Timed to Human Rights Day on 10th December, The Lancet dedicates an issue to advancing racial and ethnic equity in science, medicine, and global health. Racism is deeply and systematically embedded in society, leading to diminished life opportunities and health outcomes for minority ethnic groups worldwide. Although there is greater awareness of this fact, the pace of transformative change remains slow, and racism is yet to be widely recognised as a fundamental driver of determinants of health.
By presenting measurable evidence and expert commentary on racial and ethnic disparities—together with interventions to reduce them—the Lancet special issue goes beyond describing the problems and underscores the role of contemporary science as an agent of change. The collection of papers includes research on the impact on psychological distress among Indigenous peoples in Australia.
Racism is a health issue. Hate is a health issue. Xenophobia is a health issue. Dr Richard Horton
An Editorial in The Lancet states, “Racism is not only about the health of particular persecuted or excluded groups—it inflicts a collective trauma on us all. The positive corollary of this fact is that lessening inequities and restoring justice can bring healing to society as a whole. This special issue outlines a path towards doing so for health and medicine. It is a beginning, not an end.”
At the core of The Lancet’s special issue is a four-paper Series examining the pervasive impacts of racism, xenophobia, and discrimination in the context of health. Interventions that address the structural causes of adverse health outcomes are also reviewed.
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.”
Dr Richard Horton, Editor-in-Chief of The Lancet, says, “Racism is a health issue. Hate is a health issue. Xenophobia is a health issue. Our structurally racist societies are unsafe for too many communities, families, and individuals. Health professionals have an important part to play in defeating racism, hate, and xenophobia. This special issue of The Lancet marks a moment to recommit ourselves to defeat these insidious social pathologies—pathologies that for too long we have chosen to ignore.”
Research Articles included in the special issue:
Research in the special issue provides examples of racial bias in clinical decision-making and racial disparities in health outcomes across different global contexts. In each instance, authors propose measures to counter inequities and emphasise the importance of anti-racism efforts across all levels of health care, policy, and governance.
Even in higher-resourced environments, women from underserved racial and ethnic groups at increased risk of adverse perinatal outcomes
Study of more than 2 million pregnancies shows Black women had consistently poorer perinatal outcomes than White women in high- and upper-middle-income countries; the risks varied for other groups. These disparities were observed across all geographical regions, indicating an urgent need for multifaceted interventions to reduce racial and ethnic inequities in antenatal care.
Article reference: Effects of race and ethnicity on perinatal outcomes in high- and upper-middle-income countries: individual participant data (IPD) meta-analysis of 2,198,655 pregnancies (Sheikh et al.) Access online here.
Patient race may influence recommendations for surgical resection of primary brain tumours, suggests US study
According to a US analysis, Black race was independently associated with higher odds of being recommended against surgical resection in the four most common brain tumours—meningioma, glioblastoma, pituitary adenoma, and vestibular schwannoma. Findings provide the basis for future studies to gain further insight into unrecognised racial bias in clinical decision-making.
Article reference: Racial disparities in recommendations for surgical resection of primary brain tumours: a registry-based cohort analysis (Butterfield et al.) Access online here.
Greater risk of adverse cardiometabolic health for Indigenous Brazilian adults experiencing urbanisation, deforestation, and destruction of ways of life
Meta-analysis suggests Indigenous adults living in urbanised areas of Brazil are subject to worse cardiometabolic health outcomes compared with those still living in traditional settings. Authors advocate policies that conserve the natural ecosystem and Indigenous property rights alongside targeted socio-health approaches.
Article reference: The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry (Kramer et al.) Access online here.
Everyday discrimination has a major impact on psychological distress among Indigenous peoples in Australia
First study of its kind suggests everyday discrimination contributes up to half of the burden of psychological distress among Australia’s Aboriginal and Torres Strait Islander adults. About 31% of Indigenous adults experience high-to very high psychological distress, compared to 13% of non-Indigenous adults; nearly half of this gap may be due to everyday racial discrimination. Authors say this is an important step to recognising the potential extent of harms from discrimination and racism, urging individual and policy action.
Article reference: Population-level contribution of interpersonal discrimination to psychological distress among Australian Aboriginal and Torres Strait Islander adults, and to Indigenous–non-Indigenous inequities: cross-sectional analysis of a community-controlled First Nations cohort study (Thurber et al.) Access online here.
Comments included in the special issue:
Advancing racial health equity: a matter of funding
Inequity can be exacerbated by racial bias in the allocation of research funding. Authors argue funders need to carefully reflect on who is advising on programmes and projects and whether racially marginalised voices are foregrounded in their development. Engaging with experts on issues of racial equity and investing in resources, including time, are critical for diverse portfolios and a more equitable funding landscape. Access online here.
Diversity is not enough: lessons on inclusivity in the healthcare workforce
Workplace diversity does not guarantee inclusivity. This is evident in healthcare, where minority ethnic staff are less likely to progress to senior and leadership roles and more likely to experience discrimination. Organisations and policymakers can take steps to make the difference needed, such as committed leadership, data-driven accountability, and collective anti-racism and inclusivity efforts by all staff members, say authors. Access online here.
Medical education’s racist roots remain a barrier to health for all
Most medical curricula are based on white supremacy, with implications for health professionals’ ability to diagnose and treat patients belonging to minority ethnic groups, state authors. Solutions with potential include encouraging learners and teachers to question blind spots of science, diverse representation among editors and peer reviewers, and recognising other systems of knowledge that could improve efficacy and outcomes. Access online here.
Source: The Lancet
