Declaration

Racism, xenophobia and related intolerances are major physical and mental health determinants. Historical and current discrimination against racial, ethnic and cultural minorities, indigenous peoples, migrants, people discriminated against based on caste, asylum seekers, refugees and internally displaced people has resulted in members of these groups (especially women, youth and children) having a lower health status, less access to health care and poorer quality of health services. This is of particular concern because good physical and mental health is a precursor to the enjoyment of all other human rights.

The Situation

Health Status

ｷ United Kingdom: Black people tend to have a greater incidence of high blood pressure than white people.

ｷ Brazil: The infant mortality rate for children under 12 months is 62.3 per 1000 for Black and Brown children compared to 37.3 for White.

ｷ Global Racial disparities: Life expectancy in the United States is 26 years longer than life expectancy in Haiti.

ｷ Australia: Life expectancy at birth is 56.9 years for Indigenous men and 61.7 years for Indigenous women, compared with 75.2 years and 81.1 years, respectively, for non-Indigenous men and women.

ｷ Nepal (Dalit): Life expectancy of the Dalits is 42 years compared to the national average of 58 years.

ｷ United States: Although African Americans and Hispanics make up only 15% of US Teenagers, African Americans account for 49% and Hispanics represents 20% of the 3725 AIDS cases reported among those aged 13-19.

ｷ Global Racial Disparities: 3.7 years more years of expected disability for men born in Liberia compared to men born in the United Kingdom.

ｷ Yugoslavia (Roma Population): Only 1.4% of Roma people are over 60, compared to 26.9% of the Yugoslav population as a whole.

ｷ United States: The American Indian death rate from diabetes is 27.8 per 100,000, compared with 7.3 for Whites--380 percent higher.

ｷ India (Dalits): in 1992-1993, the Infant mortality among the Dalits was 91 per 1000 live births, an excess ranging from 22 to 45% over the national average.

ｷ United Kingdom: Age-corrected rate of limiting long illness is lower among whites than among Blacks.

ｷ United States: Black women are three times more likely to die while pregnant than White women, and four times more likely to die in childbirth. The maternal mortality rate for Hispanic women is 23 percent higher than for non-Hispanic women. Disparity occurs at all income-level.

ｷ Yugoslavia (Roma Population): one in 10 Roma households in Belgrade have experienced the death of a child, with 50% of those deaths occurring in the first year.

ｷ Global Racial Disparities: The mortality stratum for all of African is either high or very high Child /Adult, while all of Europe is either low or very low child and most of Europe is low or very low adult. Only Estonia, Hungary, Kazakhstan, Lithuania, Moldova, Russia and Ukraine have high adult.

Health Care

ｷ United Kingdom: Caribbean men are less likely to be registered with a general practitioner than white.

ｷ Yugoslavia (Roma Population): On average, 13% of Roma People in Belgrade are not registered in the regular health care system.

ｷ United States: Whites are three times more likely to undergo bypass surgery than non-Whites.

ｷ United States: Non-White patients seeking admission to nursing homes experience longer delays before placement than White patients.

ｷ United States: Doctors are less likely to recommend breast cancer screening for Hispanic women than for White women.

ｷ Nepal (Dalits): Birth Control is unknown and unavailable.

ｷ United States: Non-White pneumonia patients receive fewer hospital services than White patients.

ｷ United States: Poor urban Black and Hispanic neighborhoods average 24 physicians per 100,000 people, compared to 69 physicians per 100,000 for poor White communities.

Program of Action

Health Status

ｷ Governments to eliminate disparities in health status experienced by disadvantaged by the year 2010, including disparities in infant mortality and life expectancy, childhood immunization, and the incidence of diabetes, mental illness, heart disease, HIV/AIDS and cancer, water-borne illnesses and chronic illnesses (such as respiratory disease).

ｷ Governments, non-governmental organizations and the private sector to improve HIV/AIDS prevention efforts in high risk communities and expand access to HIV therapies and other treatment needed for HIV/AIDS, particular attention should be given to HIV/AIDS among the youth.

ｷ Governments, non-governmental organizations, the private sector and the International community must assure access to therapies and treatments to persons living in developing countries that disproportionately affected by HIV/AIDS.

ｷ Governments should provide a proper environment (including clean water and waste disposal services) for disadvantaged groups, including reducing and/or eliminating industrial pollution that affects them disproportionately and taking measures to clean and redevelop contaminated sites located in or near where they live.

ｷ Governments should assure that everyone has a standard of living adequate for the health and well-being of herself/himself and of her/his family, including food, clothing, housing medical care and necessary social services. Governments must address the linkages between racial disparities in health and racial discrimination in other sectors, e.g. education, employment and criminal justice.

 

Health Care

ｷ Governments, non-governmental organizations, the private sector and the International community should ensure equitable access to comprehensive, quality health care for all, including primary health care and basic public health services (such as clean water and waste disposal services). Special attention should be directed at preventing and eliminating racially discriminatory policies and practices in access to and quality of health care.

ｷ Governments, non-governmental organizations, the private sector and the International community should ensure that health care providers/practitioners are trained to provide culturally appropriate care; and that members of afro-descent communities, indigenous communities and other non-dominant racial, ethnic and cultural groups are adequately represented as health care providers.

Other Strategies

ｷ Governments, non-governmental organizations, the private sector and the International community, including the World Health Organization, should routinely and systematically collect race, gender and socioeconomic class data related to health status and health care; such data should not be limited to census and vital statistics but should include data on access and quality (particularly services delivery, diagnosis and treatment, facility availability, provider availability and other related health activities and services). Special attention should be placed on the impact of racial discrimination and to the publication of the conclusions.

