- Email: [email protected]
Intertwining migration, ethnicity, racism, and health
Correspondence
School of Social Science and Public Policy, Keele University, Staffordshire ST5 5BG, UK 1 2
3 4
5
Horton R. Offline: Racism—the pathology we choose to ignore. Lancet 2017; 390: 14. Macpherson W. The Stephen Lawrence Inquiry. February, 1999. https://www.gov.uk/ government/uploads/system/uploads/ attachment_data/file/277111/4262.pdf (accessed Aug 1, 2017). Welshman J. From transmitted deprivation to social exclusion: policy, poverty, and parenting. Bristol: Policy Press, 2007. Showell C, Turner P. The PLU problem: are we designing personal ehealth for people like us? Stud Health Technol Inform 2013; 183: 276–80. WHO. Health in all policies: framework for country action. 2014. http://www.who.int/ healthpromotion/frameworkforcountryaction/ en/ (accessed Aug 1, 2017).
Intertwining migration, ethnicity, racism, and health
For more on the World Congress see http://www.merhcongress. com/
For the WHO World Health Assembly Agenda see http://apps.who.int/iris/ bitstream/10665/23533/1/A61_ R17-en.pdf
932
Johanna Hanefeld and colleagues’ Comment (June 17, p 2358) 1 on research into migration, mobility, and health, and Richard Horton’s Offline Comment (July 1, p 14)2 on racism need integrating. Racism is not in Hanefeld and colleagues’ research agenda;1 their agenda is researcher orientated, which is similar to those agendas proposed for ethnicity, 3 but distant from the grave threats and challenges in Horton’s piece 2 on racism. Hanefeld and colleagues1 contend, correctly in my view, that the resolutions of the 2008 World Health Assembly and the WHO global consultation of Migrant Health 4 in 2010 have had little effect. However, this is not a new problem. WHO pub lished detailed recommendations,5 similar to contemporary recommend ations, following a comprehensive examination of migration in 1983. The reiteration, rather than imple mentation, of policy is a result of in sufficient prioritisation, management, and resources. Racism and xenophobia are among the most dangerous threats to public health, with death rates that cannot be equalled even by the deadliest contagion.6,7 Racism and xenophobia
are surely on a par with climate change as a threat to health. The increase in multiethnic and multiracial societies in the modern era puts humanity on a perilous but necessary journey. Horton2 and Hanefeld and colleagues1 concur that the anti-immigration rhetoric needs to stop, and, to para phrase, we need to embrace the full humanity of our neighbourhoods,2 and recognise migration as a social norm.1 Bridging the gap between work on racism, migration, race, and ethnicity is difficult but necessary.3 In these efforts, we should not forget the emigration of white Europeans, displacing and decimating indigenous people, with consequences still cascading across the centuries. An integration of migration, ethnicity, and race (including racism) is occurring, albeit slowly. For example, in 2008, the Migrant Health Section of the European Public Health Association incorporated ethnicity into its name and mission. Scholars, researchers, policy makers, practitioners, community groups, and the public will confer at the first World Congress on Migration, Ethnicity, Race, and Health in Edinburgh, Scotland, in May, 2018. Among other tasks, they will aim to establish a new academic body to advance this field globally. This will be an unparal leled opportunity to integrate cognate fields. I am the chairman of the executive committee of the World Congress on Migration, Ethnicity, Race and Health, a not-for-profit conference with, solely, educational and scholarly work.
Raj S Bhopal [email protected] University of Edinburgh, Edinburgh, Scotland EH8 9AG, UK 1
2 3 4
Hanefeld J, Vearey J, Lunt N, on behalf of the Researchers on Migration, Mobility and Health Group. A global research agenda on migration, mobility, and health. Lancet 2017; 389: 2358–59. Horton R. Offline: racism—the pathology we choose to ignore. Lancet 2017; 390: 14. Bhopal RS. Migration, ethnicity, race, and health in multicultural societies, 2nd edn. Oxford: Oxford University Press, 2014. WHO. Health of migrants: the way forward: report of a global consultation, Madrid, Spain, 3–5 March 2010. Geneva: World Health Organization, 2010.
