platysoft

Make no mistake, there has been a back and forth cyber war between the US and foreign powers for decades. Below are a few articles that detail publicly available information on this cyber war:

Planting Tiny Spy Chips in Hardware Can Cost as Little as $200 | WIRED

Chinese hackers also breached Charter and Windstream networks

Russian Military Cyber Actors Target US and Global Critical Infrastructure | CISA

Iranian Government-Sponsored Actors Conduct Cyber Operations Against Global Government and Commercial Networks > U.S. Cyber Command > News

Now with all of these attacks from various sources it’s interesting that suddenly the US government has decided to take a hard stance on… A social media site dedicated to the free sharing of information, and community building. It’s almost ridiculous that instead of enacting, and enforcing, legislation forcing critical US infrastructure and key US corporations to adopt mandatory security practices, they are going after TikTok.

For Example, US Carriers are still highly vulnerable to having their employees bribed to allow for sim swapping by threat actors.

Academic research finds five US telcos vulnerable to SIM swapping attacks | ZDNET

So why the focus on social media? Well if we are to believe our elected employees it’s because of the danger of a foreign power influencing the greater US population and culture. The danger of possible election interference.

Wait, didn’t we have this happen before?

Everything You Need to Know About Facebook and Cambridge Analytica | WIRED

It’s a good thing Facebook was banned after the Cambridge Analytica scandal. Oh wait, it wasn’t. As a matter of fact they got a slap on the wrists, one that was softened by the padding of billions of dollars worth of brib… I mean because of the connections that Meta fostered…

The TikTok ban is based on the age old anti-Chinese bigotry that goes larger ignored by main stream media. So old, the civil war was still in the recent memories of those that enacted the Chinese Exclusion Act (1882).

Now, thanks to short sighted bigotry, many people will lose their livelihoods. Meanwhile Meta and X, two platforms run by men that seem to desire a modern day tech based apartheid state, stand to profit from the banning of TikTok.

Despite all of the rehtoric against MAGA republicans during the campaign, democrats were happy to take money from Meta:

And they have gladly taken money from Elon Musk in the past:

But I’m sure that money has no relation to why companies like X and Meta, who have huge issues with blatant lies on their platform, continue to get support, while TikTok is due to be banned in a few days.

The twinkle in the eye of a life fulfilled

Kindness and passion being about

The loveliest sight ever seen

The smile warms the coldest night

Its warmth cradles potential future

Unknowingly of its potential 

The smile exists in peaceful oblivion

.

It tires of filling the cups of others,

While never being filled for itself.

It’s purpose, once clear is now murky,

like it’s once clear waters,

Turned to silt and mud.

What further purpose can it have,

If it can’t sustain the masses?

A steady stream flows.

Unexpected and powerful,

Daily the stream expands.

Hope cannot be diminished,

If you allow yourself to grow.

Sadly, the humble titles and diverse backgrounds of the three men I’m discussing today are far from innocent. They are working hard to undermine the systems of democracy, and to throw local politics into disarray with their unique brand of flamboyance, extremism, and manipulation.

Steve Hotze is an allergist and a local Houston GOP activist that has spread hate and misinformation for years. Among one of the more disgusting displays of hate by Steve Hotze is his campaign against the HERO ordinance in Houston.
“When conservative firebrand Dr. Steven Hotze unsheathed a sword in August while speaking at a conservative rally that doubled as a campaign launch against Houston’s nondiscrimination ordinance, even some politically aligned with the longtime anti-gay activist were taken aback.”

Steve Hotze has also come out as a radical supporter of Donald Trump’s Qanon fueled election lies. Hiring people to try and prove election fraud, where there is none. One of his hired thugs nearly murdered an innocent AC repairman in an attempt to spread misinformation.

““We’ve uncovered a massive voter election fraud scheme in Harris County,” Hotze said in an Oct. 14 video. “We have 20 investigators on the ground that will be working between now and Election Day.” Hotze’s plan blew up five days later in the pre-dawn hours of Oct. 19, when one of hisprivate investigators, former Houston Police Department captain Mark Aguirre, slammed his SUV into a box truck driven by air-conditioning repairman David Lopez-Zuniga. According to an account Lopez-Zuniga later gave to local TV station KPRC, Aguirre feigned injury after the crash. And, as Lopez-Zuniga approached to help him, Aguirre allegedly pulled a gun, disengaged the safety, and aimed it at Lopez-Zuniga’s head.“

Far from being an innocent allergist, Steve Hotze is a radical right wing bully that threatens and instills fear in under represented communities while trying to steal a legitimate election away from those he disagrees with.

Let’s now talk about Aubrey Taylor. Aubrey runs a blog, online, that he thinks is a news source. Full disclosure THIS is a blog as well, and while I do my best to reference new sources, I am not a journalist, I am an activist. My job is to uncover the truth in dirty politics and to call it out.
Aubrey Taylor profits greatly from politics. His consulting business makes a lot of money from candidates that were previously clueless about his ties to Steve Hotze and Gerry Monroe (more on him later). Aubrey Taylor is sideways with many people right now because the Harris County Democratic Party has censored Harold Dutton for pushing a GOP sponsored anti-trans education bill. Aubrey, as you can see below, throws in with anti-LGBTQ extremist Steve Hotze, and does comms work for Harold Dutton. He also takes a lot of money from GOP candidates and PACS.

Not content with just being a token to anti-trans and anti-LGBTQ hate, Aubrey is also helping Steve Hotze push election lies so that he can further profit. His support of restrictive voting bills will disenfranchise the poor, and communities of color. Meanwhile he’ll collect a paycheck.

Now on to Gerry Monroe.

I could write a novel about the self proclaimed “Five Star General” who was so offended by my critique of his misogynistic statements, he sat in front of Hobby Airport for hours, pretending like he was flying in an army of his friends to hurt me. I’ve got video of that on my social media somewhere, I promise you it’s as sad and pathetic as it sounds.

Here is a quote regarding his “activism” at HISD:

“The case, Monroe v. Houston Indep. Sch. Dist., No. CV H-19-1991, 2019 WL 7206031, (S.D. Tex. Dec. 11, 2019), examined whether a citizen who made threatening remarks and gestures toward a Houston Independent School District principal could be temporarily banned from board meetings.HISD banned Gerry Monroe from all HISD “[f]acilities, activities and meetings.” The facilities ban followed two different HISD meetings. At the first, Monroe became belligerent, yelled, banged on the table, swore profusely, insulted administrators almost incessantly, and repeatedly yelled racial epithets. Two days later, Monroe attended an HISD board meeting. He wore a bandana around his neck and a t-shirt with an HISD principal’s picture on it. Above her picture, the shirt said, “PRINCIPAL IRMA SANDATE MUST GO!”; below her picture, it said, “BECAUSE SHE DON’T LIKE BLACK PEOPLE.” Monroe gave an angry speech and repeatedly called the principal an “idiot.” He insisted that she immediately be fired. At the end of his speech, Monroe paused and raised the bandana over his mouth towards his eyes and said, “I got a team that can protect every last one of [the teachers]. You need some help?” Lowering his bandana, Monroe shouted “Do something with that idiot over there. This is the mandate: Either you take her out or I’m going to take her out.” Throughout his speech, including during the mandate, he pointed at the board with a hand gesture that, according to some in the room, looked like a gun. Monroe stated that he did not remember using a gun gesture during the meeting.“

Gerry Monroe has also mocked the Trans community. He does it often and he isn’t ashamed of it. It fits that he would throw his lot in with Aubrey Taylor and Steve Hotze, they all seem to have some extremist anti-LGBTQ views.

