Institutional Racism and Acupuncture


I was disappointed there weren’t more comments on Lisa’s blog post regarding disparities. I am however aware that most, if not all, of us within the CAN community are very busy working to create successful clinics for the very purpose of ending those disparities – and perhaps busy raising families, etc. on the side (lol) hence, there isn’t always time to blog. Still, a part of me wants to just say “got privilege?” to whomever may appreciate a gentle reminder of one of CAN’s main missions – to broaden access to acupuncture.

Recently, I was invited to be a presenter at the 2010 Seattle Race Conference. The theme this year is Racism and Health Inequities: Eliminating Barriers and Healing Our Communities.  I’ve invited a couple of my patients to co-present with me – both women of color – so that my viewpoints as a white male aren’t exclusive of other viewpoints.

I’d really like to hear from anyone in the CAN community – including patients and interested citizens – what your thoughts are on the main barriers of access to receiving acupuncture that involve race. Here’s what I’ve come up with so far:

1. The high cost of services. If you don’t have insurance, typical out of pocket for acupuncture is anywhere from $65 to $200 on average. Many insurance plans do not cover acupuncture, or do so only minimally. Many people have no insurance at all. So here, there is considerable overlap in that this is a class issue as well as a race issue. However, since economics usually plays out disproportionately along racial lines, perhaps the point is moot?


2. “Expertism”. This relates to how whites (usually white males) often set themselves up as experts in any field and the usual mode of engagement of an expert is to tell a client what they need to do in a somewhat paternalistic way. This seems to be strongly conditioned within the medical profession in general, and to a large extent the acupuncture profession has adopted this model. This plays out, for example, in the long interviews that exist in a typical acupuncture visit. There is an interesting parallel here at the level of nations within the colonial system, with more powerful nations dictating to weaker ones, how they need to behave. This is fundamentally alienating and disempowering.

3. People of color are proportionately under-represented (excepting Asians) as practitioners within the profession. That is, there are relatively few acupuncturists who are Black, Latino, Native American, or from other races.  I think this relates back generally to barriers of access in higher education, but there may also be some relationship with the high cost of an acupuncture education, in the absence of employment prospects using the traditional business model. The prospect of longer degree requirements (i.e. the First Professional Doctorate) is also relevant here, as that plays into number two (expertism) above.

4. Acupuncture is simply not familiar to many people in America – largely due to the first three reasons. Perhaps someone can point out the relevant statistics here, but I recall that it is something like a few million people in America who have tried acupuncture (i.e. 1 or 2% of the population). Therefore it is viewed with suspicion.

This is a very rough outline. I would love to hear your feedback. I’m hoping in my presentation to strike a skillful balance between talking about institutional racism as it affects acupuncture, and offering empowering information, such as how the community acupuncture model is a conscious effort to overcome these barriers and create greater access.

Thanks for your input!

river Jordan
Author: river Jordan

After graduating from the Northwest Institute of Acupuncture & Oriental Medicine in 1997, I had a hobby practice for a few years before moving to Northern India to study Buddhism. During this time, I volunteered in a local clinic, giving acupuncture to Tibetan refugees and Indian nationals. <p> Returning to the U.S. in 2002, I started a typical insurance based acupuncture practice catering to the upper middle class. In 2005, following Hurricane Katrina, I volunteered with <a href="https://www.acuwithoutborders.org/" target="_blank">Acupuncturists Without Borders</a>, using community style acupuncture to treat trauma victims in a natural disaster setting. </p> Inspired by the power and efficacy of acupuncture in a post-disaster setting, I began to contemplate issues of socioeconomic class. What could be done to make acupuncture accessible to everyone and still provider a livable wage for an acupuncturist? After attending WCA's first conference in October of 2006, I had found the answer to that question. In January 2007, together with my partner Serena Sundaram, we founded <a href="https://www.communichi.org/" target="_blank">Communichi</a>, Seattle's first dedicated community acupuncture clinic. <p> As a Buddhist, I believe that healing begins in the mind. As the positive qualities of wisdom and compassion are cultivated in the mind of a practitioner, this...

