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Racism: a threat to public health

Black women in the UK are four times more likely to die in childbirth than white women. In the United States, blacks and Hispanics are more likely than whites to be exposed to environmental hazards, especially hazardous waste. These are examples of how racism and xenophobia are bad for health, provided in a new series of four articles published this Friday in the British medical journal The Lancet. Until now, these factors—which are global problems—have been overlooked. “Racism and xenophobia exist in all modern societies and have profound impacts on the health of disadvantaged people. Until they are universally recognized […]the causes of discrimination will remain in the shadows and will continue to cause and exacerbate inequalities,” writes Delan Devakumar, Professor at University College London (UCL) and lead author of the series.

In all medical conditions, from cancers to cardiovascular disease to Covid-19, caste, ethnicity and race are often listed as risk factors, the documents say. However, they say, the reasons why minorities are at higher risk of disease have not been adequately examined by health professionals and researchers, and there is a tendency to assume that these inequalities are genetically determined and immutable. . The series challenges this notion, as science has shown that humans are one of the most genetically similar species to each other and therefore cannot be divided into subspecies or races.

Discrimination also shapes living conditions and lays the foundation for many of the risk factors associated with poor health.

These complex and interactive processes, studies point out, affect minorities throughout their lives. The evidence demonstrates, they explain, the intergenerational consequences of unequal treatment, which shapes living conditions and lays the foundation for many of the risk factors associated with poor health. Like exposure to substandard housing, poverty and violence in neighborhoods, air pollution, and limited access to green space and nutritious food. In addition, discrimination limits the opportunities through which people can improve their health and well-being, such as formal education, leisure, work, and health care.

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Furthermore, the series emphasizes the significant role of physiological responses caused by past and present discrimination in explaining racial inequities in health. On an individual level, the trials say, unequal treatment can activate the body’s stress and hormonal responses, potentially causing short- and long-term biological changes.

Evidence suggests that the biological impacts of discrimination are an important driver of racial inequities in health, rather than genetic difference, as has often been assumed.

Sujitha Selvarajah, a specialist in obstetrics and gynecology at UCL

“Discrimination affects health in many ways, which have often been difficult to measure because its effects can appear long-term. However, the evidence suggests that their direct and indirect biological impacts are an important factor in racial inequities in health, rather than the genetic difference, as has often been assumed,” confirms Dr. Sujitha Selvarajah, a specialist in UCL obstetrics and gynecology. “On a societal level, discrimination is costly and inflicts collective trauma. We call for the recognition of racism and xenophobia as determinants of health, as is already the case with political, social and economic factors”, he denounces.

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Transform discriminatory systems

Broader and deeper action is needed to transform the systems that reproduce racism and xenophobia, propose the authors of the series, and suggest the implementation of “anti-racist public health interventions.” For example, early education programs that reduce prejudice towards discriminated groups and improve the cultural sensitivity of health care providers.

Also, they analyze, there are precedents for community action. Like the campaigns organized by HIV-positive black women to protest the government’s inaction on HIV in South Africa, which disproportionately affects the black community, which have forced pharmaceutical companies to offer anti-HIV drugs at affordable prices. Or “racial equity law and policy,” both institutional and national, since stronger laws are associated with better outcomes for racial minority groups.

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Above all, the authors of the series stress, all measures must address the “intersectional nature” of structural discrimination, when considering the interactions with other forms of oppression such as sexism or social prejudice against people with disabilities.

“In recent years, we have witnessed the persistence of colonialism. During the covid-19 pandemic, we have seen how access to life-saving vaccines has been structured along colonial and racial lines, as high-income countries in the Global North have been given privileged access to them,” writes Gideon Lasco. , a medical anthropologist from the University of the Philippines. The latest estimates suggest that while 70% of people in Europe have received at least one dose, this figure is still only 32% in Africa. “An all-too-familiar situation is taking place in the context of the climate crisis,” Lasco denounces, “with disadvantaged populations already negatively affected by the health impacts of global warming, even though they are often the least affected. contribute to historical carbon dioxide emissions.” And he ends: “Unless we take steps to transform the systems that uphold racism and xenophobia, we will be unable to address racial disparities in health.”

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