Racism poses a public health threat to millions worldwide. Here’s how

Today’s global medical industry poses a public health threat to millions of people around the world and historical racism has helped shape it, according to new research.

A series of articles called Racism, xenophobia, discrimination, and health, published in The Lancet, point to the presence of discrimination in healthcare, which can cause avoidable disease and premature death among groups of people who are often already disadvantaged.

The Lancet studies find that both conscious and unconscious discrimination are significant drivers of racial health inequalities.

A number of interconnected factors combine to diminish the quality of healthcare disadvantaged people receive, including via stress responses that directly affect the body, poor living environments and factors that limit an individual’s opportunities to improve their health.

Institutionalized discrimination in healthcare access and care quality has significant real-world consequences.

Using COVID-19 as an example, Black or Latino people in the US are up to 1.8 times more likely to die from the disease than white people, data from America’s Centers for Disease Control shows.

While people of Native American ethnicity experience higher rates of hospitalization from COVID-19 infection than other groups.

The same is true in other places. Black people in the UK are 1.9 times more likely to die from COVID-19 than white people, for example. This pattern of discrimination extends to other treatments ranging from cancer to prenatal care, research shows.

Part of the problem dates back to the early days of medical history, where myths like phrenology – a 19th-century theory popular in Europe and America that equated different shaped skulls with certain character traits – persisted, claiming that Black people’s bodies were physically different to white people’s.

Although these debunked ideas no longer persist, their legacy can permeate the foundations of global healthcare provision, with unconscious bias built into many assumptions.

Fast-forward to today, and studies have found similar bias in some of the smart healthcare softwares being developed. While algorithms are not racist, they do contain the assumptions and unconscious bias of the health systems that develop them, which impacts how they operate.

A 2019 study published in Science, found evidence of racial bias in health algorithms in the US that reduced the number of Black patients recommended for additional care by more than half, for example.

The algorithm was programmed to use health costs as an indication of health need. But because less money was spent on Black patients who have the same level of need as white patients, the algorithm falsely concluded they were healthier than equally sick white patients. Changing the algorithm subsequently removed the racial bias.

The Lancet series of studies highlights the fact that structural racism in the health system has received too little attention.

Categories such as race and caste are biologically arbitrary, but the discrimination that minority groups face is very real, and public health has a responsibility to address these issues, the study notes.

Finding ways to ensure a diverse and inclusive world is one of the challenges that will be discussed at the World Economic Forum’s upcoming Annual Meeting in Davos in January 2023. Leaders from government, business and civic society will use the platform to address pressing global issues like access to healthcare and help find solutions.