The Lancet: Racism is a global public health hazard.

If you start to dig into the history of white supremacy, you start to realize that it’s still very much a part of the global political and economic system. It’s not the only force at work, of course, but it has left scars on both land and people, and it’s built into a great many aspects of how the world works. It’s not always something you can see, if you don’t have enough context for what’s in front of your eyes, but it’s there, and it continues to do real harm. There are, of course, people who are racist, and who cause harm deliberately for that reason, but it goes far beyond that.

White supremacy is a global public health problem. To some degree, we already knew that, right? Redlining – the racist housing policies that we’re told are in the past – continues to disproportionately expose communities of color to things like lead poisoning. Environmental racism is a known, global phenomenon, but I’m starting to think that we ought to view white supremacy as a sort of pollutant in its own right, or maybe a dangerous building material, like asbestos. The problem is that while the asbestos industry has definitely fought to keep making money (and keep exposing people to the stuff), the social infrastructure of white supremacy was designed to cause harm to people from the very beginning.

And for all many powerful people like to pretend racism isn’t a big problem, it turns out that it is a global public health crisis.

First, racism, xenophobia, and discrimination are fundamental determinants of health globally. The misclassification of race as a biological (rather than social) construct continues to compound health disparities. Four research papers show how discrimination leads to poorer health outcomes and quality of care. In a study of over 2 million pregnancies across 20 high-income and middle-income countries, neonatal death, stillbirth, and preterm delivery were more likely among babies born to Black, Hispanic, and south Asian women. Another shows how theft of land and destruction of traditional practices of Indigenous Brazilians are associated with adverse cardiometabolic outcomes. Among people diagnosed with brain tumours in the USA, Black patients were more likely to have recommendations against surgical resection, regardless of clinical, demographic, and socioeconomic factors, suggesting bias in clinical decision making. In Australia, everyday discrimination contributes to half the burden of psychological distress experienced by Aboriginal and Torres Strait Islander peoples. The logical conclusion is that racism and discrimination must be central concerns—for practitioners, researchers, and institutions—to advance health equity.

This issue also shows how systems intersect to perpetuate inequities. Racism converges with systems of oppression, including those based on age, gender, and socioeconomic status, to exacerbate or mitigate experiences of discrimination. The core problem is an inequality in power, historically rooted but still operating today. It shapes environments and opportunities. Specific recommendations for health include increasing cultural safety and diversity in the health-care workforce; co-designing with affected communities health-care systems that are more flexible, accessible, and welcoming; and strengthening Indigenous self-determination and land rights. A four-paper Series shows that social equity can be promoted best through interventions that target structures and systems, particularly through radical rights-based legal and political measures, led by affected communities. These are important lessons for health care, education, research, funding bodies, and government.

This report tries to quantify the material harm done by racism, and crucially draws attention to the fact that race is a social construct, and that pretending otherwise is itself harmful. It’s good to see research like this being done, and it’s good to see it being published in The Lancet. For all its mistakes, the journal is still well-respected, and I find it encouraging to see such a publication talking about the importance of self-determination, radical measures, and efforts led by affected communities.

As ever, this knowledge means little by itself. We already knew, beyond any shadow of a doubt, that racism, prejudice, and the infrastructure of white supremacy do ongoing harm, and that knowledge has not helped us stop it. What does make a difference is when people band together and use their collective power to demand change, or better yet to start making that change themselves. This is yet another example of justice delayed being justice denied. The way the British royal family clings to its stolen jewels may be the most glaring example of this, but the reality is that while the rich and powerful may be pay lip service to notions like justice and equality, they will do everything they can to obstruct both. Whether it was the broken promises to former slaves, the broken treaties with Native tribes, or the punitive debt imposed on newly “independent” colonies, justice has never been served, and that has compounded the harm, and re-inflicted the wounds on generation after generation. Do not trust to fairy tales about history having a moral arc – this will not stop unless we make it stop.

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  1. says

    That Harvard implicit bias project was a step in a good direction, right? I think it’s helpful for people who wouldn’t think of themselves as racist to find out about themselves, or at least see a scientific demonstration of the fact they should be cognizant of the possibility in how they treat people. A significant number of people in the US gov took that one seriously and added stuff derived from it to EEOC training and the like. Even under cheeto hitler, a lot of that stuff was happening under his radar.

  2. says

    I think progress is definitely being made, and that’s probably part of why we’re getting so much of a white supremacist backlash.

    It’s an odd time to be writing about political change, because we’ve made a huge amount of progress in some ways, just in the last two decades, but the government has been going in a horrific direction at the same time. Even as we’re having this murderous hate campaign, it seems like there’s a big increase in acceptance of, and respect for trans people.

    Or at least, that’s how it looks my perspective as a cis dude.

  3. says

    The Social Security Administration just announced you can choose your gender on your social security card info with no evidence needed, just your own assertion. That’s kind of astounding. Not a universal fix for anything, but considering the hoops trans people have to jump through for most things transition-related, pretty cool.

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