Now Steve Hotze is blatant about his ultra right wing views. He uses his money to champion those causes. He also uses his money to prop up people like Aubrey and Gerry, so that they can cause friction and discord in the Democratic party. They get money and some notoriety, while the rest of us see voting rights erode, and vulnerable communities slandered and harmed by their antics.

Beware of wolves in sheep’s clothing indeed. These two men should have nothing to do with Democratic Party circles. They are toxic and pathetic.

References:

https://www.houstonchronicle.com/news/houston-texas/houston/article/Fear-aiming-to-take-HERO-6589831.php

https://www.click2houston.com/news/local/2020/12/16/he-is-going-to-shoot-me-man-who-says-he-was-held-at-gunpoint-by-ex-hpd-captain-in-election-fraud-conspiracy-theory-speaks-to-kprc-2-investigates/

https://www.thedailybeast.com/how-a-qanon-backing-hormone-doctor-financed-2020s-craziest-scariest-election-conspiracy

http://aubreyrtaylor.blogspot.com/ – Beware the blatant lies and anti-lbgtq content.

An analysis of the stress factors prevalent in healthcare that led to burnout and negative patient outcomes. The application of Conservation of Resources Theory was used to analyze the stress factors, how those factors tie into employee burnout, and what the most efficient methods of addressing burnout are.

The paper presents an overview of COR theory, the methodologies used to analyze stress in healthcare, and the necessity of addressing stress in the most efficient ways.

16 articles were selected to review that analyzed the application of COR theory, the roles of stress in burnout, and how COR theory was utilized to find the most efficient ways of addressing burnout and stress. The articles were picked on the following search criteria: use of COR theory in healthcare, the inclusion of remediation steps for stress, and the inclusion of peer reviewed research to back up the data presented.

Keywords: Option 3. Conservation of Resources, Stress in Healthcare.

Introduction

Stress among healthcare workers can lead to reduced quality of care among patients. In addition to poorer patient outcomes stress can lead to an overall reduction in job satisfaction, burnout, and eventually the resignation of staff. Stress factors include exposure to critically ill or terminal patients, inefficient processes, and a lack of resources leading to excess burden among healthcare workers. Addressing these stress factors is key to avoiding burnout. The application of Conservation of resources theory will be utilized to analyze the issue of stress, and how organizations can address these issues in the most effective way possible.

Case Studies/Review

Explanation of the Theory

In order to address the challenges of handling stress in healthcare organizations, it’s important to understand the root causes of stress, and productive ways to manage and remediate stress in the organization. Using the Conservation of Resources Theory (COR Theory), we can begin to explain organizational stress, in order to remediate.(Alvaro et al., 2010)

Stress, in medical terms, is “a physical, mental, or emotional factor that causes bodily or mental tension that can be external or internal and can initiate a fight or flight response. Stress can be a positive motivating factor, allowing individuals to address the stress factors. It can also be negative factor when it leads to overwhelming individuals, or causes them to initiate a flight response. Responding to stress takes an individual’s mental or emotional effort. (Davis)

Psychological Commodities (psychological processes tied to resources) that are valued are the basis of COR theory. Examples of these commodities included job satisfaction, work/life balance, and the quality of work/life balance. Understanding these psychological processes allows us to examine components of healthcare work that lead to increased stress factors that can negatively impact workers and patients. (Halbesleben et al., 2008) These commodities are regarded as finite resources in COR theory.

COR Theory acknowledges that stress is a result of the combination of the subjective perception of events exceeding available resources or being overly taxing, i.e. stress is the over-utilization of an individual’s psychological commodities. It’s necessary for resources to be provided to mitigate stress factors such as change and increased workload, or the threat of loss will lead to the defense of assets. Defense of assets entails the withdrawal from interpersonal relationships, or decreased dedication to work.(Alvaro et al., 2010)

Factors outside of the work environment are also acknowledged by the COR Theory. If external factors add negative stress to an employee, such as home life, or other negative social factors, emotional and physical resources will be depleted, on top of those depleted due to work. COR theory seeks to address individuals holistically in order to provide solutions to the challenges. (Alvaro et al., 2010)

Examples of external factors affecting stress have been studied due to the SARS and COVID-19 pandemics. Social isolation, fear of spreading infection to family, and increased levels of social anxiety due to media coverage of the pandemic are examples of stressors that are external from the work environment, but that add to stress levels at work. During the pandemic the risk of getting loved ones infected was a particularly high stressor for healthcare workers, causing them to limit their exposure to coworkers and patients as much as possible. (Ali et al., 2020)

Burnout as a Result of Stress and its Effects on Employees

Burnout can be defined as the extended exposure of a person to chronic emotional stressors in the work environment. Emotional exhaustion, physical and mental fatigue, and weariness are key components of burnout among healthcare workers. This prolonged exposure to stressors can lead to an individual’s inability to cope with any additional input of stress. (Rogala et al., 2015)

While all professions have levels of stress and burnout, studies show that healthcare workers face an increased rate of burnout, as compared to other professions, because of the increased level of workload, and because of the emotional impact of dealing with critically ill or terminal patients. Institutional conflict in healthcare, due to the complex nature of the work involved, and the interactions between medical and non-medical aspects of the industry, are also stress factors unique to healthcare. (Ruotsalainen et al., 2015)

Additional examples of stress factors leading to burnout can be found in the experiences of healthcare workers during the SARS pandemic. These factors include quarantine and the loss of interpersonal interactions outside of work, and uncertainty about the safety of family members, especially for those healthcare workers who fear bringing exposure to the virus home to their families. There are the additional levels of stress at work, due to higher patient rates and more severe illness. (Maunder et al., 2008) These stress factors have been seen again during the COVID-19 pandemic, which is exponentially larger in scale than what happened during the SARS outbreak.

COR Theory also addresses the processes that occur once burnout has been reached. This is important in being able to respond to the symptoms of burnout caused by work stress. This allows organizations to plan a response to provider burnout that may lead to negative patient results, which are tied to providers pulling away from patients due to exhausted emotional resources. (Halbesleben et al., 2008)

Concerns Regarding Stress in Healthcare

The negative effects of burnout include not just psychological impact, but also physical health impacts. Reduced immune response and physical exhaustion are examples of the physical effects of burnout. Since burnout is a result of stress that occurs when an employee is impacted by stress in their work environment, and because it affects job performance negatively, it becomes necessary for employers and policymakers to address burnout. (Otto et al., 2021)

Stress levels will increase in caregiving situations because of the emotional burden associated with caring for others. This caregiving leads to “resource loss” or the emotional energy utilized in caregiving. The more time that is spent in caregiving the greater the perceived burden associated with caregiving. This expenditure of emotional resources leads to caregivers seeking additional ways to increase resources, whether that is more help, or finding ways to lighten the emotional burden associate with the stress of caregiving.(Hong & Harrington, 2016)

While it’s important for organizations to address burnout, healthcare workers also have a role to play in addressing stress and burnout. Burnout among healthcare workers can play a role in patient outcomes. Burnout is the emotional exhaustion that occurs as a response to stress in the workplace. It will lead to workers pulling away from others associated with the job, and a reduced feeling of accomplishment. (Halbesleben et al., 2008) Because of this impact to patient care, it’s key for healthcare workers to identify these symptoms, and to address them in the organization so that remediating steps can be implemented.