5
6 7
Colledge M, van Geuns HA, Svensson PG. Migration and health: towards an understanding of the health care needs of ethnic minorities. Netherlands: World Health Organization, 1983. Montagu A. Man’s most dangerous myth: the fallacy of race, 6th edn. London: Sage Publications Ltd, 1997. Blum R, Stanton GH, Sagi S, Richter ED. ‘Ethnic cleansing’ bleaches the atrocities of genocide. Eur J Public Health 2008; 18: 204–09.
Anchors aweigh Cognitive biases frequently result in diagnostic inaccuracies and medical mismanagement, resulting in adverse outcomes or inadequate use of resources. In June, 2017, an African-American man aged 64 years presented to our emergency room from prison, accompanied by three security guards, with a chief complaint of altered mental status, confusion, and lethargy. The man had a medical history of systolic congestive heart failure and had previously been fitted with a dualchamber implantable cardioverter defibrillator. Pertinent history was obtained by the guards, who stated that the patient might have ingested ketamine or a synthetic cannabinoid. Physical examination showed that the patient was afebrile, haemodynamically stable, lethargic (with a Glasgow Coma Scale score of 10), unable to follow commands, and jaundiced with scleral icterus, with no other notable physical findings. Laboratory investigations showed noteworthy increased total bilirubin and ammonia concentrations, and a leucocytosis with bandaemia. The urine drug screen was negative and his abdominal ultrasound was normal. He was admitted to our medical intensive care unit for presumed drug intoxication and hepatic en cephalopathy, and supportive care was initiated with intravenous fluids and lactulose. The patient’s mental status continued to deteriorate des pite supportive care, and the de cision was made to proceed with endotracheal intubation and lumbar puncture. An uncomplicated lumbar www.thelancet.com Vol 390 September 2, 2017
School of Social Science and Public Policy, Keele University, Staffordshire ST5 5BG, UK 1 2
3 4
5
Horton R. Offline: Racism—the pathology we choose to ignore. Lancet 2017; 390: 14. Macpherson W. The Stephen Lawrence Inquiry. February, 1999. https://www.gov.uk/ government/uploads/system/uploads/ attachment_data/file/277111/4262.pdf (accessed Aug 1, 2017). Welshman J. From transmitted deprivation to social exclusion: policy, poverty, and parenting. Bristol: Policy Press, 2007. Showell C, Turner P. The PLU problem: are we designing personal ehealth for people like us? Stud Health Technol Inform 2013; 183: 276–80. WHO. Health in all policies: framework for country action. 2014. http://www.who.int/ healthpromotion/frameworkforcountryaction/ en/ (accessed Aug 1, 2017).
