/ 20 March 2024

Racist systems threaten global health: It’s time to dismantle them

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The need to tackle racial inequality in health is worldwide

It is often said that illnesses do not discriminate. When we look at the effect of health crises, however, it is clear that African people, people of African descent and other racialised groups are hit harder, because of the systemic nature of racism.

Racism is deadly not only when people can no longer breathe because of police violence. Racism is deadly when people take their last breath because of policy violence, including global and national policies that result in people being unable to get the medicines or care that could save their lives.

The need to tackle racial inequality in health is worldwide. In the United States, an African American child is twice as likely to die in their first year than a white child; is more likely to die before their first birthday than a child in Libya. In the United Kingdom, black women are four times more likely to die while pregnant or just after childbirth than white women. One in 41 women in sub-Saharan Africa risks dying in childbirth, compared with one in 11 000 in Western Europe.

Racial disparities are stark when it comes to HIV. Of the 4 000 young women and girls aged 15 to 24 who become infected with HIV every week around the world, 3 100 are African. In the US, one in every two African American gay and bisexual men acquires HIV in their lifetime — compared to one in every 11 white gay and bisexual men. In Canada, indigenous people are only 5% of the total Canadian population, but account for 10% of new HIV infections. Worldwide, the majority of the nine million people living with HIV who do not have access to antiretroviral treatment are in the Global South. In Africa, Aids remains the leading cause of death of women aged 15 to 49. 

Cervical cancer’s effect is unequal too. Women in Eastern and Southern Africa are 10 times more likely to die of cervical cancer than women in Western Europe and Australia. 10% of girls in low- and middle-income countries access the human papillomavirus vaccine, compared with 90% in high-income countries.

The Covid crisis exposed what President Cyril Ramaphosa called “global vaccine apartheid”. At least a million people in the Global South could still be alive today if the Covid-19 vaccine had been distributed equitably in its first year. One life could have been saved every 24 seconds. But instead, mega corporations in the Global North were unrestrained from maximising monopoly super profits. Pharmaceutical companies made $90 billion from Covid-19 products in 2021 and 2022 alone, as people in the Global South waited in line. This was not unique — it is a repeating pattern. For example, in the 10 years after the introduction of antiretroviral therapy for HIV, 12 million people in the Global South died because pharmaceutical companies priced treatments out of their reach.

To tackle racial inequality, it is essential to tackle economic inequality. Racial and economic inequality are deeply intertwined, with historical injustices and structural barriers perpetuating disparities in wealth, income and opportunities for marginalised people. In Brazil, white people earn 75% more than people of African descent. In the US, the wealth of a typical African American household is just 16% of a typical white one. In South Africa, the average white male chief executive earns the same as 461 African women in the bottom 10% of earners. Across the world, institutions, policies and practices continue to systematically disadvantage certain racial groups while privileging other groups. For example, discriminatory hiring practices, unequal access to education and healthcare, and racial profiling contribute to economic inequality by limiting the opportunities and resources available to racialised people. 

Racial discrimination and exploitation have been embedded in economic systems for centuries. From the transatlantic slave trade to colonialism and segregation, racial hierarchies have been used to justify the economic exploitation of certain groups. These historical injustices have had long-lasting effects on wealth distribution and opportunities, contributing to persistent economic inequalities along racial lines. Systemic racism has remained wired into global economic systems. The health of people in Global South countries is held back by an international financial architecture that is structurally unjust to low- and middle-income countries. More than 3.3 billion people live in countries that spend more on debt interest payments than on health and education.

World leaders have long committed to address racial inequality. The establishment of the International Day for the Elimination of Racial Discrimination was a promise not only to mark a moment but to act to overturn an injustice. Indeed, this year marks the final year of the United Nations International Decade for People of African Descent. But progress is not yet matching promise. 

We do know, however, that progress is possible. Rooted in the learning that ill health and inequalities are inseparable, the Aids movement is a racial justice movement too. We know that to protect everyone’s health, we must protect everyone’s rights, and that systems that are man-made can be unmade. Tackling racial inequality requires a multifaceted approach that acknowledges the intersectionality of race, class, gender and other inequalities, and implements policies that promote justice for all.

We can address systemic racism in health care systems by redesigning them to prioritise the most marginalised and to be inclusive of all. We can tackle inequality in access to medicines by reshaping the systems, policies and practices under which life-saving medicines are produced, priced and distributed, so that they are made available to all who need them, not just to people of privilege or people in the Global North. We can tackle inequality in the financial architecture by supporting UN secretary general António Guterres’s call to restructure the unsustainable debt facing developing countries and ensure they have the fiscal space needed to invest in healthcare, education, and sustainable development. Our international financial system can and must serve all countries, promote economic stability, and advance the sustainable development goals.

An equal future is possible. It starts with all of us of every background recognising that none of us is any better or worse than our neighbour, and that we need each other now more than ever to survive the challenges ahead.

Winnie Byanyima is the executive director of UNAids and under-secretary general of the United Nations.