Patient outcomes are not the only concerns organizations should have regarding burnout. Burnout can also lead to staff turnover, decreased performance, and decreased job satisfaction among workers. Organizations will suffer from employee burnout because of the loss of talent due to staff turnover, and reduced efficiencies of current staff. Resources (employees) are not optimized, due to burnout, causing employees to have a reduced ability to interact with patients and coworkers, and thus not able to respond to new situations or emergencies. COR theory works to address these causal stressors and to find the most efficient way to address them. (Halbesleben et al., 2008)

Other Factors Affecting Stress

Healthcare workers also must contend with other stress factors, for example violence against workers that may occur in the Emergency Department. In addition to assault due to the presence of patients suffering from psychiatric conditions, the influence of illicit substances, and other acute conditions, there are psychological stress factors such as fear, anger, PTSD, and others due to the exposure of workplace violence. These additional factors, along with the higher exposure to critically and terminally ill patients lead to increased stress factors for those working in EDs. (D’Ettorre et al., 2018)

Negative leadership styles also negatively affect stress among healthcare workers. While it’s fully accepted that work alienation can occur among workers that are exposed to positive leadership styles, such as supportive or transformational leaders, it is much more pronounced in leadership styles that are more aversive in nature. (Fatima et al., 2018)

Stress also increases based upon the expectations of workers to have “positive” interactions with patients or customers. Having to do the emotional labor of appearing positive can increase exhaustion for those team members that are only “surface acting” or forcing a positive attitude, versus those workers that take actual joy out of interacting with others. (Zhao et al., 2020)

Reducing Stress

Reducing stress factors is necessary to keep healthcare workers from burnout, thus ensuring better patient outcomes, and increased employee job satisfaction. Some types of interventions utilized in reducing stress include cognitive interventions that help change the way employees approach work, and how they feal. There are also relaxation techniques that help employees reach physical and mental relaxation, through either physical activity such as exercise of massage. There are also organizational level strategies such as increasing resources or modifying the way work is conducted. (Ruotsalainen et al., 2015)

Studies analyzing solutions for addressing burnout and compassion fatigue are relatively new, however recent studies show that there are a few solutions that are effective. One would be the inclusion of structured meditation. Another, effective solution is the inclusion of focused education around the subject of burnout, teaching coping mechanisms and risk factors. (Cocker & Joss, 2016)

The American Nurses Association has a guideline of ethics for members that states the professional ethical standards expected of its members. This guideline includes provisions that ensures “the nurse’s primary commitment is to the patient” however, in addressing the role of stress and burnout, the guideline also servers a reminder that “the nurse owes the same duty to themselves as to others”. (Ali et al., 2020)

Discussion

People will attempt to prevent burnout naturally, by making changes in their home, work, and personal environments. All aspects of a person’s life can add to the effects of stress in the workplace and lead the burnout. Often times people are ill equipped to properly address the causes of burnout, leading to further frustration and compounding the stress factors affecting them. (Otto et al., 2021)

Examples of burnout are plentiful in the world of the COVID-19 pandemic. Being able to maintain safe and high-quality patient care is highly tied to the need for healthcare workers to remain physically and mentally well. Since burnout is tied to a lack of resources, and we know that personal issues can add to the effect of burnout on the job, this year has provided challenges in addressing stress and maintaining the necessary quality of care. (Chersich et al., 2020)

The experiences of healthcare workers during the COVID-19 pandemic has led to increasing levels of stress, raising anxiety and PTSD. This increased stress can lead to a reduction of resources (workers ability to handle stress) and leads to them having decreased patient outcomes as well as leading to self-doubt in treatment decisions. These inefficiencies have to be addressed at an organizational and individual level in order to deal with the extreme nature of the situation. (Chersich et al., 2020)

The role of job gratification in reducing workplace stress, thus reducing burnout is tied to multiple factors. Training healthcare workers to care for the patient on a more personal level is one way to increase job gratification. This type of empathetic relationship also leads to greater patient outcomes because the patient becomes involved in their healthcare by feeling able to share their opinions. It is essential that the employees come to positive patient interactions as a part of their natural personality, otherwise forced requirements for “positive” interactions can compound stress factors. (Zwack & Schweitzer, 2013)

Burnout can be addressed in multiple ways, including individually focused efforts, organizational based efforts, and a combination of the two. Among the most effective individually focused methods self-care workshops that taught healthcare workers mindfulness was highly effective. Training programs that focused on stress management and communication skills were also effective. Making use of physical methods for stress reduction such as massage, meditation, and yoga were also highly effective. Organizations bear a responsibility for making these options available to workers.(Zhang et al., 2020)

From an organizational focused approach, the use of flexible or rotating schedules helped to address burnout. Reduction of workload by the use of additional resources (hiring supplemental workers) also helped to address stress and burnout. In addition, trainings around teamwork building, stress management, and in person debriefs were effective. Organizations that included extended interdisciplinary care teams that included mental health and other professions were effective at reducing burnout as well.(Zhang et al., 2020)

It’s important to note that the increased levels of stress observed during the COVID-19 pandemic has been shown to lead to increased burnout. Over 52% of healthcare professionals polled during the pandemic expressed that they considered quitting their job. While we noted the previous studies done during the SARS pandemic, it seems that not enough work was done to prepare healthcare workers for another large scale stressor. (Ali et al., 2020)

What is common between both events is the belief that organizational support is essential in mitigating burnout. Many healthcare workers viewed both events, and their work tied to the events, as an “act of duty,” however positive support from organizational administration led to a higher degree of job satisfaction, and better coping strategies for healthcare workers. In addition to organizational support, healthcare workers that focused on the facts necessary to do their jobs, and who focused their engagement with their patients, dealt with less burnout than those workers that over consumed media reports. (Ali et al., 2020)

While healthcare workers tend to be most satisfied when engaging in unforced compassion towards those they are treating, it’s important to note that the happiest workers had a high level of self-compassion. As previously noted, mindfulness leads to a reduction of stress by increasing happiness among healthcare workers. Studies also show that reducing isolation from others through the use of techniques that address isolation is also important. (Benzo et al., 2017)

Organizations that implement the above remediations are able to reduce the impact of stress on healthcare workers, allowing them to extend their individual emotional and physical resources, and preventing an exhaustion of these resources. The proactive prevention of burnout, by using COR theory to analysis the causes, lead to higher patient outcomes, and lower staff turnover, as well as increased job satisfaction among workers. (Otto et al., 2021)

Conclusion

COR theory has been used to analyze stress factors, and burnout, in the healthcare fields for the last decade. While the time period for data gathering has been relatively short, the ability to analyze stress factors, based on both internal and external criteria, has led to a greater understanding of what causes burnout, and what the most efficient ways of addressing it are.

