Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Global health interventions invariably involve organizations from high-income countries aiding at-risk populations. These structural issues prevail so much that dismantling them involves the same deconstruction we have seen in many sectors in the post-Black Lives Matter movement.
Even the decolonisation on teaching the ‘social determinants of health’ (SDOH) is needed and emphasis on an understated determinant, racism. With rising awareness of racial disparities from Black Lives Matter, it is undeniable that personal and structural racism directly impacts the health of Black populations. Therefore, this response contributes to the discussion of racism within global health, hoping that future initiatives might help communities with ‘social and racial determinants of health’ in mind.
There are ongoing conversations about the decolonizing global health agenda. Generally, these conversations broadly highlight the SDOH and how they must be integrated to overturn colonial attitudes. As part of the SDOH, emphasising racial determinants has the same goal. Racial Attitudes in Global Health Racial stigmas affect modern-day evidence-based practices.
Modern approaches fail to recognize factors “… such as failing livelihood strategies, political economy, and historical dynamics…” (Chigudu, 2021). Without recognition, it is difficult to comprehend the reasoning for adverse health outcomes. A pathway established in the fight against Ebola was: “‘lack of trust → noncompliant actors → increased risk for EBOV infection’”(Chigudu, 2021). Missing from the picture was the lack of trust originating from “…long histories of racism and colonialism, medical experimentation, [and] humanitarian misadventures…” (Chigudu, 2021). There was too much focus on blaming the local population’s mistrust of Western medicine and not enough emphasis on understanding why this mistrust existed. Social and Racial Determinants of Health Including the SDOH in research and practice can mitigate the issue. The World Health Organization (2023) defines them as “ … conditions in which people are born, grow, work, live, and age …” They are factors not included in the traditional scope of medicine.
Although race is considered part of the SDOH, it does not receive adequate attention. Racial disparities and health outcomes are deeply intertwined. Williams et al. (2019) found increasing evidence showing “ … racism as a driver of multiple upstream societal factors that perpetuate racial inequities in health for multiple non-dominant racial groups worldwide.” Therefore, racism must be prioritized in global health. Personal and Structural Racial Determinants of Health Racism at the individual level directly affects individual health outcomes. Derricks et al. discussed how Black American individuals hold differing perceptions of their healthcare treatment based on the race of their physician. As a result of medical mistrust, Black individuals “ …may exhibit negative behavioural responses, such as reduced adherence to treatment. Therefore, racial determinants will recommend and decrease healthcare service utilisation, which can facilitate poorer health outcomes” (Derricks et al., 2023). These studies displayed how negative racial interactions lead to poor health outcomes that must be structurally resolved.
Similarly, structural racism contributes to poor health outcomes. Shonkoff and Williams illustrated that when infected with COVID-19, “ …people of colour are more likely to need hospitalization and, tragically, more likely to die, regardless of income” (Shonkoff & Williams, 2020). This resulted from residential segregation, which created a disproportionate exposure to toxins and other marginalizations in the Black population. As Shonkonff and Williams (2020) put it, eliminating racial inequities would be the “ultimate ‘vaccine’”. With the understanding that negative racial determinants contribute to poor health outcomes, racial disparities must be prioritised. The term ‘social determinants’ has already been recognized and utilized to decolonize global health. However, given the modern global health struggle to emphasize the importance of structural racial determinants, the SDOH should be improved and addressed as the ‘social and racial determinants of health’.
Racial determinant - an understated component in Global Health
Dear Editor
Global health interventions invariably involve organizations from high-income countries aiding at-risk populations. These structural issues prevail so much that dismantling them involves the same deconstruction we have seen in many sectors in the post-Black Lives Matter movement.
Even the decolonisation on teaching the ‘social determinants of health’ (SDOH) is needed and emphasis on an understated determinant, racism. With rising awareness of racial disparities from Black Lives Matter, it is undeniable that personal and structural racism directly impacts the health of Black populations. Therefore, this response contributes to the discussion of racism within global health, hoping that future initiatives might help communities with ‘social and racial determinants of health’ in mind.
