Race, Health Care and the Law 
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WCAR Health Caucus Proposed Declaration

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Vernellia R. Randall
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Health and Health Care
Situation, Declaration, Program of Action
World Conference Against Racism, Racial Discrimination, Xenophobia and Related Intolerance, Durban, South Africa, August 28 - Sept 7, 2001.

Please Send your comments to randall@udayton.edu no later than August 10, 2001

Declaration

Racism, xenophobia and other intolerance 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

The information listed in this section is intended to demonstrated the world wide existence of race related problems in health and health care. It is not intended to provide "country to country" comparision. By citing different statistics it is hoped that a sense of the scope of the problem will be demonstrated. A significant limitation is the availability of data. Very little research has been done on the impact of racism and racial discrimination on health status and health access.

Health Status

· United Kingdom: Black people tend to have a greater incidence of high blood pressure than white people.(1)

· 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.(2)

· Global Racial disparities: Life expectancy in the United States is 26 years longer than life expectancy in Haiti .(3)

· 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. (4)

· Nepal (Dalit): Life expectancy of the Dalits is 42 years compared to the national average of 58 years.(5)

· 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.

· Global Racial Disparities: 3.7 years more years of expected disability for men born in Liberia compared to men born in the United Kingdom.(6)

· Yugoslavia (Roma Population): Only 1.4% of Roma people are over 60, compared to 26.9% of the Yugoslav population as a whole.(7)

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

· India (Dalits): in 1992-1993, the Infant mortality among the Dalits was 91 per 1000 live bithrs, an excess ranging from 22 to 45% over the national average.(8)

· United Kingdom: Age-corrected rate of limiting long illness is lower among whites than among Blacks.(9)

· 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.

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

· 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.(11)

Health Care

· United Kingdom: Caribbean men are less likely to be registered with a general practitioner than white.(12)

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

· United States: Whites are three times more likely to undergo bypass surgery than non-Whites.(14)

· United States: Non-White patients seeking admission to nursing homes experience longer delays before placement than White patients.(15)

· United States: Doctors are less likely to recommend breast cancer screening for Hispanic women than for White women.(16)

· Nepal (Dalits): Birth Control is unknown and unavailable.(17)

· United States: Non-White pneumonia patients receive fewer hospital services than White patients.(18)

· 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.(19)

Program of Action

Health Status

· 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.

· 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. Goverments must address the linkages between racial disparities in health and racial discrimination in other sectors, e.g. education, employment and criminal justice.

· Governments should 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 illnesses, heart disease, HIV/AIDS, cancer, water-borned illnesses and chronic illnesses (such as respiratory disease).

· Governments, non-governmental organizations and the private sector should improve HIV/AIDS prevention efforts in high risk communities, particular attention should be given to HIV/AIDS among the youth.

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

Health Care

· 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.

· 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

· 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.

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

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

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

Sources (20)

1. Ntombenhle Protasia Kotie Torkington, Black Health : A Political Issue, p. 50 (Liverpool, England 1991)

2. Escrito Nacional Zumbi dos Palmares, Race Inequalities in Brazil, page 8 (August 2000)

3. World Health Organizarion, The World Health Report 2000 (2000)

4. Australian Bureau of Statistics. Health and welfare of Australia's Aboriginal and Torres Strait Islander peoples. Canberra: ABS, 1999. (Catalogue No. 4704.0.)

5. Dalit in Nepal and Alternative Report for WCAR-2001, Jana Uttha Pratisthan (April 2001)

6. World Health Organization, The World Health Report 2000 (2000)

7. Survey, " The Roma from Belgrade Settlements", Oxfam,, GB office in Federal Republic of Yugoslavia (April 2001).

8. Black Paper, Broken Promises & Dalits Betrayed, Dalit Right to Livelihood (2001).

9. James Y. Nazroo, Health and Health Services, in Ethnic Minorities in Britain: Diversity and Disadvantage, Tariq Modood and Richard Berthhoud, et. al. Editors, p. 224-258 (London, England 1997)

10. Survey, " The Roma from Belgrade Settlements", Oxfam,, GB office in Federal Republic of Yugoslavia (April 2001).

11. World Health Organizarion, The World Health Report 2000 (2000)

12. James Y. Nazroo, Health and Health Services, in Ethnic Minorities in Britain: Diversity and Disadvantage, Tariq Modood and Richard Berthhoud, et. al. Editors, p. 224-258 (London, England 1997)

13. Survey, " The Roma from Belgrade Settlements", Oxfam,, GB office in Federal Republic of Yugoslavia (April 2001).

14. Report of the United States Commission on Civil Rights, The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality , Volume I and Volume II (September 1999).

15. Vernellia R. Randall, Racist Health Care: Reforming an Unjust Health Care System  to Meet The Needs of African-Americans, 3 Health Matrix 127-194 (Spring, 1993).

16. Report of the United States Commission on Civil Rights, The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality , Volume I and Volume II (September 1999).

17. Dalit in Nepal and Alternative Report for WCAR-2001, Jana Uttha Pratisthan (April 2001)

18. Report of the United States Commission on Civil Rights, The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality , Volume I and Volume II (September 1999).

19. Report of the United States Commission on Civil Rights, The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality , Volume I and Volume II (September 1999).

20. 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

 

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Contact Information:
Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
300 College Park 
Dayton, OH 45469-2772
Email: randall@udayton.edu

 

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 03/10/2010

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