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The four-paper series, published in The Lancet, examines how prejudice impacts the health of minoritised people across the globe 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.
For example, in the UK, higher mortality rates were seen amongst the Black African, Black Caribbean, Bangladeshi, Pakistani and Indian ethnic groups in the second Covid-19 wave. Meanwhile, migrant groups and others – such as the ‘scheduled castes’ in India – were found to be particularly disadvantaged by barriers to healthcare imposed by governments. Additionally, Indigenous populations across the world have suffered from poorer health outcomes including lower life expectancy, higher infant and maternal mortality and malnutrition.
Discrimination affects health in many ways, which have often been challenging to measure because the effects of discrimination can appear over long periods of timeSujitha Selvarajah
Consequently, the authors are calling for wider recognition of racism and xenophobia as fundamental determinants of health and urge the health community to advocate for and implement measure that focus on the structural causes. Lead author, Professor Delan Devakumar (UCL Institute for Global Health), said: “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.”
The series found that across health conditions – from cancers to cardiovascular disease to Covid-19 – caste, ethnicity, and race are often listed as risk factors. However, the reasons why minoritised people are at greater disease risk has received inadequate scrutiny from health professionals and researchers, and there is a tendency to assume these inequities are genetically determined and unchangeable. The researchers challenge this notion and emphasise the significant role of physiological responses caused by past and present discrimination in explaining racial health inequities. For, not only do these complex and interacting processes affect minority individuals across their whole lifetime, but evidence also demonstrates the intergenerational consequences of discrimination, via changes in maternal mental health and the way that environmental factors influence how a person’s genes function.
Co-author Dr Sujitha Selvarajah (UCL Institute for Global Health) said: “Discrimination affects health in many ways, which have often been challenging to measure because the effects of discrimination can appear over long periods of time. However, the existing evidence suggests that the direct and indirect biological impacts of discrimination are a significant driver of racial health inequities around the world – rather than genetic difference as has often been assumed due to flawed notions of racial difference. At a societal level, discrimination is costly and inflicts collective trauma. We call for the unequivocal recognition of racism, xenophobia, and discrimination as fundamental determinants of health, as is already the case for political, social, and economic factors. We call upon academics, scientists, and health professionals to actively modify this relationship between minoritised groups and inequitable health outcomes.”
Beyond measures that lessen the health impacts of racism and xenophobia on individuals, the authors suggest:
- The implementation of anti-racist public health interventions, such as early education programmes.
- Organisational and community change and active engagement with movement-building and activist campaigns.
- Legislation, including both institutional and national race equity policies.
- Addressing the intersectional nature of structural discrimination by considering interactions with other forms of oppression, such as sexism or ableism.
Source: University College London