Intertwining migration, ethnicity, racism, and health
For more on the World Congress see http://www.merhcongress. com/
For the WHO World Health Assembly Agenda see http://apps.who.int/iris/ bitstream/10665/23533/1/A61_ R17-en.pdf
932
Johanna Hanefeld and colleagues’ Comment (June 17, p 2358) 1 on research into migration, mobility, and health, and Richard Horton’s Offline Comment (July 1, p 14)2 on racism need integrating. Racism is not in Hanefeld and colleagues’ research agenda;1 their agenda is researcher orientated, which is similar to those agendas proposed for ethnicity, 3 but distant from the grave threats and challenges in Horton’s piece 2 on racism. Hanefeld and colleagues1 contend, correctly in my view, that the resolutions of the 2008 World Health Assembly and the WHO global consultation of Migrant Health 4 in 2010 have had little effect. However, this is not a new problem. WHO pub lished detailed recommendations,5 similar to contemporary recommend ations, following a comprehensive examination of migration in 1983. The reiteration, rather than imple mentation, of policy is a result of in sufficient prioritisation, management, and resources. Racism and xenophobia are among the most dangerous threats to public health, with death rates that cannot be equalled even by the deadliest contagion.6,7 Racism and xenophobia
are surely on a par with climate change as a threat to health. The increase in multiethnic and multiracial societies in the modern era puts humanity on a perilous but necessary journey. Horton2 and Hanefeld and colleagues1 concur that the anti-immigration rhetoric needs to stop, and, to para phrase, we need to embrace the full humanity of our neighbourhoods,2 and recognise migration as a social norm.1 Bridging the gap between work on racism, migration, race, and ethnicity is difficult but necessary.3 In these efforts, we should not forget the emigration of white Europeans, displacing and decimating indigenous people, with consequences still cascading across the centuries. An integration of migration, ethnicity, and race (including racism) is occurring, albeit slowly. For example, in 2008, the Migrant Health Section of the European Public Health Association incorporated ethnicity into its name and mission. Scholars, researchers, policy makers, practitioners, community groups, and the public will confer at the first World Congress on Migration, Ethnicity, Race, and Health in Edinburgh, Scotland, in May, 2018. Among other tasks, they will aim to establish a new academic body to advance this field globally. This will be an unparal leled opportunity to integrate cognate fields. I am the chairman of the executive committee of the World Congress on Migration, Ethnicity, Race and Health, a not-for-profit conference with, solely, educational and scholarly work.
Raj S Bhopal [email protected] University of Edinburgh, Edinburgh, Scotland EH8 9AG, UK 1
2 3 4
Hanefeld J, Vearey J, Lunt N, on behalf of the Researchers on Migration, Mobility and Health Group. A global research agenda on migration, mobility, and health. Lancet 2017; 389: 2358–59. Horton R. Offline: racism—the pathology we choose to ignore. Lancet 2017; 390: 14. Bhopal RS. Migration, ethnicity, race, and health in multicultural societies, 2nd edn. Oxford: Oxford University Press, 2014. WHO. Health of migrants: the way forward: report of a global consultation, Madrid, Spain, 3–5 March 2010. Geneva: World Health Organization, 2010.
5
6 7
Colledge M, van Geuns HA, Svensson PG. Migration and health: towards an understanding of the health care needs of ethnic minorities. Netherlands: World Health Organization, 1983. Montagu A. Man’s most dangerous myth: the fallacy of race, 6th edn. London: Sage Publications Ltd, 1997. Blum R, Stanton GH, Sagi S, Richter ED. ‘Ethnic cleansing’ bleaches the atrocities of genocide. Eur J Public Health 2008; 18: 204–09.
Anchors aweigh Cognitive biases frequently result in diagnostic inaccuracies and medical mismanagement, resulting in adverse outcomes or inadequate use of resources. In June, 2017, an African-American man aged 64 years presented to our emergency room from prison, accompanied by three security guards, with a chief complaint of altered mental status, confusion, and lethargy. The man had a medical history of systolic congestive heart failure and had previously been fitted with a dualchamber implantable cardioverter defibrillator. Pertinent history was obtained by the guards, who stated that the patient might have ingested ketamine or a synthetic cannabinoid. Physical examination showed that the patient was afebrile, haemodynamically stable, lethargic (with a Glasgow Coma Scale score of 10), unable to follow commands, and jaundiced with scleral icterus, with no other notable physical findings. Laboratory investigations showed noteworthy increased total bilirubin and ammonia concentrations, and a leucocytosis with bandaemia. The urine drug screen was negative and his abdominal ultrasound was normal. He was admitted to our medical intensive care unit for presumed drug intoxication and hepatic en cephalopathy, and supportive care was initiated with intravenous fluids and lactulose. The patient’s mental status continued to deteriorate des pite supportive care, and the de cision was made to proceed with endotracheal intubation and lumbar puncture. An uncomplicated lumbar www.thelancet.com Vol 390 September 2, 2017