Health justice lawyer Priti Krishtel was named along with four other US-based experts last week to the O’Neill-Lancet Commission on Racism, Structural Discrimination and Global Health.
The three-year commission, the secretariat of which is based out of the O’Neill Institute at Georgetown University Law Center, Washington DC, includes almost 20 experts from across the world with a goal to promote anti-racist strategies and actions that will curb barriers to health and well-being.
The body begins with substantial evidence that communities are facing health barriers only on the basis of factors such as race, ethnicity, tribe, cast, gender identity or expression, sexual orientation, geography, ability, class or religion.
Speaking on her inclusion in the commission, Krishtel said, “I’m so proud to serve on this Commission that will help shape a future where all people know they can keep their loved ones healthy, where people actively shape what access to medicines looks like for their families and communities.”
Krishtel, co-founder and co-executive director of I-MAK, a non-profit building a more just and equitable medicines system, has spent 20 years exposing structural inequities that affect access to medicines and vaccines across the Global South and in the US.
The four other experts named to the commission besides Krishtel are — Camara Jones, an African American family physician and epidemiologist; Margareta Matache, a Roma scholar; Tendayi Achiume, a Southern African legal scholar; and Loyce Pace, assistant secretary for global affairs and US liaison, US department of health and human services.
“For a long time, anti-Roma racism, the legacies of 500 years of enslavement in Romania and the Holocaust across Europe, and other structural injustices, violence, and health inequities faced by the Roma people, as well as our voices, have been neglected in mainstream scholarship, policies, and laws,” Matache said.
Jones, Krishtel, Matache, Achiume, and Pace were among the latest appointed by the commission co-chairs, Dr Tlaleng Mofokeng and Dr Ngozi Erondu in consultation with The Lancet, independent thought leaders, academics, and civil society organisations working in the area of health and racial justice.
The global group spans across academia, medicine, law, and civil-society leaders — bridging work on public health, racial discrimination, law, human rights and public policy.
The commission’s concept is founded on the recognition that racism, rather than race, creates and maintains unjust and avoidable health inequities in countries around the world. Racial and ethnic disparities in health outcomes are being increasingly recognized worldwide.
“I have confronted the racism denial so staunchly held by so many with allegories that illustrate four key messages: 1) racism exists; 2) racism is a system; 3) racism saps the strength of the whole society; and 4) we can act to dismantle racism,” said Jones.
“I look forward to learning from work on ‘race,’ racism, and anti-racism that is going on across the globe. And then I hope that we will link these efforts, because collective action is power.”
The commission starts from the premise that racism is a transnational phenomenon that requires global solutions, both inside and outside the health sector. While national racism has been researched in some countries, racism as a driver of health inequities is not sufficiently understood and addressed as a phenomenon that spans borders.
“As a former independent expert for the United Nations on racism and xenophobia, I witnessed firsthand the global entrenchment of structural discrimination in access to health, and the global entrenchment of structures and systems that subject people to differential health vulnerability on account of their race, ethnicity, national origin, alongside gender, and disability status among others,” said Achiume.
“I am eager to be part of this important opportunity to study concrete possibilities for change.”
The spread of Covid-19 highlighted how socioeconomic inequalities, systemic racism, and structural discrimination influence not only the risk and impact of disease, but also access to quality treatment and care.
A year into the pandemic, a UK government inquiry on minority ethnic groups and Covid-19 found that institutional racism and bullying discouraged and prevented Black, Asian, and minority ethnic nurses from speaking up about situations that put them more at risk for Covid-19. Ultimately, the inquiry found that these groups had a 10 to 50 per cent higher risk of dying from Covid-19 when compared to White British nurses.
“During the Covid-19 pandemic, systemic racism was also evident as world leaders failed to grant a patient waiver for Covid-19 vaccines. This would have ensured wider, earlier access to vaccinations for people living in Africa and parts of Southeast Asia,” said Dr Mofokeng, who is also the United Nations special rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
This commission will go beyond simply documenting disparities, as that is insufficient for understanding the connections between race, ethnicity, structural discrimination and global health.
“It is too easy to see race, rather than racism, as a driver of poor health outcomes and to dismiss these as the products of particular historical contexts,” said Dr Erondu, who is also a senior scholar at O’Neill Institute for National and Global Health Law.
“That narrow view misses both the local and international causes of racial inequities.”
The commission will investigate specific outcomes seen across countries and consult communities to understand their causes and impact.
For instance, it is well-documented that in many countries around the world, maternal mortality rates are rooted in both gender and racial injustices.
In the United Kingdom of Great Britain and Northern Ireland, for example, Black women are four times more likely, and Asian women twice as likely, to die in childbirth than white women.
The commission will further impact these outcomes and examine their transnational implications.
Recognizing that global health financing and foreign aid between colonial powers and formerly colonised regions are shaped by the legacy of these relationships, the commission will also set out to examine and challenge current global health governance systems and structures.
“We’ve known for some time now that racism leads to increased rates of sickness and death,” added Dr Erondu.
“Our aim with this Commission is to not only further document and unpack these realities on a global level, but most importantly help promote meaningful change. And we’re doing this by bringing together individuals who are not only experts in their respective fields, but who have experienced racism and structural discrimination and fight against it for their communities.”
To achieve its goals, the commission has set out four charges:
Diagnose the problem of racism in health globally, by reviewing existing national and cross-national evidence on racism in health in a global context. The Commission will then describe the effects of racial and ethnic discrimination and its intersections on health at a national and international level.
Identify best practices and actionable anti-racist strategies, by, among other activities, holding consultations with people who have lived experiences of structural discrimination in health, to discover how racist structures in select countries were addressed to close health equity gaps.
Compile a report of its findings, highlighting the strategies, tactics, and actionable lessons that other countries can use to develop anti-racist approaches in the sphere of health policy and service delivery to ensure equitable and just health outcomes.
Disseminate its findings widely to the public, to ensure that the anti-racist strategies and actionable lessons produced are used and contribute a body of knowledge to augment efforts to decolonize global health.
“Now is the time for the public health and human rights communities to come together to recognize the ways that racism, structural discrimination and the long-lasting impacts and remnants of colonialism and oppression shape our health and well-being,” said Dr Mofokeng.
“This commission will help bring new voices to the table that can share learnings and solutions across borders to address these issues with the level of attention and urgency they deserve.”
To find out more about the commission’s work, click here.