This discussion is trending today. How can we use this debate to improve health outcomes for all?
The current global debate on racism provides an opportunity to discuss the contribution of racism and other forms of sectarianism to population health outcomes. The WHO Commission on Social Determinants of Health and other studies have pointed out racial discrimination as a key social determinant and driver of racial health inequities. This is mediated by direct and indirect pathways such as differential access to societal resources, education, employment and living conditions.
The world has been gripped by the reaction of disgust expressed through widespread global protests in over 60 countries against the killing of Floyd George a black man by a white policeman in Minneapolis, USA. This incident took place in broad daylight and was vividly captured in a live video recording that went viral and touched the hearts of many around the world. This global reaction is a vivid illustration of our humanity at work where we feel the pain of another human being and respond to stop the same from happening again to others. It is this humanity that has enabled our species homo sapiens to collaborate, learn together and prosper by turning planetary resources to our advantage.
However, we also have innate in us the tendency to promote self, kith and kin and other communities which are the building blocks of society. There are legitimate reasons for ‘birds of the same feather to flock together” as communities and when well managed; within defined boundaries and limits this has benefits for the overall common good and should be encouraged. These boundaries get breached when greed by individual and group self-benefit override and do harm to the overall societal common good. This becomes discrimination and constitutes the vices of racism, tribalism, nepotism and other expressions of sectarianism.
The permanent challenge of our humanity is to get and maintain the right balance between individual and community interests on the one hand and the overall common good on the other. To a large extent we have been able to make progress in this direction but there are still significant gaps and historical vestiges of sectarianism that need to be dealt with within countries and as the international community. This is achievable through an open minded approach guided by our innate human tendency.
Racism has been practiced for centuries when it was accepted as normal through slavery, colonialism and apartheid. “Good” people including some churches owned and profiteered from owning slaves. Colonialism and apartheid were equally exploitative and accepted as normal. Time came when they were rejected as abhorrent and were ended. The legacy of these practices dies hard and persists in many ways. Knowingly or unknowingly there are people who regard and treat black and colored people as less and not equal to white people. A celebrated illustration was the refusal by Adolf Hitler to award four gold medals to Jesse Owen, a black American athlete during the Berlin 1939 Olympics. These conscious and unconscious biases contribute to the disproportionately poor outcomes observed in the treatment of patients of color in some settings. They also impact relations with the justice system, police and act as barriers to professional career growth and power dynamics in society.
African and Asian countries are now post-colonial and independent and sit on the same table with other nations at the UN and other platforms but there are still power inequalities which affect trade and the economies, resulting in health disparities between nations. Sub-Saharan Africa lags far behind other regions of the world in health and development indices and we should seize the opportunity offered by the SDGs to end for example, avoidable maternal deaths, poverty and ignorance; the aspirations for ending colonialism. The High Income Countries should fulfill international commitments on development assistance and fair trade in order to reduce these global inequalities.
I have to refer to so many white people who as religious missionaries left the comfort of their homes, traveled to the colonies and provided quality education and humanitarian services to African and Asian people. I am a product of these exceptionally dedicated missionaries who educated so many of us who are now leaders in our respective countries. This was humanity at its best expressed through religious belief.
This discussion will be incomplete without reference to the harm done by sectarianism in our own African countries and communities that negatively impact our health systems, governance and health outcomes. Tribalism, nepotism, religious bias are at play in many African countries and societies. Our best professionals are kept away from occupying leadership roles in our institutions because of sectarianism as key jobs go to “who knows who” and not “who knows what”. My personal experience is that well-qualified highly performing public servants tend to serve the common good and are generally above sectarianism.
We must not tire of expressing our disgust for these vices in the same in way that the world has responded to the murder of Floyd George. Our humanity and common good tendencies will prevail and overcome and will progressively deliver social justice and equity that leave no one behind. Keep going. Victory is certain.
What do you all think?