Racism, xenophobia, and discrimination adversely affect health across all ages, leading to health inequities, according to Lancet.
In its latest series, Lancet argues that discrimination is a significant driver of racial health inequities and outlines the diverse pathways through which discrimination harms health, including directly impacting the body via stress responses, profoundly shaping living environments, and limiting individuals’ opportunities to improve health.
Lead author, Professor Delan Devakumar, UCL, says, “Racism and xenophobia exist in every modern society and have profound effects on the health of disadvantaged people. Until racism and xenophobia are universally recognised as significant drivers of determinants of health, the root causes of discrimination will remain in the shadows and continue to cause and exacerbate health inequities.”
Racism, xenophobia, and discrimination are global issue and its health consequences are evident worldwide.
In the UK for example, higher mortality rates were seen amongst the Black African, Black Caribbean, Bangladeshi, Pakistani and Indian ethnic groups in the second COVID-19 wave. Migrant groups and others—such as the ‘scheduled castes’ in India—are often particularly disadvantaged by barriers to healthcare imposed by governments. Similarly, Indigenous populations across the world have suffered from poorer health outcomes including lower life expectancy, higher infant and maternal mortality and malnutrition, the series say.
In addition to the profound damage to oppressed and minoritised groups globally, the authors say that racism and discrimination financially strain health systems. For example, an estimate of health-care-related costs from racial inequalities in the USA over a 4-year period (2003–08) was US$229 billion, along with a loss of $1 trillion due to lost productivity from illness and premature deaths. From 2001 to 2011, racism cost the Australian economy three per cent of annual gross domestic product.
In the series, the authors stress that discrimination directly affects the body through activation of the stress response, resulting in short-term and long-term biological changes. They note that exposure to discrimination in one generation might propagate adverse health effects to the subsequent generation. The importance for health of biological responses to discrimination has been severely under-recognised, due to a tendency to assume that population differences in disease risk have a genetic basis, they added.
The series also says that discrimination shapes people’s environments and opportunities, driving diverse processes for ill-health. It affects formal education, informal networks, recreation, jobs and careers, and access to health care. Discrimination also increases the likelihood of facing poor quality housing, neighbourhood deprivation and violence, air pollution, limited access to green space, and unhealthy food retail environment
The authors point out that COVID-19 pandemic highlights the cumulative imprint of discrimination on health outcomes, reflecting differences in susceptibility to disease, occupational exposure, access to appropriate care, clinical prognosis, and outcomes.
Apart from this, the authors point out that discrimination is costly and inflicts collective trauma at a societal level. “There is evidence that discrimination affects all groups, and it would benefit us all to tackle it. Although tackling discrimination will improve health outcomes, a key motivator to addressing racism, xenophobia, and discrimination is to address our collective trauma through motivations rooted in justice and healing,” they said.
SOME EXAMPLES OF DISCRIMINATION
Black women in the UK are Four times more likely to die in childbirth than White women, whereas in some districts in Odisha, India, children belonging to a minoritised caste are more likely to be anaemic after adjusting for socio-economic status.
In the second wave of the pandemic in the UK (Sept 12, 2020 and onwards), Bangladeshi women were 4·11 (hazard ratio adjusted for age, 95% CI 3·62 to 4·66) times more likely and Bangladeshi men 4·96 (4·49 to 5·48) times more likely to die from COVID-19 than the White British population. Higher mortality rates were also seen among Black African, Black Caribbean, Pakistani, and Indian ethnic groups.
In New Zealand, Indigeneity is a stronger predictor than migratory status and skin colour of low birth weight and short gestation length.
Aboriginal women in Australia experiencing discrimination during perinatal care were also more likely to have a baby with low birth weight (odds ratio [OR] 1·9, 95% CI 1·0–3·8) than non-Aboriginal women.
Migratory status, Indigeneity, and religion intersect to result in Palestinian Arab mothers in Israel experiencing compounded discrimination, and being more likely to have post-partum depression compared with migrants and non-migrant Jewish mothers.
TRANSFORMATIVE CHANGE NEEDED
The authors stress the need for broader and deeper action to transform the existing systems that uphold and reproduce racism and xenophobia.
The authors suggest such change can be achieved through the implementation of anti-racist public health interventions. For example, early education programmes that reduce prejudice towards discriminated groups, improving cultural sensitivity among healthcare providers, and strengthening social security provision.
Organizational and community change and active engagement with movement-building can also form a key part of the health community’s action to tackle racial inequity. Effective precedents include the activist campaigns set up by Black HIV-positive women to protest government inaction on HIV in South Africa, which disproportionately impacts the Black community, and have succeeded in forcing pharmaceutical companies to make HIV medicines available at affordable prices.
Legislation, and both institutional and national race equity policies are also raised as effective starting points for progress, as evidence suggests that stronger racial equality and non-discrimination laws are associated with better outcomes for racially minoritised groups.
All measures must also address the inter-sectional nature of structural discrimination by considering interactions with other forms of oppression (such as sexism or ableism). An inter-sectional approach to tackling the health impacts of racism, xenophobia and discrimination addresses history and coloniality, focuses on overlapping disadvantages, works to overcome all forms of institutionalised discrimination, and promotes non-violence.