Race, Health Care and the Law 
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Racism Health and Sustainable Development

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Vernellia R. Randall
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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.


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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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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