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Racism, xenophobia, and discrimination: mapping pathways to health outcomes
BY:
Sujitha Selvarajah, MBBS
Susanna Corona Maioli, MBBS
Thilagawathi Abi Deivanayagam, MPH
Priscila de Morais Sato, PhD
Prof Delan Devakumar, PhD
Seung-Sup Kim, ScD
Published: December 10, 2022
Summary
Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.
Who does racism, xenophobia, and discrimination harm?
In addition to the profound damage to oppressed and minoritised groups globally, 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.
(PAY CLOSE ATTENTION TO THIS PART RACISTS!)
Although many studies on structural racism show damaging effects on the health of Black people but not White people, other studies show deleterious effects on both groups. In addition to this complexity, there is now ample evidence that socioeconomic inequalities within societies are bad for everyone's health and wellbeing, and individual wealth and power (beyond a fairly low threshold) does little, if anything, to improve overall health or happiness. As such, there is a compelling argument for the privileged to address racism and discrimination, not only as an ethical wrong, but as an endeavour that, in seeking to address a collective trauma which affects everyone in distinct ways and to various intensities, converges with their own interests.
Conclusion
Despite the overwhelming evidence regarding these health inequities, racism, xenophobia, and discrimination are potentially modifiable risk factors; they are contingent on geopolitical economic power relations rather than anything intrinsic to the categorisations of caste, ethnicity, migration status, Indigeneity, race, religion, or skin colour. Racism, xenophobia, and discrimination constitute a social, political, and cultural crisis in themselves, fracturing and undermining social cohesion and inclusion worldwide. As the profound effects of resource extraction and capital accumulation on climate and ecosystems unfold in the coming decades, discrimination will continue to exacerbate the crises faced by minoritised people—especially in low resource settings—during the disasters and emergencies to follow on from COVID-19.
Although health inequities, patterned by manifestations of oppression, are a powerfully deleterious feature of the current state of our world, they are also a reflection of factors that are far more fundamental than health. Specifically, discrimination is underpinned by the existence, in modern global societies, of profoundly oppressive hierarchical societal configurations characterised by rampant individualism and competition, and artificial scarcity produced through regimens of ownership that result in severely unjust global wealth concentrations. Racism, xenophobia, and discrimination need not be a permanent fixture of our world.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01972-9/fulltext