TUG Feelings of Perceived Racism - Concept Requests

SNOMED Groups Translation User Group
1

Hi all,

Fourteen new Clinical finding concepts have been requested by the Gravity Project terminology team. These concepts are designed to capture how a subject feels they have been negatively impacted by perceived racism and for one concept perceived discrimination. The references below demonstrate the use cases for these concepts.

Given the sensitive nature of this content and the need to ensure accurate translation, we are seeking comments regarding their addition to the terminology from the Content Managers Advisory Group and the Translation User Group before moving forward with these requests.

In addition to this forum post, the topic will be discussed at each group’s April meeting. Feedback on this topic should be provided by Friday 8th May, 2026.

The requested concepts are:

  • Feels autonomy in care compromised due to perceived racism (finding)

    • Definition: Subject feels their autonomy in care is negatively affected due to perceived racism.

    • Racism is incorporating ideologies of superiority, negative attitudes and beliefs toward racial and ethnic outgroups, and differential treatment of members of those groups by individuals and/or societal institutions.

  • Feels respectful care compromised due to perceived racism (finding)

    • Definition: Subject feels that respectful care towards them is negatively affected due to perceived racism.

    • Racism definition as noted above.

  • Feels care provision delayed due to perceived racism (finding)

    • Definition: Subject feels their care was delayed due to perceived racism.

    • Racism definition as noted above.

  • Feels care denied due to perceived racism (finding)

    • Definition: Subject feels their care was denied due to perceived racism.

    • Racism definition as noted above.

  • Feels trust in care compromised due to perceived discrimination (finding)

    • Definition: Subject feels their trust in care is negatively affected due to perceived discrimination.

    • Discrimination is the treatment of a person or particular group of people differently, in a way that is worse than, the way people not in that particular group are treated.

  • Feels trust in care compromised due to perceived racism (finding)

    • Definition: Subject feels their trust in care is negatively affected due to perceived racism.

    • Racism definition as noted above.

  • Feels food insecurity is due to perceived systemic racism (finding)

    • Definition: Subject feels their food insecurity is due to perceived systemic racism.

    • Systemic racism (also referred to as structural racism) is racism that arises across society from the interactions of institutions and individuals. It is the cumulative, long-term effects from power inequities or unequal opportunities across systems.

    • Food insecurity is uncertain, limited, or unstable access to food that is adequate in quantity and in nutritional quality; culturally acceptable; safe and acquired in socially acceptable ways.

  • Feels employment problem is due to perceived systemic racism (finding)

    • Definition: Subject feels their employment problem is due to perceived systemic racism.

    • Systemic racism definition as noted above.

  • Feels education compromised due to perceived systemic racism (finding)

    • Definition: Subject feels their education is negatively affected due to perceived systemic racism.

    • Systemic racism definition as noted above.

  • Feels housing instability is due to perceived systemic racism (finding)

    • Definition: Subject feels their housing instability is due to perceived systemic racism.

    • Systemic racism definition as noted above.

  • Feels homelessness is due to perceived systemic racism (finding)

    • Definition: Subject feels their homelessness is due to perceived systemic racism.

    • Systemic racism definition as noted above.

  • Feels inadequate housing is due to perceived systemic racism (finding)

    • Definition: Subject feels their homelessness is due to perceived systemic racism.

    • Systemic racism definition as noted above.

  • Feels healthcare access compromised due to perceived systemic racism (finding)

    • Systemic racism definition as noted above.

  • Feels mental health service access compromised due to perceived systemic racism (finding)

    • Systemic racism definition as noted above.

References:

Racism
Discrimination
Respectful care

Regards,

Cathy Richardson

2

The Norwegian NRC has analyzed these concepts from a translation point of view. We would like to make some remarks:

1 Some concepts are not clear to us. These refer to existing concepts in the SNOMED CT hierarchy which should be defined textually:

Feels housing instability is due to perceived systemic racism (finding):
We would need a clarification of the concept 1156191002 |Housing instability (finding)|, for example with a text definition.

Feels employment problem is due to perceived systemic racism (finding): We would need a clarification of the concept 75148009 |Employment problem (finding)|, for example with a text definition.

Feels inadequate housing is due to perceived systemic racism (finding): “Inadequate housing” is one of several synonyms of 105531004 |Housing unsatisfactory (finding)|. These synonyms have different meanings (and hence, different translations), so we would need a clarification. As far as we understand, there is a substantial difference between ‘accomodation’ and ‘housing’.

2 Many text definitions are circular, which doesn’t really help a lot. One important exception is the wording “negatively affected”, which is being used in the definition for “compromised”. The word “compromised” can be render different translations in Norwegian, so the clarificaiton of “negatively affected” is quite helpful for us.

