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Vernellia R. Randall
Health and Sustainable Development
Sustainable development, as defined by the World Commission on
Environment and Development (the Brundtland Commission), is "the
capacity to meet the needs of the present without compromising the
ability of future generations to meet their own needs." Development
needs are now understood to go beyond economic issues to encompass the
full range of social and political issues that define the overall
quality of life, which necessarily includes health. Thus, a prime
directive of Agenda 21 is "protecting and promoting human
health". The World Health Organization defines health as ". .
. a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity."
Health and development are intimately interconnected. A healthy
population is essential to sound development and most development
activities affect the environment, which in turn causes or exacerbates
many health problems. Furthermore, the lack of development adversely
affects the health of many people. In laying out it’s health
objectives, Agenda 21 specifically addresses the needs of
"vulnerable population" such as "infants, youth, women,
indigenous people, the very poor, the elderly and disabled". In
addition, it lays out a specific plan for addressing the health of the
"urban population". In doing so it is generally comprehensive
and detail. Unfortunately, it overlooks a significant barrier to health
and, therefore, to sustainable development - the impact of racism.
Racism and Sustainable Development
Racism is any action or attitude, conscious or unconscious, that
subordinates an individual or group based on skin color or race. Racism
can be enacted individually or institutionally. Even though socially
constructed, race, like geo-political constructions, conveys both
privilege and deprivation. We live in a world marked by poverty and
under-development. Significant disparities in resource distribution
exist between countries and within countries. These resource
distributions disparities are characterized by race. Slavery,
colonization, neo-colonialism, cultural imperialism and rape of the
resources of the developing world (predominantly non-white) has resulted
in the wealth of the developed world (predominantly white). Even within
societies the distribution of valuable resources tracks race and racism;
with one group being privileged and the other groups deprived.
Racism and Health
Colonialization, slavery, neo-colonialism and racism has assured that
the developing world lags behind the developed world. This lag has
resulted in persons in developing countries being sicker than people in
developed countries and these disparities track racial lines.
Furthermore, "racially disadvantaged" groups within countries
are sicker and dying at significantly higher rates than the majority
populations of their countries.
There are many examples of disparities in health status between
racial/ethnic groups. In the United Kingdom, Black people tend to have a
greater incidence of high blood pressure than white people. In
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. The
life expectancy in the United States is 26 years longer than life
expectancy in Haiti . In 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. The American Indian death rate
from diabetes is 27.8 per 100,000, compared with 7.3 for Whites--380
percent higher. In the 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. Health
disparities occur at all income-level.
The mortality stratum for all of Africa is either high or very high
for child and 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.
By any standard, "racially disadvantaged" groups fail to
have "a state of complete physical, mental and social
well-being" and that failure is tied to race and not merely wealth
or poverty.
The current health disparities issues are not isolated health system
problems. In fact, health disparities is the cumulative result of both
past and current racism throughout the society. For instance, because of
institutional racism, in general "racially disadvantaged"
groups have less education and fewer educational opportunities;
"racially disadvantaged" groups are disproportionately
homeless and have significantly poorer housing options; and
"racially disadvantaged" groups disproportionately work in the
lowest pay and high health risk occupations.
Another aspect of the health status disparities is between the
"racially privileged" countries and "racially
disadvantaged". There is a significant economic gap between the
developing world and the developed world. And that economic gap is
traceable, in significant part, to colonialization, slavery and
neo-colonial policies and practices. An important aspect of the economic
gap is the huge disparity in health. Furthermore, the physical and
economic burdens of diseases affect peoples in the "racially
disadvantaged" countries more significantly than they do those in
"racially privileged" countries. In its 1999 World Health
Report, the World Health Organization (WHO)
stated that " despite the long list of success in health achieved
globally during the 20th century, the balance sheet is indelibly stained
by the avoidable burden of disease and malnutrition that the world's
disadvantaged populations continue to bear."
What WHO doesn’t comment on. is how that disadvantaged is tied to
racism.
