Alison Barrett writes:
The global health community has been urged to challenge racism, xenophobia and discrimination in health systems as a matter of urgent priority.
Actions to improve equity in access to healthcare include decolonisation, justice, genuine diversity and inclusion, taking an intersectional approach, anti-racism, and human rights-based approaches, a recent webinar was told.
“Issues such as migration and racism should be urgently treated as a core determinant of health and a priority within the century,” Professor Delan Devakumar from the University College London told attendees at the webinar hosted by the Australian Multicultural Health Collaborative, Monash University and World Wellness Group.
Devakumar – one of the authors on The Lancet’s series on Migration and Health and racism, xenophobia, discrimination, and health – said interventions at multiple levels, including individual training and legislation, are required.
Dr Chris Lemoh from Western Health in Victoria also made strong calls to decolonise health and stop thinking of health as a commodity.
“One of the really pernicious influences [on access to healthcare] has been the commodification” of health services, he said. The effects of this have disproportionately impacted some groups more than others, including Indigenous people and people from migrant backgrounds.
“The sort of financialisation and the micromanagement and microbudgeting of health services, both in primary care and the hospitals, has led to a real paralysis in improving the care for people when everybody is counting the pennies,” Lemoh told the webinar.
Impacts of colonialism
According to Lemoh, “racial stereotypes are just the norm” in clinical practice and continue even though there is increasing diversity in the workforce. He said the “Anglophone chauvinism” culture is very slow to change.
Lemoh – who is Australian-born, with Anglo-Australian and Sierra Leone background – told the webinar that “scientific racism was just the air we breathed” when he went to medical school. Characteristics and test ranges they were taught were all “European by default”.
He said that having a transnational perspective is important to counter nationalism and identity politics, which is something that “public health and global health is starting to grapple with, but clinical medicine is still way behind”.
For example, a migrant or international visitor seeking care at a hospital without health insurance “creates a whole lot of dilemmas about how much care they should get and who’s going to pay for” what is a human right, Lemoh told the webinar. He said this is a very common occurrence particularly in suburban hospitals located in areas of migrant populations.
“As we know all too well, microbes don’t respect national boundaries,” he said.
Another colonial influence is the way in which people are labelled, in both health research and healthcare, whether it be by colour, race, or health condition – “it is a very…colonial way of dealing with people”, Lemoh said.
However, he said we need to remember that for some people “there is no label” and by trying to categorise people we run the risk of “trying to shove them into [any] box” or “leaving them out altogether”.
Lemoh said instead, we should ask patients what they want to be called and what their priorities are.
Every time we make a decision, we draw a boundary between what is and what is not, what we’re going to do and what we’re not going to do….Every time we make a decision about how we’re going to deal with information, we leave things out. There are always gaps in every set of services and we need to see what’s in those gaps.”
Busting myths
“Demonisation of migrants” by some of the most powerful people and countries in the world – such as former President Donald Trump’s comments about and actions towards Mexican migrants, and Brexit under the Theresa May Government – negatively perpetuate myths about the impact that migrants have on society, according to Devakumar.
This in turn leads to increasing discrimination towards migrants and then poorer physical, mental and social health and wellbeing outcomes.
One of the myths that the Lancet Commission tried to challenge is that ‘migrants are a burden on societies and services’. Devakumar said they found the opposite is true – migrants help build jobs, grow the economy and increase services.
“A one percent increase in migrants leads to a two percent increase in gross domestic product”, he said, adding that migrants of all skill levels contribute to the economy.
He told the webinar that the National Health Service in the UK “would collapse” without overseas trained health professionals.
Lemoh also mentioned the valuable experience of people with overseas healthcare qualifications, but said that structural discrimination makes it time consuming for their qualifications to be recognised in Australia.
A recent story published at Croakey also reported these barriers for healthcare workers with overseas qualifications, saying that “the current process makes them feel undervalued, disrespected and even demeaned”.
The second myth – and one embraced by Trump – is that ‘migrants carry diseases that pose a risk to the rest of the population’.
This really isn’t “borne out of the evidence”, Devakumar said. He referred to a meta-analysis that found migrants have a lower mortality risk compared to local population. For refugees and asylum seekers, they found no difference in mortality risk when compared to local populations.
Devakumar said the problems are the migration journey and process – often very prolonged – and the conditions in which migrants live, in terms of physical environment and structural systems, which cause restrictions and interruptions to healthcare.
“We see restrictions put on people, see the right to access being denied for people,” Devakumar said.
“Public leaders and elected officials have a political, social and legal responsibility to oppose xenophobia and racism.”
More research needed
The webinar also heard a call to increase research outputs on multicultural health in Australia.
Professor Helen Skouteris from Monash University discussed recent research exploring the proportion of research on multicultural health in three Australian journals – The Medical Journal of Australia, Australian Health Review and the Australian and New Zealand Journal of Public Health.
A review of these journals’ editions between 2008 and 2023 found that 1.1 percent of the total articles focused primarily on multicultural health issues.
Given half of Australia’s residents are born overseas, or have an overseas-born parent, this does not reflect Australia’s diversity.
“Without research and dissemination of findings and issues faced by immigrants in Australia, the disparities in access to equitable health and social care for this population will continue,” Skouteris said.
Calls to action
See more information about the Australian Multicultural Health Collaborative, the multicultural health peak that is working to end systemic racism and inequity, and how to become involved here.
Further reading
Intersectionality Based Policy Analysis of How Racism is Framed in Medical Education Policies Guiding Aboriginal Health Curriculum, by Petah Atkinson, Marilyn Baird and Karen Adams at Monash University
The UCL–Lancet Commission on Migration and Health: the health of a world on the move, December 2018
The Lancet Series on racism, xenophobia, discrimination, and health, December 2022
Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges, by Resham B. Khatri and Yibeltal Assefa in BMC Public Health
Watch a recording of the webinar here.
From Twitter
See Alison Barrett’s Twitter thread of the webinar here.
Croakey thanks and acknowledges donors to our public interest journalism funding pool who have helped support this article.