COR theory has shown that organizations bear a responsibility to give employees the training necessary to address burnout. They also must allow employees the flexibility in schedules to be able to avoid burnout, as well as incorporate healthy personal activities such as meditation, exercise, and yoga. Addressing the root causes of burnout in the most efficient way possible will lead to more positive patient outcomes, and reduced staff fatigue and turnover.

References:

Ali, H., Cole, A., Ahmed, A., Hamasha, S., & Panos, G. (2020). Major Stressors and Coping Strategies of Frontline Nursing Staff During the Outbreak of Coronavirus Disease 2020 (COVID-19) in Alabama. J Multidiscip Healthc, 13, 2057–2068. https://doi.org/10.2147/jmdh.s285933

Alvaro, C., Lyons, R. F., Warner, G., Hobfoll, S. E., Martens, P. J., Labonté, R., & Brown, R. E. (2010). Conservation of resources theory and research use in health systems. Implement Sci, 5, 79. https://doi.org/10.1186/1748-5908-5-79

Benzo, R. P., Kirsch, J. L., & Nelson, C. (2017). Compassion, Mindfulness, and the Happiness of Healthcare Workers. Explore (NY), 13(3), 201–206. https://doi.org/10.1016/j.explore.2017.02.001

Chersich, M. F., Gray, G., Fairlie, L., Eichbaum, Q., Mayhew, S., Allwood, B., English, R., Scorgie, F., Luchters, S., Simpson, G., Haghighi, M. M., Pham, M. D., & Rees, H. (2020). COVID-19 in Africa: care and protection for frontline healthcare workers. Global Health, 16(1), 46. https://doi.org/10.1186/s12992-020-00574-3

Cocker, F., & Joss, N. (2016). Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health, 13(6). https://doi.org/10.3390/ijerph13060618

D’Ettorre, G., Pellicani, V., Mazzotta, M., & Vullo, A. (2018). Preventing and managing workplace violence against healthcare workers in Emergency Departments. Acta Biomed, 89(4-s), 28–36. https://doi.org/10.23750/abm.v89i4-S.7113

Davis, C. P. MedicineNet. Retrieved 4/24/2021 from

Fatima, T., Majeed, M., & Shah, S. Z. A. (2018). Jeopardies of Aversive Leadership: A Conservation of Resources Theory Approach. Front Psychol, 9, 1935. https://doi.org/10.3389/fpsyg.2018.01935

Halbesleben, J. R., Wakefield, B. J., Wakefield, D. S., & Cooper, L. B. (2008). Nurse burnout and patient safety outcomes: nurse safety perception versus reporting behavior. West J Nurs Res, 30(5), 560–577. https://doi.org/10.1177/0193945907311322

Hong, M., & Harrington, D. (2016). The Effects of Caregiving Resources on Perceived Health among Caregivers. Health Soc Work, 41(3), 155–163. https://doi.org/10.1093/hsw/hlw025

Maunder, R. G., Leszcz, M., Savage, D., Adam, M. A., Peladeau, N., Romano, D., Rose, M., & Schulman, B. (2008). Applying the lessons of SARS to pandemic influenza: an evidence-based approach to mitigating the stress experienced by healthcare workers. Can J Public Health, 99(6), 486–488. https://doi.org/10.1007/bf03403782

Otto, M. C. B., Van Ruysseveldt, J., Hoefsmit, N., & Van Dam, K. (2021). Examining the mediating role of resources in the temporal relationship between proactive burnout prevention and burnout. BMC Public Health, 21(1), 599. https://doi.org/10.1186/s12889-021-10670-7

Rogala, A., Shoji, K., Luszczynska, A., Kuna, A., Yeager, C., Benight, C. C., & Cieslak, R. (2015). From Exhaustion to Disengagement via Self-Efficacy Change: Findings from Two Longitudinal Studies among Human Services Workers. Front Psychol, 6, 2032. https://doi.org/10.3389/fpsyg.2015.02032

Ruotsalainen, J. H., Verbeek, J. H., Mariné, A., & Serra, C. (2015). Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev, 2015(4), Cd002892. https://doi.org/10.1002/14651858.CD002892.pub5

Zhang, X. J., Song, Y., Jiang, T., Ding, N., & Shi, T. Y. (2020). Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine (Baltimore), 99(26), e20992. https://doi.org/10.1097/md.0000000000020992

Zhao, X., Fu, N., Freeney, Y., & Flood, P. C. (2020). Revisiting the Effect of Emotional Labor: A Multi-Level Investigation in Front-Line Service Teams. Front Psychol, 11, 570048. https://doi.org/10.3389/fpsyg.2020.570048

Zwack, J., & Schweitzer, J. (2013). If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med, 88(3), 382–389. https://doi.org/10.1097/ACM.0b013e318281696b

Let me break this down.

We have over 600k people who have died from covid.

For a year many government officials did all they could to ignore expert scientific and economic advice.

So the nation forced service industry workers to risk their lives for the convenience of people to narrow minded to think of the long term consequences.

So now there is a worker shortage. People aren’t willing to take service industry jobs.

This isn’t laziness. This isn’t because you think $300 a month is keeping people from working. Trust me that’s not a living wage.

We have a worker shortage because people died. People saw loved ones worked to death.

And those 600k dead caused a worker shortage.

They left fear and heartbreak behind.

So yes, you’re going to be inconvenienced. Not because people are lazy. Because people are dead, and others aren’t willing to settle for stagnant wages and rude interactions.

What would have prevented this. Ask New Zealand. A month hard lock down followed by competent contact tracing and we wouldn’t have had to deal with any of this.

But here we are.

#LivingWage #COVID19 #serviceindustry

An analysis of inequities in healthcare based on racial and ethnic differences, and the use of Critical Race Theory to analyze, and remediate these inequities through increasing diversity. This paper outlines the changing demographics of the United States, and the need to address increasing diversity in order to provide comprehensive, accurate, and unbiased data to clinicians and researchers, educators, and students.

The paper presents an outline of CRT, the methodologies used to apply it in healthcare settings, and the reasons why it is a necessary approach to identifying and remediating healthcare inequities. A review of the current inequities in healthcare in relation to racial and ethnic minority groups is provided, the need for diversity in research and clinical trials is discussed, and an explanation of how to used this data to remediate the issues is presented.

20 articles were selected to review and discuss the history of CRT in healthcare, and to present the current challenges facing diversity in healthcare and why increased diversity is necessary. The articles were picked based on the following search criteria: Use of CRT across a range of specialties, the inclusion of diversity as a focus of the research, and the inclusion of background data around racial bias in healthcare.

Keyword: Option 2, Race and Ethnic Diversity in Healthcare.

Introduction

Increasing ethnic and racial diversity in healthcare organizations leads to better outcomes for patients, and an increase in trust in the healthcare system. The need for ethnic diversity in healthcare is essential to insure positive patient outcomes. This diversity must include diversity in research studies, in education, and among healthcare providers. Critical Race Theory provides a template for increasing this diversity, by acknowledging institutional racism and addressing these issues in an intersectional and productive approach.

Case Studies/Review

The overall outcomes in healthcare environments are highly dependent on the need for accurate data, comprehensive and unbiased research, well trained medical professionals and a communicative relationship between healthcare providers and patients.