In general, overall health status has improved in many "racially
disadvantaged" countries as life expectancies
increase and infant mortality decrease. However, the disparities between
life expectancy and infant mortality for the "racially
privileged" and "racially disadvantaged" is still very
significant. In fact, in some aspects, health status is getting worse.
HIV/AIDS crisis is spreading and deepening; water-borne diseases such as
cholera continue to cause illness and death; and
bacterial based illnesses such as malaria, pneumonia and tuberculosis
are developing significant resistance to antibacterial drugs.
Racism in Health Care
Racism establishes separate and independent barriers to health care.
Despite significant health status disparities, individuals are denied
equal access to quality health care on the basis of race. To understand
the impact of racism on health and health care there must be a developed
knowledge base. The country with the most developed body of knowledge
related to racism and health care is the United States. In the US,
Whites are three times more likely to undergo bypass surgery than
non-Whites. Non-White patients seeking admission to nursing
homes experience longer delays before placement than White patients.
Doctors are less likely to recommend breast cancer screening for
Hispanic women than for White women. Non-White pneumonia patients
receive fewer hospital services than White patients. Finally, poor urban
Black and Hispanic neighborhoods average 24 physicians per 100,000
people, compared to 69 physicians per 100,000 for poor White
communities.
This denial of health care occurs not only as overt racism, but also
as a result of institutional racism. The research from the United States
clearly demonstrates that within a country, racial barriers to quality
health care may manifest themselves in a number of ways including:
disproportionate lack of economic access to health care, barriers to
hospitals and health care institutions, barriers to physicians and other
providers, disparities in medical treatment, discriminatory
health care policies and practices, lack of language and culturally
competent care, disparities based on the impact of the intersection of
race and gender, lack of data and standardized collection methods,
inadequate inclusion in health care research, commercialization of
health care, and the disintegration of traditional medicine. These
factors contribute to "racially disadvantaged" groups having
disparities in health status, unequal access to health care services,
insufficient participation in health research or exploitation in health
research and insufficient receipt of health care financing. Global data
collection and analysis on the impact of racism on health care will
demonstrate the same problems that exist in the United States.
Racialized Conduct in Development and Health
Racism in health care is one aspect that need concerted efforts to
achieve sustainable development. The other aspect is the racialized
conduct of scientists, professionals and other public figures on matters
relating to development, scientific experiments, clinical trials,
industrial products and safety standards. In recent years, there has
been a number of cases in which scientists abused their professional
codes of conduct and caused harm to populations that look different from
themselves. Also, many companies routinely use different raw materials
for their products in different countries, evade standards or offer low
quality goods to poor countries with weak legal regulations. Finally,
there is the additional problem of companies dumping industrial waste in
countries and communities that appear different from firm owners and
managers. Racial prejudice, hidden biases and cultural racism may
influence the choices of scientist and industrialists in selecting
sites, individuals or groups for not only topic dumping, but also
experiments, clinical trials and development.
Summary
Everyone will directly benefit from the successful implementation of sustainable
development that eradicates poverty , eliminates sexism and racism, and
that corrects the unequal distribution of global resources. Sustainable
development will create communities with low unemployment rates and good
opportunities for development. Sustainable communities offer a high
quality of life and are desirable places to live, work, and raise a
family. Sustainable communities can not be attained without assuring
health for all persons.
Global health issues have global consequences that not only affect
the people of developing nations but also directly affect the interests
of all persons. Healthy, productive citizens are essential for global
economic growth and regional security. Stable populations reduce
pressures on economies and the environment and reduce the risk of
humanitarian crises. Programs to control the spread of infectious
diseases reduce the threat of epidemics. Solving global health issues is
essential to sustainable development. The ability to resolve global
health issues is directly affected by eliminating racism.
The problem of racism and racial discrimination is evident not only
in health status, but also in health care and in health care research.
The pervasive nature of racism affects individuals at all economic
levels and is evident in relationship between countries. Thus, the WHO
standard for health can never be met, because there cannot be
"complete . . . mental and social well-being", until the
problem of racism is addressed and resolved and without health there
cannot be equitable and sustainable development.
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