauw, & McNamara, 2013; Sakamoto, 2007). For
example, strategies involving critical reflection (Blanchet Garneau, 2016) and reflexive
antiracism training (Franklin, Paradies, & Kowal, 2014) have been presented as promising
alternative to multiculturalist education. These strategies include reflection upon the sources and
impacts of discrimination and racism in society while avoiding essentialist perspectives on
culture.
Antiracist pedagogy is theoretically grounded in the critical pedagogy and orients students
through an analysis of systems of oppression and domination to « explain and counteract the
persistence and impact of racism using praxis as its focus to promote social justice for the
creation of a democratic society in every respect » (Blakeney, 2005, p. 119). However, as much
as anti-racist pedagogy has to offer to nursing education in terms of promoting reflection and
action on the structural causes of racism, it is imperative that nursing education prepares nurses
not only to address racism as a basic social process with harmful impacts but racism as it
intersects with multiple social locations, such as gender and class. If social justice is a goal of
nursing, an approach is required that takes into account multiple intersecting forms of structural
and interpersonal discrimination, with an emphasis on racism. The CADP we discuss in this
paper builds on ideas related to anti-racist approaches, but it extends beyond its singular
dimension to an intersectional perspective. CADP also pushes beyond culturally sensitive,
tolerant, and respectful attitudes promoted by multiculturalist approaches.
Expanding Beyond Anti-racist and Multiculturalist Perspectives
A CADP both acknowledges and challenges the long tradition of liberal individualism in
healthcare, as well as culturalist and racializing processes prevalent in nursing. In this approach,
education based on developing humanistic care that is sensitive and respectful, without
addressing structural conditions related to health and healthcare is insufficient (Dovidio, 2015).
Building on antiracist pedagogy and developed from a critical perspective, the CADP we discuss
in this paper extends beyond an individualistic and essentialist perspective of discrimination.
Indeed, it is grounded in an intersectional perspective, which investigates “the interaction of
numerous characteristics of vulnerable populations, not only at the individual level but also at
Garneau & Pepin, 2015; Herring, Spangaro, Lauw, & McNamara, 2013; Sakamoto, 2007). For
example, strategies involving critical reflection (Blanchet Garneau, 2016) and reflexive
antiracism training (Franklin, Paradies, & Kowal, 2014) have been presented as promising
alternative to multiculturalist education. These strategies include reflection upon the sources and
impacts of discrimination and racism in society while avoiding essentialist perspectives on
culture.
Antiracist pedagogy is theoretically grounded in the critical pedagogy and orients students
through an analysis of systems of oppression and domination to « explain and counteract the
persistence and impact of racism using praxis as its focus to promote social justice for the
creation of a democratic society in every respect » (Blakeney, 2005, p. 119). However, as much
as anti-racist pedagogy has to offer to nursing education in terms of promoting reflection and
action on the structural causes of racism, it is imperative that nursing education prepares nurses
not only to address racism as a basic social process with harmful impacts but racism as it
intersects with multiple social locations, such as gender and class. If social justice is a goal of
nursing, an approach is required that takes into account multiple intersecting forms of structural
and interpersonal discrimination, with an emphasis on racism. The CADP we discuss in this
paper builds on ideas related to anti-racist approaches, but it extends beyond its singular
dimension to an intersectional perspective. CADP also pushes beyond culturally sensitive,
tolerant, and respectful attitudes promoted by multiculturalist approaches.
Expanding Beyond Anti-racist and Multiculturalist Perspectives
A CADP both acknowledges and challenges the long tradition of liberal individualism in
healthcare, as well as culturalist and racializing processes prevalent in nursing. In this approach,
education based on developing humanistic care that is sensitive and respectful, without
addressing structural conditions related to health and healthcare is insufficient (Dovidio, 2015).
Building on antiracist pedagogy and developed from a critical perspective, the CADP we discuss
in this paper extends beyond an individualistic and essentialist perspective of discrimination.
Indeed, it is grounded in an intersectional perspective, which investigates “the interaction of
numerous characteristics of vulnerable populations, not only at the individual level but also at
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