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Survey of CAN clinics

Skeptics in the acupuncture community say that CA clinics can’t be successful.  A variety of reasons are cited – prices too low, patients want one-on-one attention and wouldn’t like treatments in a room with other people, Dr.

Responses

  1. need the right messenger

    with less than 2% of licensed acupuncturists being Hispanic or African American, you may have to look outside the US acupuncture profession to find them using acupuncture needles widespread within their own communities.

    in your search don’t forget the first US institution to use filiform needles for healing, and the activists who fought/fight to keep acupuncture needles legally in the hands of communities of color. they have long stood by ancient wisdom: the message of acu needs the right messenger–or as they tell us in acu school: not just anyone can deliver an effective treatment–as once noted, “If acupuncture is removed and if people like Mutulu and Mickey and Georgie are not around to reach patients with their analysis and communication, then it will be like what we’re against, because its the treatment and the information together that make Detox work.”

  2. Location, Location, Location

    Acupuncturist want to make a good living, and acupuncturist are “hip and cool”, therefore they want to live in happening areas. When was the last time you saw acupuncture clinic in a poor, crime ridden neighborhood? So location of clinics, is also a factor in determining availability.

     

  3. Good point. I agree that

    Good point. I agree that most acupuncturists are conditioned to set up clinic in wealthy neighborhoods because those are the only people who can
    generally afford the high cost of a conventional acup. clinic. I do know of several community clinics that are in working class neighborhoods with a high proportion of immigrants and/or racial minorities.

  4. newer data

    Thanks for your reply. I haven’t had time to read the linked article yet, and intend to do so. Hopefully, reading that will help me understand your points better, because – for one, I’m not sure which institution you are referring to that was first – sounds like it was a detox clinic? Also, I would be most grateful if you are aware of any  data on the racial composition of practitioners which is more recent than the AT article you linked to which is from 2002.

  5. Here’s the latest:
    70.4%

    Here’s the latest:
    70.4% white
    21.6% asian
    5.2% “other”
    –from the 2010 very bland survey by nccaom

    No funding/method for research like this on the demographics of the other “other” america that needles. Some call them “lower tiers”. In these “low” places— reservations, border colonias, among sickle cell survivors— and other ghettos etc etc, we can assume that most of these other needlers are “other.” But you know interesting and hopeful stuff can come from low places even without the support of acupuncturists–the drive to recover and sustain health by any means possible always overcomes the myriad of -isms that oppose them. However history shows that much greater quantities of interesting stuff can come from low places when acupuncturists and physicians get over their -isms.

  6. What about AWB?

    AWB seems to give away a lot of acupuncture treatments to the poor of the world. They’re a group of acupuncturists from the United States. They’ll go into any community, even Haiti, as I read in acupuncture today.

  7. the messenger

    Thanks for the linked article giving insights into the beginnings of Lincoln Hospital and the ongoing battle against the system of profiteering in lives which is the legacy of the racist capitalist system we live in. 

    In terms of reducing racial barriers today – while I think it is definitely a red flag that there are so few acupuncturists of color, I think anyone can be the right messenger, providing treatments are affordable, and accessible in other ways, such as being located in neighborhoods where people of color live (thank you Baba).

    I totally agree that in the context of drug detox acupuncture, counseling is an important component (and I also agree that social history is an important aspect of that counseling), but outside of the detox setting, many people within CAN (hope I am relating this accurately) feel that too much counseling and probing into personal details from the outset – which is often a part of the mainstream medical/acupuncture model – can be alienating to people.  It can feel paternalistic and oppressive and it would seem logical that people from minority races expecially would feel uncomfortable by this.

    That said, obviously language could also be a barrier in some communities…so if the messenger can speak multiple languages or at least, the language of the community they serve  (e.g. Spanish, French/Creole, etc.) that is clearly a plus.

  8. charity acupuncture

    I personally think AWB is a great organization that has a genuinely compassionate vision to go to the places where there is extreme suffering – like New Orleans, Haiti, and Nepal – with the vision of setting up long term programs run by the local communities. It is still a small organization in need of a lot of support of all kinds.

