Categorisation and minoritisation

The disproportionate mortality of COVID-19 and brutality of protective institutions has shifted anti-racism discourses into the mainstream. 1 Increased reckoning over categorisations of people demonstrate that racial categories, while imprecise, fluid, time and context-specific, embody hierarchical power. We interrogate categorisations used in the UK, South Africa and the USA; their origins and impact. We emphasise needing to recognise commonality of power structures globally,while acknowledging specificity in local contexts. In identifying such commonality, we encourage use of the term ‘minoritised’ as a universal alternative

Categorisation and Minoritisation

The disproportionate mortality of COVID-19 and brutality of protective institutions has shifted anti-racism discourses into the mainstream. 1 Increased reckoning over categorisations of people demonstrate that racial categories, while imprecise, fluid, time and context-specific, embody hierarchical power. We interrogate categorisations used in the UK, South Africa and the USA; their origins and impact. We emphasise needing to recognise commonality of power structures globally, while acknowledging specificity in local contexts. In identifying such commonality, we encourage use of the term ‘minoritised’ as a universal alternative

Racism, xenophobia, and discrimination: mapping pathways to health outcomes

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

Envisioning environmental equity: climate change, health, and racial justice

Climate change has a broad range of health impacts and tackling climate change could be the greatest opportunity for improving global health this century. Yet conversations on climate change and health are often incomplete, giving little attention to structural discrimination and the need for racial justice. Racism kills, and climate change kills. Together, racism and climate change interact and have disproportionate effects on the lives of minoritised people both within countries and between the Global North and the Global South. This paper has three main aims. First, to survey the literature on the unequal health impacts of climate change due to racism, xenophobia, and discrimination through a scoping review. We found that racially minoritised groups, migrants, and Indigenous communities face a disproportionate burden of illness and mortality due to climate change in different contexts. Second, this paper aims to highlight inequalities in responsibility for climate change and the effects thereof. A geographical visualisation of responsibility for climate change and projected mortality and disease risk attributable to climate change per 100 000 people in 2050 was conducted. These maps visualise the disproportionate burden of illness and mortality due to climate change faced by the Global South. Our third aim is to highlight the pathways through which climate change, discrimination, and health interact in most affected areas. Case studies, testimony, and policy analysis drawn from multidisciplinary perspectives are presented throughout the paper to elucidate these pathways. The health community must urgently examine and repair the structural discrimination that drives the unequal impacts of climate change to achieve rapid and equitable action

Policing is a threat to public health and human rights

Policing is a public health concern because it is a tool of racist and discriminatory power structures, actively harming the physical, mental, social and emotional health and well-being of populations, particularly Black and people of colour, and other minoritised populations. Policing is a matter of public health because criminalisation and punitive responses to social problems reproduce the social and economic conditions that result in criminalised behaviours, undermining healthy communities. A fundamental tenet of abolitionist public health is developing and implementing interventions that tackle the interpersonal, social, economic and political determinants of health at the root of societal problems, thus making policing obsolete. Defunding the police and reallocating public funds to primary and secondary preventative policies aligned with the social determination of health are essential steps towards abolition. We call for the support and creation of alternative systems that centre collective care and well-being, and a non-violent public health rooted in transformative justice

Racism, xenophobia, discrimination, and the determination of health

This Series shows how racism, xenophobia, discrimination, and the structures that support them are detrimental to health. In this first Series paper, we describe the conceptual model used throughout the Series and the underlying principles and definitions. We explore concepts of epistemic injustice, biological experimentation, and misconceptions about race using a historical lens. We focus on the core structural factors of separation and hierarchical power that permeate society and result in the negative health consequences we see. We are at a crucial moment in history, as populist leaders pushing the politics of hate have become more powerful in several countries. These leaders exploit racism, xenophobia, and other forms of discrimination to divide and control populations, with immediate and long-term consequences for both individual and population health. The COVID-19 pandemic and transnational racial justice movements have brought renewed attention to persisting structural racial injustice

Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems

Racism, xenophobia, and discrimination are key determinants of health and equity and must be addressed for improved health outcomes. We conclude that far broader, deeper, transformative action is needed compared with current measures to tackle adverse effects of racism on health. To challenge the structural drivers of racism and xenophobia, anti-racist action and other wider measures that target determinants should implement an intersectional approach to effectively address the causes and consequences of racism within a population. Structurally, legal instruments and human rights law provide a robust framework to challenge the pervasive drivers of disadvantage linked to caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour. Actions need to consider the historical, economic, and political contexts in which the effects of racism, xenophobia, and discrimination affect health. We propose several specific actions: a commission that explores how we action the approaches laid out in this paper; building a conversation and a series of events with international multilateral agency stakeholders to raise the issue and profile of racism, xenophobia, and discrimination within health; and using our multiple platforms to build coalitions, expand knowledge, highlight inequities, and advocate for change across the world