Context of Racism and Critical Race Theory

Historically Race has been used to define people as distinct differing groups based on shared physical characteristics or ancestry, however work in genetics has proven race to be more of a social construct. (Williams, Ford, Morse, & Feldman, 2020) Critical Race Theory explains the basis of these beliefs, founded on institutional racism, as the foundation for inequality between racial groups in regards to wealth, access to employment and healthcare, as well as other factors. (Williams, Ford, Morse, & Feldman, 2020) Critical Race theory is a multidisciplinary, race-equity methodology grounded in social justice that was first developed in legal studies, based on several different concepts including Public Health, Centering in the Margins, Critical Consciousness, Experimental Knowledge, Ordinariness, Praxis, Primacy Race Consciousness, and the Social Construct of Race. (Ford & Airhihenbuwa, Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis, 2010). The public health critical race praxis (PHCRP) is a framework developed by public health medical health providers and researchers that considers all research to be influenced by prior racial bias, thus pushing for an intersectional and critical analysis of these biases and assumptions. (Williams, Ford, Morse, & Feldman, 2020)

These concepts require the acknowledgment of previous research being conducted from a white or Eurocentric reference point, and the tendency for “colorblindness” to ignore legitimate differences among populations in the desire to appear “neutral”, shifting the dialogue from a majority group viewpoint, to referencing marginalized groups experiences. (Ford & Airhihenbuwa, Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis, 2010) In the field of Public health this new approach to research, and care allows for way to target inequalities among racial and ethnic lines. (Ford & Airhihenbuwa, Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis, 2010)

Disparities in Healthcare Settings

Modern Healthcare systems are focused highly on reform and improving the quality of access. Several recommendations made by the Institute of Medicine regarding quality of care, however equity has been one recommendation that hasn’t been fully realized. (Betancourt, Tan-McGrory, Flores, & Lopez, 2019) The Institute of Medicine defines healthcare disparities as differences in healthcare received by differing groups that are independent of group preferences or underlying healthcare needs. (Essing-Bot, Lamkaddem, Jellema, Nielsen, & Stronks, 2013)

Per the Annual National Healthcare Quality and Disparities Report (QDR), there exists a large and persistent disparity in healthcare outcomes. The QDR in 2016 highlighted showed a 60% worse percentage of care between White and African American populations, and a 43% worse percentage of care between Hispanic and Non-Hispanic White populations, as an example of the inequity in quality of healthcare provided. (Fiscella & Sanders, 2016). More recent QDR reports show that in 2019 these disparities, while better, still indicated disparity in care, with African American Populations still at a 40% disparity than whites, and a 33% disparity among Hispanics. (Agency for Healthcare Research and Quality, 2020)

As referenced above, in 2003 a study from the Institute of Medicine identified disparities in treatment among minority groups. This study is the basis for much of the focus of remediating disparities in healthcare. In particular Hispanic groups faced significant cultural, linguistic, and cultural barriers. A lack of trust of traditionally white medical professionals, and cultural norms that have Hispanic groups seeking alternative treatments has contributed to a higher rate of diabetes and obesity. (Juckett, 2013) It’s essential to be culturally aware, and respectful of the cultural challenges facing Hispanic groups. Alternative care preferences should be addressed, and acknowledged by physicians in order to build trust with the community. (Juckett, 2013)

Breaking down the differences based on categories, there is significant disparity of care in chronic disease control, including management of high blood pressure, blood sugar, cholesterol, and HIV. Some contributing factors to these results include patient-provider communication, literacy rates, and trust in medications. (Fiscella & Sanders, 2016) It has been documented that clinicians tend to have implicit racial bias when it comes to dealing with chronic pain or pain management in some racial and ethnic groups, particularly when it comes to the Black community. (Fiscella & Sanders, 2016)

The Infectious Disease workforce, along with other specialties, is not representative of the diversity in the general population of the US, with less than 12% of the workforce being either African American or Hispanic. This under representation presents challenges in outreach to patient populations of racial and ethnic minorities. This is because many of these groups prefer to interact with healthcare providers that are representative of their own cultural or racial identities. (Marcelin, Manne-Goehler, & Silver, 2019) Racial minority groups also face increased challenges in healthcare education, with few students likely to be rewarded with membership in honor societies such as Alpha Omega Alpha. There is also a lower likelihood of ethnic minorities reaching senior ranks across different specialties. (Marcelin, Manne-Goehler, & Silver, 2019)

An example of disparity of care can be found in the lower rates of knee replacement surgery due to Osteoarthritis among Black patients. Previous assumptions attributed this lower rate of replacement to a preference among Black patients to seek nonsurgical treatments for their issues, despite the likelihood of poorer outcomes. Additional research, using the PHCRP has shown that increased education to patients, using non-technical terminology, tailored to health literacy, can mitigate these differences in outcomes. (Williams, Ford, Morse, & Feldman, 2020)

The COVID-19 Pandemic has shown how inequities in healthcare can lead to poor outcomes for Racial and Ethnic patient groups. Higher rates of death and infection among ethnic and racial minorities can be partly attributed to societal discrepancies, in particular the communication of strategies to mitigate the spread of Covid 19, such as social distancing and mask mandates, that are messaged in ways to appeal to majority groups. (Ford, Addressing Inequities in the Era of COVID-19, 2020) These prevention strategies, specified for the White populations in the US, have failed to properly inform or convince various ethnic minority groups to utilize the strategies. In addition, no consideration was given to vaccine distribution in socioeconomically disadvantaged areas, that tend to have a higher percentage of Ethnic and Racial minorities. (Ford, Addressing Inequities in the Era of COVID-19, 2020)

In addition to the differences in prevention strategies, ethnic minorities and migrants face differences in healthcare access, socioeconomic challenges, and lack of access to preventative care that increase the chances of severe disease related to Covid-19. It is well known that many ethnic minorities reside in economically disadvantaged areas with lack of easy access to transportation or healthcare resources. Cost of preventative care is also a blocker for these groups. (Greenaway, et al., 2020)

Studies in the US have shown that readmission rates and length of stay rates are higher among racial and ethnic minority populations. Studies done in other Western nations, such as the Netherlands also show that ethnic minorities report poorer health and higher healthcare use. While other western nations are not as heterogenous as the US, they do have large concentrations in urban areas and face similar challenges that are found in large urban centers in the US. (de Bruijne, et al., 2013)

Studies in Hong Kong mirror examples found in Western Nations. Hong Kong is a city with a diversity of Ethnic and Racial populations. South Asian populations have grown steadily over the last decade. There was a lack of culturally competent care among physicians in Hong Kong, leading to poorer outcomes for patients that were of South Asian descent. In addition, Patient and Provider interactions suffered, due to the lack of diversity among providers. Language barriers proved to be an issue, and a bias among providers toward South Asians , regarding hygiene and other cultural assumptions also led to poorer results. (Vandan, Wong, Lee, Yip, & Fong, 2020) Increased diversity among healthcare workers would lead to fewer such assumptions, due to increased frequency of interactions.