    I know there are some out there who will say that the nonprofit community in general is part of the dominator culture that will never adequately provide for all the needs of oppressed people around the world – somewhat analogous to the theory Howard Zinn puts forth in “the People’s History of America”, that the middle class has evolved as a convenient buffer to insulate the rich from the poor. Not as if its part of some conscious conspiracy, but more as a convenient pressure relief valve that has evolved over time to squelch the demands of disaffected groups of lower classes/non-whites, etc.

    Doubtless, there is much truth in that. However, my own view is that many nonprofits like AWB do awaken a broader awareness in the urgent need and responsibility to create a more equitable world for all people. It’s easy to complain and pick apart the work of others, but more difficult to acknowledge your privilege, take responsibility and engage your own life in progressive work for global equity.

    But my main concern in this thread is about racial barriers to accessing acupuncture in America outside the nonprofit system. One of the tenets of understanding behind the affordable sliding scale within the community acupuncture movement, is that it is difficult for most people to accept charity. Places of desperation, like Haiti – where people are starving, then the people usually have little choice. But here in America – and although the current economic situation is increasing the sense of desperation for millions – the vast majority of people fall between the two extremes of comfortable wealth, and extreme poverty. These people do not want a hand out because naturally, there is a loss of dignity over time when people receive free handouts, and have no opportunity to give back to the greater society.

    Even more to the point, the way tax laws are written, charities generally have to prove that their target populations are below a certain income level – I guess this must be waived in a disaster because we never had verify income in New Orleans.

    It’s fundamentally demeaning to have to prove your income is below a certain level in order to qualify to receive benefits. CAN sliding scales allow people to pay a modest amount $15-$35 usually – no questions asked, and that’s one of the main ways that the CAN model removes barriers to access.

     

     

     

  9. Outreach and Marketing

    Most of us naturally spread info regarding our clinics to the people we know.  Unless our friends, church, social groups, book clubs, hairdresser, etc. include as many folks of different races than our own as they do people of our particular race, our outreach/marketing efforts in those circles will be limited to people mostly like ourselves.   

    Nancy S.

  10. the quest for cultural brokers…

    yes, anyone can deliver the message, but i’m not just talking verbal messages. the cultural baggage is projected mostly in the non-verbals and the context of the cultural exchange. i.e. a bi-cultural hispanic acu practitioner does have an edge over the spanish-speaking non-hispanic acu practitioner–it’s an issue of confianza…

    the fact that fewer minorities come to wca has nothing to do with a discriminatory atmosphere, but rather (likely) the fact that the punks there (like most punks) are mostly white. yes, ca clinics may pose fewer cultural barriers than the average medical institution or the average lcsw or therapist. but ca clinics thrive on the primary common ground that most acupuncturists (who are mostly middle class) have with their clients (who are mostly middle class). this is what lisa taught us–this is why can is so successful—it’s best to market to the folks from your roots.

    back in the early 80’s: the counseling field posed the same question you are posing today: why are minorities not seeking our help? (see Sue and Sue, “Counseling the Culturally Different” as a primer) this spawned the entire field of cultural competency. this does help the counseling field, but still didn’t solve the problem. yes, as you point out, this is partly due to the implicit barriers of the modality of verbal therapy, and why group acu (not just ca) works so well cross culturally. still: wca sees many fewer minorities than whites though they are located in the most diverse neighborhood in portland. why?

    access to care remains a barrier for minorities in every health field, including counseling, in spite of progress in building cultural competency. and most counselors remain white–one big reason why minorities turn to culturally indigenous spiritual support systems to seek help–they trust their own families—confianza companero! this is where the other acu america excels. and i’m not just talking drug detox acupuncture. this protocol has been effective for for much more than drug addicts. it remains the most accessible acu care for many minorities.

    dismissed as “other” “lower” “not the main concern”—yup.
    accused of “not representing the fullness of the medicine”?–ah yeah yeah yeah.
    confused with “charitable acu”? — come along now brutha.
    underutilized?– ubetcha.

    but not for lack of activists continuing the struggle to create access for minorities to use the protocol within their communities.

    if you believe acu could become as familiar as noodles in a bowl at home, each home must have its own acu practitioner, each community must have a cultural broker trained.

    that is, if this is folk medicine you’re talkin about…

    that is, if you want this thing to be mainstream…

  11. even in Haiti people don’t just need handouts

    even in Haiti people don’t just need handouts. the long term recovery in any community hinges on Haitians or New Orleans whatever the group building the capacity to help themselves. the larger question is–and it’s similar to your original q: how can acu become a part of the fabric of communities (from the US to Haiti) where no licensed acupuncturists exist? Especially when the number of non-asian/non-white LAcs is not increasing:
    2002–4% were hispanic or black
    2010–5% of all non-asian/non-white are lumped into the “other” category
    by 2025, the price of acupunk education will be ???? which will leave how many minorities?

