No place for racism
It may seem more like a social issue, but racism can have a real impact on health and healthcare.
IN Prophet Muhammad’s final speech, he said: “There is no superiority of an Arab over a non-arab, or of a non-arab over an Arab, and no superiority of a white person over a black person, or of a black person over a white person, except on the basis of personal piety and righteousness.”
The message against racism is echoed by all major religions.
Racism is never right, and is particularly dangerous in a multicultural setting such as Malaysia.
Part of the post-election period was filled with disturbing videos circulated over Tiktok that called for violent retribution on those of a different race and/or religion, following dissatisfaction with the results of the recently-concluded general election.
Such overt and explicit forms of racism are never acceptable and should be called out.
However, there are more subtle forms of racism that can even rear its ugly neck in healthcare.
Racism and health
A paper by sociologist Professor Dr David Williams and public health researcher Prof Dr Selina Mohammed in the journal American Behavioral Scientist identified a number of ways in which racism can negatively affect health outcomes:
> Institutional racism has developed policies and procedures that have reduced access to housing, neighbourhood and educational quality, employment opportunities, and other desirable resources in society.
> Cultural racism, at the societal and individual level, negatively affects economic status and health by creating a policy environment hostile to egalitarian policies, triggering negative stereotypes and discrimination that are pathogenic and foster healthdamaging psychological responses, such as stereotype threat and internalised racism. > Experiences of racial discrimination are an important type of psychosocial stressor that can lead to adverse changes in health status and altered behavioural patterns that increase health risks.
In my previous column (Attention, politicians!, Health Matters, Starhealth, Oct 30), I had highlighted the importance of addressing the social determinants of health (SDH), which can affect up to 80% of health outcomes.
Unequal access due to differences in SDH can be shaped by ethnicity; in models of health, racism is recognised as a key SDH that underpins systemic health and social inequities.
There is plenty of data that highlight how racial and ethnic minorities suffer from more negative health outcomes and chronic disease prevalence.
In the United States, life expectancy for Black/african Americans is four years lower than that of white Americans.
According to the US Centers for Disease Control and Prevention (CDC), the Covid-19 pandemic disproportionately impacted communities of colour.
Recent data shows that Black/ African American, Hispanic/latino, American Indian/native populations all experiencing higher rates of hospitalisation and deaths compared to the white population.
More personally, racism in doctor-patient relationships can also adversely affect outcomes.
A review by the National University of Singapore that was published in The Lancet Global Health
journal looked at 23 studies from across six countries and came up with three key themes: > Alienation of minority patients
This occurred as a result of supremacism of healthcare providers who behaved in a condescending manner and were consequently less empathetic.
> Labelling of minority patients
These patients were negatively labelled and became victims of generalisations regarding their lower socioeconomic class, lifestyle practices and needs.
This led to inadequate treatment, including denial of medical therapy.
Some providers were also fearful of minorities because of negative assumptions and stereotypes.
> Denial of racism
Some practitioners tend to portray minority groups for being oversensitive, and shift the blame to the individual patients for poor outcomes rather than acknowledge the presence of racism.
What do we do?
The first step is to acknowledge that we as individuals do occasionally have racist thoughts.
Auditing one’s self – thoughts, jokes, feelings, behaviour, reactions – and identifying which are rational and which are driven by prejudice is an important tool that will allow us to take a step back and both adjust and improve ourselves.
On a wider societal scale, we all have to play a part.
Anti-racism work is not passive and is a long-term effort.
We each play a role – as friends, teachers, parents, children, colleagues – and we should also call out racism when we come across it.
This is particularly important in conversations behind closed doors, when it is “safe” to talk about “others”.
No single race has a monopoly on racism, and being our own strictest critic will go a long way towards making a difference.
It is also important to engage those who have different views and backgrounds from us.
Oftentimes, it is a lack of interaction with those deemed different that fans misconception and prejudice.
Nelson Mandela is quoted as saying: “No one is born a racist, but if they can learn to hate, they can be taught to love, for love comes more naturally to the human heart than its opposite.”
More can also be done at a systemic level.
From a healthcare perspective, The Commonwealth Fund listed a number of strategies to combat racism in health care.
These include:
> Examining institutional policies
with an equity lens. > Establishing accountability frameworks such as equity scorecards.
> Auditing medical school curricula for erroneous references to race.
> Reviewing clinical algorithms
that erroneously rely on race. > Training leadership and staff in diversity, equity, inclusion and anti-racism principles.
> Creating real-time reporting initiatives to track and respond to racist or other discriminatory behaviour.
> Creating more equitable workplaces.
> Listening to and learning from patients and healthcare professionals of various ethnic backgrounds.
As we move on from a rather fractious general election, let us remind ourselves that the peace and unity that we have in Malaysia is not something to take for granted, but one in which we must all take an active role to cherish and protect.
Dr Helmy Haja Mydin is a consultant respiratory physician and chief executive officer of the Social & Economic Research Initiative, a thinktank dedicated to evidencebased policies. For further information, email starhealth@thestar.com. my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.