3 We suspect the definition of “Feels inadequate housing is due to perceived systemic racism (finding)” to be a duplicate of the definition of “Feels homelessness is due to perceived systemic racism (finding)”

4 Even though we only comment the translateabilty of these concepts, we are a little bit surprised by the lack of balance between “racism” and “discrimination”: Only one concept refer to “discrimination”.

1 Like
3

Hi,

What is the difference between homelessness, inadequate housing and housing instability? Homelessness, you have no housing at all I guess, not even lodging with friends. Inadequate housing for me describes too small housing for the family size or crappy lodgings. But what is housing “instability”? And why do you have the same definition for homelessness and inadequate housing? Is that a mistake when posting the definitions on the forum? I’m not sure of the scope of employment “problems”. It’s pretty vague, which means the use of this concept will be heterogenous and that is normally quite the reverse of the point of using a terminology.

I would agree with the Norwegian NRC that racism is but one type of discrimination and there are a lot of issues where people are being discriminated in healthcare that are not linked to race but to being LGBTQIA+ or simply being a woman. If you create concepts related to racism, it would only be fair not to discriminate the other victims by refusing them a concept to express the other forms of discrimination, which are sadly no less common and problematic.

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4

My recommendations regarding these proposed concepts are as follows:

  1. Add explicit text definitions for housing-related concepts
    The housing-related findings (e.g., homelessness, housing instability, inadequate housing) require harmonized textual definitions.

  2. Prefer postcoordination over extensive precoordination
    The current approach risks an unmanageable proliferation of precoordinated concepts combining:

  • type of social or healthcare-related issue (e.g. housing)
  • perceived kind of discrimination / degree of impact (e.g. denying rights, bullying, 
)
  • causal attribution of discrimination (“race”, ethnia, gender, sexual orientation)

This would require postcoordination, as only a compositional approach would allow flexible, scalable representation without requiring enumeration of all possible combinations. We should favor a smaller set of well-defined base concepts combined through postcoordination, rather than attempting to precoordinate the full combinatorial space.

5

Hi Cathy,

To sum up what I said during our meeting on May 5, I think it’s important that enough research on current content is carried out to prevent the creation of duplicate or near-duplicate concepts, as Ole also pointed out.

I think that Marie-Alexandra also has a good point about the differences between the different terms related to not having adequate housing. These terms may be clearly different in English, but those differences do not necessarily translate into other languages. Hence the need to unambiguously define homelessness, inadequate housing and housing instability.

The term ‘feels’ poses another problem to us. I know this terms is already in SNOMED CT. We understand what it means when describing physical sensations (“Feels hot”, “Feels light-headed”), but in these new concepts, it’s unclear what the meaning is. For example, “Feels trust in care compromised due to perceived racism”: what’s the scenario in which you think the clinician will use this concept? Is it because the clinician deducts the patient has a ‘feeling’ that trust in care is compromised due to perceived racism? Or is it when the patient explicitly tells the clinician that they feel trust in care is compromised? In that case, then why not replace ‘feels’ with a more concrete verb, such as ‘says’ or ‘states’?

Similarly, while I think these concepts address a gap in SNOMED CT, I also think some of them are too complicated and no clinician will ever find their way to them, so they will never be used. All of these concepts were built through the combination of technical terms from sociology and similar disciplines that need be explicitly defined because their meaning is not clear at face value. However, clinicians do not have the habit nor the time to look at text definitions in SNOMED concepts. For example, during a consultation, a patient might describe a personal situation that qualifies as “food insecurity,” but without using the technical term. If the clinician does not know the term either (why should they), they are never going to type it into their health record search bar, so they will never find the concept “Feels food insecurity (
)”.

Finally, I think there are more terms whose meaning cannot be assumed and that should be defined before we go on with the debate:

“Perceived” (racism/systemic racism): what does this mean? Is it the subject that says that they perceive racism? What is the difference between perceive and feel? Does it mean that the subject explicitly says that they perceive structural racism? Or is that the subject blames structural racism, but that the clinician interprets it as just a perception of the patient’s and not a real cause? Why not omit the word ‘perceived’? Are there pairs of concepts in which this distinction is essential? E.g. Feels education compromised due to perceived systemic racism vs. Feels education compromised due to systemic racism.

“Compromised” the definitions use the term “negatively affected”. Why not use this term instead of “compromised”? Compromised is vague and does not translate well.

“Autonomy in care”: this term is not crystal-clear to me.

Finally, I think you should consider reducing the risk of ambiguous interpretations in different languages by replacing the elliptical constructions with more explicit constructions without any omitted words. E.g. instead of Feels care denied due to perceived racism write Feels that care was/is denied due to perceived racism.