    Even without the inflation of acupunk education, it doesn’t make a different in the end: there have always been relatively few “other” licensed acupuncturists, that’s just the way it’s been, the way it is, some things will never change…

    RE: AWB or ARP or other tourist-acupuncturist group with a compassionate vision, there’s really nothing else to say but: people need to be able to help their own people. If this isn’t part of the assumption behind the compassionate vision–not just an “afterthought”–then privilege hasn’t been checked at the door. there’s a lot of talk among these groups about helping communities to set up their own clinics, but aint seen nothing yet baby– therefore no sustainable vision is in play.

    GUAMAP, and Pan African Acu project, Real Medicine, NADA, CRREW and Naturopaths International–these are some of the exceptions, and these are the groups that have left acu clinics behind that sustain themselves in the third world– where you can teach health workers any full body point. meanwhile in the good ol usa–most of the country–including minority groups–remains blocked from being able to train health workers in acu.

  12. confianza and finding a common language

    HI again,

    I had to look up confianza as my Espanol is not that sophisticated. What I garnered from the article though is that confianza derives from confidence with special emphasis on trust and familiarity.

    In today’s racially charged world, there is no question that trust across racial lines can take time to build trust. So, on the one hand, I think that there is a need for more therapists who have the built in trust that comes with culture of origin…on the other hand, I think it is of critical importance to the survival of humanity that we not give up on the goal of people like Dr. King and Gandhi – of creating a society where we all live in peace as one big family.

    In my own case, I have some advantage in that I chose to locate my clinic inside a Latino community center that also services the minority community in general (housing, food bank, legal assistance, senior center, children, etc.). I also owe a debt of gratitude to the work of many others – like Lisa Rohledor – to bring greater awareness within our profession, to issues of class and race, white privilege, and so forth. So, with time, and effort on the part of practitioners, trust can be earned and bridges can be built, and one’s horizons and heart starts to expand…a breath of liberation.

    Also, I see a lot of possible alliances between the CA movement and NADA, – a sentiment that I believe is shared by many of us in the CAN.

  13. absolutely

    And since you seem to have researched this better than I, perhaps you could spell out where the blocks are coming from in your last paragraph. Let’s lay it out on the table brother/sister!

  14. to remove stagnation, start with distal points

    some blocks have been spelled out pretty clearly as of recent, and has been pointed out from time to time in print since 1993. it’s all there if you do the research. i don’t know if the can blogging table is the best place to go for the de qi at this moment. may need some distal points first. let’s let the needles simmer at a shallow depth…and pray like hell…community outside of our familiar communities does feel good…

  15. CAN blog is all about needling and going for de qi

    Of course, it does require courage to speak out and you may have your own reasons for not identifying yourself, or spelling out your point of view more explicitly. So I won’t second guess you there.

    I have my own view and my own research, but would be interested to hear yours so that viewpoints can mingle and bridges of understanding can be built. 

  16. Thanks for your candor and

    Thanks for your candor and your openness to dialogue river jordan. I’m sorry this isn’t easier to discuss. an old friend once told me “don’t push the river.” that’s all i have to say.

  17. Okay. Geting dumb again.

    Seems like some folks who read this blog can’t take Jordan’s thoughts in a coherent fashion and wind up raving like lunatics. Such comments are deleted.

  18. WHAT IS “INSTITUTIONAL RACISM?”

    WHAT IS “INSTITUTIONAL RACISM?”This is Skip and for a third time I am removing posts from this thread.. Third time’s the charm so from now on here I’ll remove any Guest non verified post on this thread regardless of if they are racist or not.