ｷ The World Health Organization, including the Pan American Health Organization, should promote activities for the recognition of race, ethnicity, gender and descent as significant variable in health.

ｷ Governments should provide effective mechanisms for the monitoring and elimination of health care racism, racial discrimination and other forms of discrimination; such mechanism must involve the communities/populations affected.

ｷ Governments should develop effective anti-discrimination laws that provide an adequate institutional framework for redress that is specific to the issues of racial discrimination in health care.

Sources

Contact Information:

Vernellia R. Randall, Professor of Law, The University of Dayton 300 College,
Dayton, OH 45469-2772 Phone: 1-937-229-3378, Fax: 1-937-229-2469,
Email: randall@udayton.edu, Website: www.raceandhealth.org

Lorraine Anderson, Jonathan Fine Fellow, Physicians for Human Rights
1156 15th St. NW, Washington DC, 20005, Phone: 202-728-5335, Fax: 202-728-3053,
Email: anderson@phrusa.org, Website: www.phrusa.org







Statement on Health Care, before the Working group on the Governmental Program of Action

By Vernellia Randall, Professor of Law with the University of Dayton and representative of the Physical and Mental Health Caucus

Thank you, Mr. Chairperson and honourable delegates for providing me with the opportunity to intervene. My name is Vernellia R. Randall, I am a Professor of Law with the University of Dayton and I am also here has a representative from the Physical and Mental Health Caucus.



Mr. Chair, It is my experience that abstractions often dilutes the urgency of a problem. Before I get to the specifics of the Program of Action, I would like to take a moment to perhaps refocus us. I would like to do that by providing a personal and longitudinal history of the problem of race, racism and health care. My family has had over 125 years of a personal and up-close experience with racism in health care:



  • 品n the 1800s, my great grandparents who were freed from slavery lost several children in child-birth and from the lack of health care


  • 品n the late 1800's, my grandfather's first wife died from injuries in a horse-buggy accident and lack of health care


  • 品n the early 1900's, my grandmother (my father's mother) died when my father was 8 years old from a condition that was treatable at the time, but not for a black person


  • 品n the 1940's my mother lost her first child because the white doctors would not see her and the 1 black doctor for the area would not make house calls


  • 品n the 1950's, when I was 7 years old, my mother died from cancer in a segregated hospital ward. My last memory of my mother is associated with being hustled through some back door, upstairs to a dark and dirty floor to see my mother dying.


  • 品n the 1960's, when I went away to college I had a number of teeth pulled because of the lack of dental care as a child.

  • 品n the 1970's, I worked as a public health nurse with African descendant communities and indigenous peoples communities and saw up close and in personal, the lack of access, the different treatment and the racialized attitudes of health care providers.

  • 品n the 1980's, my sister could not get diagnosis with a health disorder because many of the doctors believe that certain test were not necessary because, as one doctor told my sister "black people don't have that problem" It took my sister five years to get a proper diagnosis


  • 品n the 1990's, I had to pull privilege as a nurse and attorney to get proper care for my father who was being inappropriately treated for a heart condition and my son who would have received inadequate treatment by being discharge too early from a hospital. In fact, the episode with my son involved both a nurse, a doctor and administrator treating me with condescension and racialized attitudes. It was not until I told them that I was a nurse and an attorney that their behaviour changed.




Mr. Chair, I am afraid that the actions being taken at this conference will not and cannot lead to the elimination of racism, racial discrimination xenophobia and related intolerances.



Why?



Well, not because you do not recognize health as a significant issue, you do and the program of action as written reflects such recognition



Not because you do not recognize the actions that need to be taken to eliminate racial discrimination in health care, again the program of action has much of the components necessary .



But rather because, in general, the programme of action focuses on the process measures rather than the outcome measures. The danger of focusing on process measures is that the process then becomes the measure of success.



For instance, I would never tell my son to "take steps to clean his room"; or tell my students "to provide effective mechanisms for producing a paper"; or set goals for myself which are "to adopt and implement policies and programmes to improve my teaching".



I believe that the Program of Action for WCAR on health and health care must focus on outcome measures. For example, turning to the language of the program of action:

143. (a) Instead of saying

"Urge States to provide effective mechanisms to monitor and eliminate racial and ethnic discrimination in the health care system, such as the development and enforcement of effective anti-discrimination laws;"

Say instead:

"Urge States to monitor and eliminate racial and ethnic discrimination in the health care system, including the development and enforcement of effective anti-discrimination laws;"



(b) Instead of saying

"To take steps to ensure equal access to comprehensive, quality health care for all"



Say instead:

Ensure equal access to comprehensive, quality health care for all





(d) Instead of saying

"To adopt and implement policies and programmes to Improve HIV/AIDS prevention efforts in high-risk communities and work to expand availability of HIV/AIDS care, treatment and other support services; "



Say instead

Improve HIV/AIDS prevention efforts in high-risk communities and work to expand availability of HIV/AIDS care, treatment and other support services;



144. Instead of saying

"Take measures and to set targets to ensure the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, with a view to eliminating disparities in health status;""



Instead say:

"ensure the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, with a view to eliminating disparities in health status;"



While I have used my own family as an example of the problem, it should go without saying that the issue of poorer health status, lack of access to health care and poorer or substandard health care based on racism, racial discrimination, xenophobia and related intolerance exist where ever those intolerances exist.



Mr. Chair and Honourable delegates, I truly do not want to add my grandchildren to the 125 year burden carried by family. It is with in our power to make a significant change in the world, but only if we focus the program of action clearly and strongly on the outcomes rather than the process.

 
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