Racial and ethnic minorities also have less access to mental healthcare resources than majority groups do, and also face lower quality of care when they are able to access mental health resources. It’s necessary to increase diversity in the mental healthcare workforce in order to provide more equitable and better quality care. (Lokko, Chen, Parekh, & Stern, 2016)

The basis of Critical Race Theory is to address the problems minority populations face due to previous attempts to generalize healthcare based on a standard developed by addressing majority groups. One issue that is highlighted by this is the rate of Dementia among different racial and ethnic groups. Studies show that Dementia rates were higher among African Americans, even though the rates of misdiagnosis were higher, showing a possible larger burden to African American groups as compared to Whites. The data suggests additional care must be taken to address imaging and diagnosis disparities in this field. (Mayeda, Glymour, Quesenberry, & Whitmer, 2016)

Diversity in Research and Clinical Trials

Medical research, in particular clinical trials of new treatments and medicines, is needed in order to determine the safety and efficacy of new therapies. The possibility of subgroups having different results than mainstream “majority” populations is why diversity in medical research is important. Of 167 new molecular treatments approved by the FDA between 2008 and 2013 there was a 20 percent difference in results among racial or ethnic groups. (Clark, et al., 2019) Furthermore the research identified five critical barriers in research, these are mistrust, a lack of comfort with the clinical trail process, fear, lack of information, the stigma of being involved in the study, time and access constraints, and lack of awareness of trials. The research concluded that in order to overcome these barriers, greater care must be made to reach out to diverse patients, as well as having more diverse investigators, referring physicians, and clinical coordinators. (Clark, et al., 2019)

A study conducted by the Veterans Health Administration (VHA) highlights ongoing unconscious bias and disparities awareness among providers. The goal of the study was to prompt healthcare providers to reduce disparities. Using the Bernard Winder Theory of Social behavior, which states that the response to an event by individuals, includes determining the cause of the event. The assumption being that if a provider attributes the cause of an issue to be something that is inherent with the patient’s ethnicity, they would be less likely to address the disparity than if they realized the factors were external, thus addressable by them. The conclusions of the study showed that racial and ethnic minority patients received lower quality of care, and those providers that recognized the disparities based on external factors had higher patient satisfaction results than those who didn’t. (Gollust, et al., 2018) Increased diversity among providers would further increase patient outcomes, due to an increased understanding of the reasons for racial disparity.

Using the Data to Remediate Disparities

Data shows that 98% of senior management in healthcare systems are composed of non-Hispanic White individuals. This data also suggests that certain specialties in specific fields, such as Plastic Surgery. Studies in diversity in the field of Plastic Surgery saw little improvement over a decade. Improving diversity in these areas is essential to opening access to minority populations. (Nair & Adetayo, 2019)

As with any other organization or systems, health care systems are defined, and dependent, on the leadership and employees that are involved. The push to address inequities has been ongoing since 2003’s report regarding over 175 studies that proved racial and ethnic disparities. The conclusions then indicated a greater need for healthcare systems to mirror the general population in regards to ethnic and racial diversity, both from a healthcare worker and leadership perspective. (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003)

Additional factors affecting disparities in healthcare are tied to Low Health Literacy, Cultural differences, trust in the system, and stereotyping among providers. These issues can be mitigated by an increased diversity in the workforce. Language barriers, mistrust and cultural misunderstandings would not be as significant issues if there were greater representation among providers from ethnic and racial minorities. If the composition of healthcare providers were as diverse as the general population, all providers would be exposed to different racial and ethnic minorities on a professional level, thus leading to mitigation of these stereotypes.(Betancourt, Tan-McGrory, Flores, & Lopez, 2019)

Addressing disparities among Hispanic groups requires environments that are welcoming to Hispanic populations, including bilingual literature and posters, recognition of culturally specific holidays, and increased representation of Hispanic staff and healthcare workers. (Juckett, 2013) The growth of Hispanic populations in the US, expected to be 30% of the US population by 2050, requires healthcare systems to address the inequities currently present. (Juckett, 2013) Becoming sensitive to the needs of Hispanic populations will also allow healthcare systems to expand that sensitivity to African American and AAPI groups as well. Demographic changes to the US are not limited to just Hispanic populations, and data suggest all ethnic and racial minorities face some degree of disparity in healthcare outcomes. (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003)

The ACR Commission for Women and General Diversity has identified efforts to increase diversity have led to overall improvements in patient care. Additionally, data suggests that minority physicians tend to serve in traditionally underserved areas. Increased diversity among faculty also allows healthcare students to learn from mentors that have a wider view of lived experiences than is currently possible, thus leading to better outcomes. (Betancourt, Tan-McGrory, Flores, & Lopez, 2019)

Discussion

The inequities in healthcare outcomes among racial and ethnic lines have been long studied. The results of increasing diversity, not just in the employment of healthcare professionals, but in research and education have proven that outcomes improve. These results would not have been studied in detail if the framework of CRT hadn’t been applied to healthcare, allowing physicians to study racial disparities in healthcare outcomes and how racism directly correlates to them. This included the deeply seeded bias and racism present in education, research, and patient health services. (Williams, Ford, Morse, & Feldman, 2020)

Members of ethnic and racial minority groups face linguistic barriers in many cases, by increasing diversity among healthcare providers, this barrier can be mitigated. (Juckett, 2013) In addition to linguistic barriers, there are cultural and racial stereotypes among white medical professionals that lead to reduced outcomes for minority groups. Again, increasing diversity, along with cultural sensitivity training, mitigates these barriers. (Harrison, et al., 2019)

The application of Critical Race Theory allows the healthcare community to address these inequities in healthcare in a holistic approach. By addressing Race Consciousness, the theory addresses biases based on the assumptions that race consciousness is indicative of racisms, or that “colorblindness” is indicative of a lack of racism. Both assumptions have further led to inequities in care and research. (Ford & Airhihenbuwa, Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis, 2010) The CRT also seeks to “Center the Margins” or shift the perspective, of addressing inequities, towards ethnic and racial minorities perspectives instead of from the perspective of the majority group. (Ford & Airhihenbuwa, Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis, 2010) This approach requires the inclusion of racial and ethnic minorities in researching and addressing inequities. The concept of Praxis in CRT is a process of ensuring investigators are focused on equity while carrying out their research and practices in healthcare, through mutual discussion of “Lived” experiences of marginalized communities. (Ford & Airhihenbuwa, Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis, 2010)

This process of addressing and acknowledging racism and bias also includes acknowledging the disparate economic and social situations that marginalized groups experiences as a result of institutional racism and implicit biases. Healthcare doesn’t negate that many immigrant groups or ethnic and racial minorities don’t have access to the same resources as majority groups. Studies acknowledging these issues are designed to take them into account and address them as factors in research and education. (Sue & Dhindsa, 2006)

This increased diversity in research studies, and in educational opportunities, and the Healthcare workforce have proven to be essential for increasing healthcare outcomes for racial and ethnic minority populations, not just in the US, but worldwide.

Conclusion

The application of Critical Race Theory in addressing known racial and ethnic inequities in healthcare has proven to be a good framework for remediating these issues. Research studies in Public Health, Infectious Diseases, Rheumatology, and Psychiatry have utilized CRT to try and bring equity in healthcare. The studies references show that increasing racial diversity in healthcare education, research, and practice have led to slow and steady improvements. The intersectional approach to improving healthcare outcomes should be continued and expanded in order to fully mitigate current disparities, especially since the demographics of the US will continue to change.

