Institute for Global Health, University College London, London, UK; St George's Hospital NHS Foundation Trust, London, UK.
Institute for Global Health, University College London, London, UK.
Lancet. 2022 Dec 10;400(10368):2109-2124. doi: 10.1016/S0140-6736(22)02484-9.
Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.
尽管种族主义、仇外心理和歧视在全球普遍存在，但它们并不是普遍公认的健康决定因素。我们挑战与特定种族和少数群体相关的死亡率和发病率增加不可避免的普遍观念。在驳斥种族类别具有遗传基础，并承认社会经济因素在理解这些健康差异方面提供了不完整的解释的同时，我们研究了基于种姓、族裔、原住民身份、移民身份、种族、宗教和肤色的歧视影响健康的途径。这些类别的歧视尽管具有许多独特的历史和文化背景，但以相同的方式运作，具有重叠的途径和健康影响。我们综合分析了这种歧视如何影响卫生系统、空间决定因素和社区，以及这些过程如何在个体层面、整个生命周期和代际间表现出来。我们探讨了个人如何在心理、行为和生理上对这些复杂机制做出反应并将其内化。证据表明，种族主义、仇外心理和歧视影响着世界各地所有年龄段的一系列健康结果，并且仍然存在于我们面临的普遍挑战中，从 COVID-19 到气候紧急情况。
