Cape Town — “Of all the forms of inequality, injustice in health is the most shocking and the most inhumane’ – Dr Martin Luther King Jnr.
The issue of racism in healthcare is nothing new, but the Covid-19 pandemic has once again brought it to the fore. African countries had to look on as the scramble by Western nations to find a vaccine for the novel coronavirus highlighted the chasm that exists between rich and poor nations, and rich and poor citizens within the same country.
Pharmaceutical companies like Pfizer and Johnson & Johnson produced vaccines at huge cost, shutting out poorer nations. This despite calls for a collaborative effort, by the World Health Organization (WHO) and calls for richer nations to help countries unable to afford vaccines. Poorer nations in Africa, Asia and Latin America found themselves last in the queue and African leaders bemoaned the crisis unfolding in their countries.
South Africa was the African nation hardest-hit by the Covid-19 pandemic with thousands of people dying before the vaccines were manufactured, and thousands more while awaiting supplies. Before the vaccines arrived, the government devised a staggered approach to how the vaccines would be administered with vulnerable groups first such as the elderly and those with co-morbidities like diabetes. Then the dispensing of the vaccines were divided by age. This was hoped to be a fair system, so that vaccines were not wasted. Many people, outside of a particular age group, became very ill and in thousands of cases, many died from complications brought on by the novel coronavirus.
As the novel coronavirus variants – Beta, Delta and Omicron – had the world in its grip, discussions on the origins of the novel coronavirus arose and the world turned its attentions to China – where allegations that the disease was born in a laboratory, or spread through “wet markets” (where live animals are sold for consumption) was rife. A U.S.-led delegation sent to China to investigate, could not conclusively determine whether the novel coronavirus had its origins there. Attacks on Asian people, particularly in the U.S., increased.
Africa has borne the brunt of blame for many diseases – even HIV/Aids. Ebola, first discovered in 1976 is also considered ‘African’. It commonly affects people and primates. Symptoms for the disease include fever, internal bleeding and vomiting. There is no cure except for supportive hospital care.
The effects of colonialism through institutional racism is still very apparent – particularly in South Africa, more than 27 years since the first democratic elections. Richer suburbs have better, less crowded health clinics, while townships a stone’s throw away, have overcrowded facilities with less resources to treat patients.
Professor Ntobeko Ntusi, chairperson and head of the Department of Medicine at the University of Cape Town (UCT) and Groote Schuur Hospital (GSH) says that structural racism goes beyond individual prejudice. He described it as a perpetual inequity, deeply ingrained in social policy, legislation, law enforcement, the economic system, and the healthcare system.
The O’Neill Institute for National and Global Health Law in Washington D.C., launched a commission which over the next three years will work toward identifying, studying and eradicating the scourge of racism in the U.S., and the world. Restoring people’s dignity is a key driver in the initiative.
At its launch, commission Chairperson Dr Tlaleng Mofokeng – the UN Rapporteur on Right to Health and distinguished lecturer at the O’Neill Institute – said that she is aware that the commission cannot eradicate racism in three years. She said it would use targeted research and collaborations within and across sectors that impact health and wellbeing. “We want to engage with empirical research. Some of our commissioners will themselves be conducting empirical research”, Mofokeng said.
Mofokeng said the commission does have a problem with data – not only who data leaves behind, but also the fact that policymakers, legislators and health systems are not agile enough to change, modify and respond to what the data says. The commission wants to change that. Mofokeng said members have experienced multiple compounding impact of racism and structural discrimination on a daily basis, both on a personal and professional level. And it’s that humility that we take up this work of the commission.
Mofokeng said that the work is a three-year project. “One of the maybe four good goals that I can share, is that we want to describe the current knowledge. We know people have worked on racism, we are not the first, but we are the first to be convened in this manner. And we want to then talk about the effects of racism and the intersecting structural inequalities on health on a global context, but also the transnational context. Of course, we will be looking at existing research, like I said, through our commissioners, we aim to do site visits and focused visits. She added that there will be expert groups supporting the commission’s work by looking at, and reviewing existing data. The groups will review whether data is missing and who is being left behind because of it”, Mofokeng said.
She said that the commission wants to define and explore policies and activities that create found power shifts, that lead to more equitable outcomes.
“This is important for us to understand where power lies within ourselves as commissioners, as co-chair, we want this and we demand this of our partners as well who are part of the commission. And we demand the power shift and analysis of how power moves through the global health architecture on a regional level, national and ultimately in communities, with the aim of supporting and identifying the work that we know many communities are already doing. But because they don’t have the power, their voices are often not heard, their practices, their knowledge production is often minimised and demonised – even if you think about African health systems, or even indigenous health. And finally, we want to amplify our findings and recommendations. Absolutely. With the global health, world sector, our colleagues, and national policy spaces, which is really good for us.”
The importance of addressing racism in health was emphasised by David Williams, professor of Public Health and Chairperson of the Department of Social and Behavioral Sciences at the Harvard TH Chan School of Public Health. He said that the racial ethnic differences in health is a global problem. Looking at examples of infant mortality, the professor said that in the U.S., African Americans and native Hawaiians and other Pacific Islanders and Native Americans die at a higher rate. In the UK, Black people, Pakistanis, and Bangladeshis and Indians die at a higher rate than whites. The figures in Latin America, across multiple countries, the Afro-descendant population have a higher rate of infant mortality than the non-African descended population. Professor Williams said a similar pattern is seen across Latin America for the indigenous population. And then if we look in South Africa he said, Black, Mixed-race and Indian people have higher rates of infant mortality. If we look in Australia, the Aboriginal population have higher rates of infant mortality. So it’s a global problem. And the time has come for a global commitment to new solutions, he said.
Loyce Pace, the assistant secretary for Global Affairs at the U.S. Department of Health and Human Services, said there is an urgent need to look at those people who are historically marginalised and left behind. “We need to look at what can be done to dismantle these systems and structures in a way that hinders progress for a number of different groups that have been historically marginalised and under-served. Of course, we’re looking primarily at racial and ethnic groups, again, that have been left behind, and that includes Black, Indigenous and Native persons.
But it’s not exclusive to those people, either. And I think that’s important, because we talk a lot about the intersectionality, when it comes to this work, and the importance of looking at people who are affected by persistent poverty and inequality, or people with disabilities or those who are gay, lesbian, bisexual, transgender and queer persons. We need to check whether we are doing what we can to check our own practices and think about the degree to which we are complicit or continued to be complicit in racism and discrimination in the global health space,” she said.
Dr Kumanan Rasanathan, the unit head for Equity and Health at the World Health Organization in Geneva, said that social injustice continues to kill on a grand scale – driving persisting health inequities. Rasanathan said that Covid-19 has shown shocking inequities and infection, morbidity and mortality, and in the social and economic consequences of the pandemic. “It very much reflects the structural discrimination in our society and the failings of our systems and governance to tackle. It’s also an issue that the health sector cannot tackle by itself. I think it’s very important that we focus on racism within the health sector. But unless we tackle racism more broadly, and the intersection with other structural discrimination, we will never be able to have equitable healthcare,” he said.
The O’Neil Commission will present its findings during and after its three-year period.