References

Agency for Healthcare Research and Quality. (2020). National Healthcare Quality and Disparities Report. Rockville, MD: .AHRQ Publication.

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003, July-August). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep, pp. 293–302.

Betancourt, J. R., Tan-McGrory, A., Flores, E., & Lopez, D. (2019, April 16). Racial and Ethnic Disparities in Radiology: A Call to Action. Journal of the American College of Radiology, pp. 547–553.

Clark, L. T., Watkins, L., Pina, I. L., Elmer, M., Akinboboye, O., Gorham, M., . . . Regnante, J. (2019, May). Increasing Diversity in Clinical Trials: Overcoming Critical Barriers. Current problems in cardiology, pp. 148–172.

de Bruijne, M. C., Rosse, F. V., Uiters, E., Droomers, M., Suurmond, J., Stronks, K., & Essink-Bot, M.-L. (2013, December 23). Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study. European journal of public health, pp. 964–971.

Essing-Bot, M., Lamkaddem, M., Jellema, P., Nielsen, S., & Stronks, K. (2013, December 23). nterpreting ethnic inequalities in healthcare consumption: a conceptual framework for research. European journal of public health, pp. 922–926.

Fiscella, K., & Sanders, M. R. (2016, January 18). Racial and Ethnic Disparities. Annual Review of Public Health i, pp. 375–394.

Ford, C. L. (2020, July/September). Addressing Inequities in the Era of COVID-19. Family & Community Health, pp. 184–186.

Ford, C. L., & Airhihenbuwa, C. O. (2010, April). Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis. Ford, C. L., & Airhihenbuwa, C. O. (2010). Critical Race Theory, race equity, and public health: toward antiracism praxis. American journal of public health, 100 Suppl 1(Suppl 1), S30–S35. https://doi.org/10.2105/AJPH.2009.171058, pp. S30-S35.

Gollust, S. E., Cunningham, B. A., Bokhour, B. G., Gordon, H. S., Pope, C., Saha, S. S., . . . Burgess, D. J. (2018, February 7). What Causes Racial Health Care Disparities?A Mixed-Methods Study Reveals Variability in How Health Care Providers Perceive Causal Attributions. The Journal of Health Care Organization, Provision, and Financing, p. 55.

Greenaway, C., Hargreaves, S., Barkati, S., Coyle, C., Gobbi, F., Veizis, A., & Douglas, P. (2020, June 16). COVID-19: Exposing and addressing health disparities. Journal of Travel Medicine, p. 3.

Harrison, R., Walton, M., Chauhan, A., Manias, E., Chitkara, U., Latanik, M., & Leone, D. (2019, December 4). What is the role of cultural competence in ethnic minority consumer engagement? An analysis in community healthcare. International journal for equity in health, pp. 181–191.

Juckett, G. (2013, January 1). Caring for Hispanic patients. American family physician, pp. 48–54.

Lokko, H. N., Chen, J. A., Parekh, R. I., & Stern, T. A. (2016, December). Racial and Ethnic Diversity in the US Psychiatric Workforce: A Perspective and Recommendations. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, pp. 898–904.

Marcelin, J. R., Manne-Goehler, J., & Silver, J. K. (2019, August 20). Supporting Inclusion, Diversity, Access, and Equity in the Infectious Disease Workforce. The Journal of infectious diseases, pp. S50-S61.

Mayeda, E. R., Glymour, M. M., Quesenberry, C. P., & Whitmer, R. A. (2016, March 12). Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimer’s & dementia : the journal of the Alzheimer’s Association, pp. 216–224.

Nair, L., & Adetayo, O. (2019). Cultural Competence and Ethnic Diversity in Healthcare. The American Society of Plastic Surgeons, p. 3.

Sue, S., & Dhindsa, M. K. (2006, Aug). Ethnic and racial health disparities research: issues and problems. Health education & behavior : the official publication of the Society for Public Health Education, pp. 459–469.

Vandan, N., Wong, J. Y., Lee, J. J., Yip, P. S., & Fong, D. Y. (2020, March 28). Challenges of healthcare professionals in providing care to South Asian ethnic minority patients in Hong Kong: A qualitative study. Health & social care in the community, pp. 591–601.

Williams, J. N., Ford, C. L., Morse, M., & Feldman, C. (2020, November). Racial Disparities in Rheumatology Through the Lens of Critical Race Theory. Rheumatic diseases clinics of North America, pp. 605–612.

In the last 20 years Pearland has grown by over 400%. The community is becoming much more diverse and progressive, however the school board of Pearland ISD and the city council, are still under a full and tight control of the “old” Pearland. Just take a look at the Brazoria County Republican Party’s website – nearly all of the elected positions in the county, about 40 of them, are occupied by this single party. Even non-partisan positions, including school boards, local city councils, MUD districts, etc, follow a similar trend as the Pearland City Council.

The working-class of Pearland, who live in newer master planned communities, are not even aware of how and who makes the decisions that affect their day-to-day lives. This is by design, with the local GOP happy to keep people in the dark. The voter turnout in local elections has hardly gone beyond 10% over the years. Those who are frequent voters most likely belong to a close network of churches and social circles related to the established. In the 2021 local election that is going on right now, less than 2000 people (or 1%) have voted in Pearland so far, out of a population of 155,600 (Source: Brazoria County Election Office).

It is not that people haven’t noticed or challenged this status quo. But the establishment, with its power, money, and structures, has tried to block and stifle the change. Since 2016, numerous attempts have been made to increase voter turnout and to elect those who can represent the new dynamics of Pearland. Nevertheless, most of these efforts have been stymied, including a petition to move local elections to November, where turnout would be greater. Some new candidates have received death threats and become the targets of vicious attacks on social media. 

Despite the fact that local election turnout has been overwhelmingly low, this year, the early voting days have been cut several days shorter (ending on Apr 27th, Tuesday). Perhaps the Republican party doesn’t want people to know and come out to vote, just like what’s happening at the state level? Bills that attempt to strip voter rights and redraw voting districts for the controlling party’s advantage (called “redistricting” or “gerrymandering”) are being shoveled into the state legislature, whose session is ending at the end of May.

The real questions facing people of Pearland and the county are: who are actually controlling the tax dollars? What about corruption and lack of transparency in local politics? How are those who are willing to challenge the established being targeted?

COVID has brought even more controversial issues. As schools and cities reopen in person operation, will they follow policies guided by science or by political ideology? Will the school board and city council remove the mask mandate against public health guidelines?

In addition, many people saw this year’s property appraisal value jumping by 10%, following the pattern of previous years, despite financial difficulties many residents are facing in the pandemic. How will the federal and state relief fund (which comes from your tax dollars) be used in local business and school districts? Will the money be kept in the close loop of the power circle?

These are tough questions residents need to ask and follow. Yes, life is too busy for the working class. But if nobody pays attention, the effects of local politics will have a much greater impact than federal policies on your daily life, such as the water you drink and schools your kids go to.