There are ongoing conversations about the decolonizing global health agenda. Generally, these conversations broadly highlight the SDOH and how they must be integrated to overturn colonial attitudes. As part of the SDOH, emphasising racial determinants has the same goal. Racial Attitudes in Global Health Racial stigmas affect modern-day evidence-based practices.
Modern approaches fail to recognize factors “… such as failing livelihood strategies, political economy, and historical dynamics…” (Chigudu, 2021). Without recognition, it is difficult to comprehend the reasoning for adverse health outcomes. A pathway established in the fight against Ebola was: “‘lack of trust → noncompliant actors → increased risk for EBOV infection’”(Chigudu, 2021). Missing from the picture was the lack of trust originating from “…long histories of racism and colonialism, medical experimentation, [and] humanitarian misadventures…” (Chigudu, 2021). There was too much focus on blaming the local population’s mistrust of Western medicine and not enough emphasis on understanding why this mistrust existed. Social and Racial Determinants of Health Including the SDOH in research and practice can mitigate the issue. The World Health Organization (2023) defines them as “ … conditions in which people are born, grow, work, live, and age …” They are factors not included in the traditional scope of medicine.
Although race is considered part of the SDOH, it does not receive adequate attention. Racial disparities and health outcomes are deeply intertwined. Williams et al. (2019) found increasing evidence showing “ … racism as a driver of multiple upstream societal factors that perpetuate racial inequities in health for multiple non-dominant racial groups worldwide.” Therefore, racism must be prioritized in global health. Personal and Structural Racial Determinants of Health Racism at the individual level directly affects individual health outcomes. Derricks et al. discussed how Black American individuals hold differing perceptions of their healthcare treatment based on the race of their physician. As a result of medical mistrust, Black individuals “ …may exhibit negative behavioural responses, such as reduced adherence to treatment. Therefore, racial determinants will recommend and decrease healthcare service utilisation, which can facilitate poorer health outcomes” (Derricks et al., 2023). These studies displayed how negative racial interactions lead to poor health outcomes that must be structurally resolved.
Similarly, structural racism contributes to poor health outcomes. Shonkoff and Williams illustrated that when infected with COVID-19, “ …people of colour are more likely to need hospitalization and, tragically, more likely to die, regardless of income” (Shonkoff & Williams, 2020). This resulted from residential segregation, which created a disproportionate exposure to toxins and other marginalizations in the Black population. As Shonkonff and Williams (2020) put it, eliminating racial inequities would be the “ultimate ‘vaccine’”. With the understanding that negative racial determinants contribute to poor health outcomes, racial disparities must be prioritised. The term ‘social determinants’ has already been recognized and utilized to decolonize global health. However, given the modern global health struggle to emphasize the importance of structural racial determinants, the SDOH should be improved and addressed as the ‘social and racial determinants of health’.
References:
Chigudu, S. (2021). An Ironic Guide to Colonialism in Global Health. The Lancet (British edition) 397, no. 10288: 1874–1875.
https://doi-org.libproxy.berkeley.edu/10.1016/S0140-6736(21)01102-8
Derricks, V., Johnson I. R., & Pietri, E. S. (2023). Black (patients’) Lives Matter: Exploring the Role of Identity-Safety Cues in
Healthcare Settings Among Black Americans. Journal of health psychology, 28(1), 30–47.
https://doi-org.libproxy.berkeley.edu/10.1177/13591053221090850
Shonkoff, J.P. & Williams, D. R. (2020). Thinking About Racial Disparities in COVID-19 Impacts Through a Science-Informed, Early
Childhood Lens. Center on the Developing Child - Harvard University.
https://developingchild.harvard.edu/thinking-about-racial-disparities-in...
early-childhood-lens/
Williams, D. R., Lawrence, J. A., Davis, B. A. (2019). Racism and Health: Evidence and Needed Research. Annual Review of Public
Health, 40, 105-125. https://doi.org/10.1146/annurev-publhealth-040218-043750
World Health Organization. (2023). Social determinants of health.
https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Competing interests: No competing interests