Election Day is May 1st, Tuesday (there is no voting day available between Apr 27th and May 1st). For voting hours, locations, and sample ballots, visit the county election office website: https://www.brazoriacountyclerk.net/departments/elections/current-election-information. Check out the candidates’ websites and see what they are talking about. Find trusted organizations in your community to make noise and make changes that make sense to a majority of the people rather than a selected few in power.

https://www.history.com/topics/immigration/chinese-exclusion-act-1882

Let us never forget that when it suits white supremacists, we are depicted no differently than any other ethnic group. The same narratives used against the Chinese would later be used against Eastern European, and immigrants from Central and South America.

In times of war, the “model minority” AAPI groups are frequently targeted as an outlet for the ignorant. The worst example of this ignorant hatred is how Japanese Americans were treated by their government during WWII. Loyal Americans of Japanese descent were rounded up, their businesses and homes seized, and they were forced into camps. There was never any threat of “spies” among the Japanese Americans. Many of which loyally served in the military. Ignorance and fear mongering won the day.

https://www.smithsonianmag.com/history/injustice-japanese-americans-internment-camps-resonates-strongly-180961422/

The Korean and Vietnam wars would avoid the internment of other AAPI, but the increase in hate rhetoric against AAPI groups would continue, well into the 1980s.

After 9/11 Muslim Americans also felt the brunt of ignorant racism and hatred. Their business and places of worship were targeted, and they lived in a state of fear, that continues to this day.

http://www.csun.edu/~sm60012/GRCS-Files/Muslims-post-9-11.htm

After COVID-19 reached US Shores, hatred and ignorance against Chinese Americans, and other East Asian AAPI groups again increased. Chinese businesses faced boycotts by the ignorant, and AAPI citizens have seen an exponential increase in hate crimes levied against them. From racial slurs, to dangerous chemicals being thrown at them, to murder, the cycle of ignorance and violence continues.

https://www.washingtonpost.com/opinions/2021/02/23/anti-asian-violence-is-surging-we-cant-answer-bigotry-with-bigotry

From the article“In April, a Brooklyn woman suffered severe burns after being doused with chemicals. Last month, 84-year-old Thai immigrant Vicha Ratanapakdee died in an assault in San Francisco. Noel Quintana, a 61-year-old Filipino man riding the New York subway this month, required about 100 stitches after being slashed with a box cutter. Stop AAPI Hate, a coalition documenting anti-Asian hate amid covid-19, has tracked more than 2,800 incidents of violence, harassment or discrimination between March and December 2020, many aimed at the elderly. Activists say the true numbers are surely higher.“

The question I hear often is “well AAPI are considered model minorities, you aren’t always targeted, and people have a generally positive opinion about AAPI groups”. This is still white supremacy at work. There is a narrative that AAPI groups are harder working or smarter than other BIPOC groups. This in itself is damaging, setting the stage for unrealistic expectations, and pitting AAPI groups against Black and Latin Americans.

The narrative is used against other groups in an attempt to attack Affirmative Action, a necessary policy that is used to try and bring equity to Blacks and other BIPOC groups after centuries of oppression and devastation.

AAPI groups are used as a tool, to incite fear and anger, when it suits a society build on white supremacy, or as a tool against other groups in an attempt to keep us permanently split. AAPI too often fall into a pattern of “anti-blackness” or “anti-Latino” that is damaging not just to those groups, but also to AAPI. It isolates us, and when we face overwhelming discrimination, we have no moral high ground from which to defend ourselves, and far fewer allies than we need to push back. It is high time AAPI groups deal with our own bigotry, and begin outreach to groups that know all to well the damaging effects of white supremacy.

The actions in DC this week may have been triggered by the actions of Donald Trump, but even he is just a symptom of a larger disease that is part of the legacy of the United States.

The US has always suffered from a white nationalist problem, born out of a sick need for plantation owners to placate the poor southern whites, a narrative of superiority was fed to the poor southern farmers that, in many cases, lived in poverty as dire as could be found anywhere. Yet, they were fed a sense of superiority over the slaves that fueled the Southern economy.

The wealthy plantation owners fed poor whites a dream, work hard and you too can eventually own slaves. Over the course of generations, this toxic rhetoric was used to keep the poor whites in check, while plantation owners enjoyed the fruits brought forth by the bondage of others. Is the bondage of others not terrorism?

During the Civil War, wealthy plantation owners, and their sons, avoided front line duty, sending poor white farmers to fight for them instead. Again the narrative, “you are fighting for your heritage” was simply a dog whistle for the defense of slavery, and empty promises. Is insurrection in defense of slavery not terrorism?

After the fall of the civil war, and the onset of disillusionment of the frontline confederate soldiers began to wear off, the “Lost Cause” narrative was pushed to keep the poor whites in check, while the wealthy worked to build the systems of government into something that would lead to Jim Crow and a racially biased criminal justice system. Is the lynching and oppression of others not terrorism?

Wealth and power were concentrated among the corporate elite. Railroads were built at the expense of Irish, Chinese, and other immigrants, many of whom were turned against each other in order to keep them compliant to those in power.

When, despite Jim Crow and a system setup to make them fail, Blacks were able to build their own power structures in Tulsa, white rage was used to fuel anti-black sentiment. The Tulsa Race Massacre led to the destruction of black owned businesses, ensuring Blacks would be set back even further in society. Was this massacre not terrorism?

Attempts to eventually desegregate led to further weaponization of white rage. Poor whites were compelled to push back against desegregation, with false narratives of “the spread of communism” and threats against their racial “purity”. Meanwhile those in power sat back, immune from any such concerns. Was this not Terrorism?

The problem with the toxic white nationalism that is the legacy of our nation, is that it cannot be contained. Anger, rage, and fanaticism spread like a cancer throughout society. As society grew, and equity began, racism didn’t go away, it simply hid. White rage was redirected in other way, all while the undercurrents of bigotry remained to fuel it. Distrust in the government led to violence such as the Oklahoma City Bombing. Fanaticism led to tragedies such as the standoff in Waco. This was absolutely terrorism.

Poor whites remain poor. Those in power began further consolidation of wealth, all while distracting and feeding a narrative of fear. Beware of the immigrants, beware liberal policies coming for your “guns”. Meanwhile the rage and toxicity stated to consume schools, churches, and any public place that served as a venue for toxicity to explode.

Enter Donald Trump, a populist, yet mediocre, tyrant. He excels at one thing, feeding off the ignorance and rage of a poor white population that feels threatened at the very concept that they are not superior at all. Equity is heresy to a society that has spent the last 200 years benefiting over factual inequity and perceived superiority.

This is American’s legacy. It doesn’t have to be. Despite the best attempts of the few who benefit, America has steadily progressed towards a more just and inclusive society. We are far from it, but not so far as when this journey began. It is possible to keep pushing to a society where “All men are created equal” is not just a dream, but a fact. That cannot, and will not happen if we hope for the status quo.

We must hold EVERYONE accountable that enabled the toxicity of this week to blossom into all out insurrection and terrorism . We must not forget the lessons of the past, and we must not allow false narratives to take root any further.

Content warning, this is disgusting and violent. I don’t cheer this. But this IS the America we live in. I’ve seen this multiple times. The LGBTQ and BIPOC communities have seen it. Women walking home alone have seen it. We can, and must, do better.

https://www.independent.co.uk/news/world/americas/us-election-2020/us-capitol-police-officer-crushed-riot-b1784670.html