Yesterday evening, I was supposed to take part in a Medact reading group to discuss this paper:
Selvarajah S, Deivanayagam TA, Lasco G, et al Categorisation and Minoritisation BMJ Global Health 2020;5:e004508. Accessible via this link: https://gh.bmj.com/content/5/12/e004508
BIPOC? BAME? Minoritised? White, black, coloured, Asian?
Otherisation – possibly a term coined by Oxford neuroscientist Kathleen Taylor – is much broader than skin tone. Otherisation leads to discrimination and marginalisation and with marginalisation and discrimination come health disparities. While it is good to be aware of that, and perhaps also document it, the solution does not lie in semantics.
The solution lies in inclusivity.
How did I arrive at this conclusion? I am BAME, a minority nationality in the UK, but I am never included as part of BAME because BAME = non-white skin tone, isn’t it? And I am white.
The first GP I encountered in England did not (seem to) believe me when I said I was a scientist. He also wrote in my file that I had an alcohol problem, without ever having discussed alcohol with me, let alone what kind and how much. It was the result of an innocent language hiccup and his bias, towards older women and/or unmarried women, I think, rather than towards migrants. I was 45.
His colleague, the great younger guy I saw next, a week or so later, discovered the problem. He noticed my confusion when he started explaining that alcohol abuse had negative health effects, at the start of the appointment. He ordered a blood test to make sure that my sugar levels were fine.
He also opened and drained a cyst on my back. He gave me his trust and belief in me when I said that I’d be fine in a few minutes and needed nothing and that the best they could do was leave me in peace and not force me to talk so that I could regain my breath after I started hyperventilating. (It’s related to a childhood incident; it was made worse by teachers in my early school years. It’s no big deal and I figured out how to deal with it a long time ago; these days, it’s very rare for me to hyperventilate.)
He’d already noticed it during the treatment, bless him. To him, I was a person, not a label.
Health and healthcare disparities also affect people with mental health issues and physical disabilities. In the UK, people with non-negligible disabilities currently are five times more likely to be food-deprived. Nutrition-deprived. There you have one major cause of health disparities.
As a result of otherisation, discrimination, marginalisation, in a country with excessive inequality.
Older adults, too, just like people who are not white, often receive less good healthcare. People who aren’t white are less likely to be referred to a specialist (called “consultant” in the UK). Or for tests. The hospital.
The solution to healthcare and health disparities is to treat everyone as a human being, not as a label. Education. Unfortunately, in order to do that, we have to convince the powers that be that these health disparities exist (and how they come about, to a large degree, that is, to the extent that they are not caused by for example by the nature of a disability).
In some cultures / countries, that is frowned upon as something to be abolished. Collecting data on skin tone and ethnicity at every medical facility because it is experienced as discriminatory. In others it is seen as something that we must do first in order to be able to remedy the problem.
So we’re back to labels.
It’s not about labels. It’s about acknowledging that we are all human beings and deserve the same basic levels of housing, nutrition and other necessities in order to be in good health.
I hope that the Medact reading group ended up deciding to write and submit a comment to that article in the BMJ.
(I may not have the equipment needed to take part in such online meetings, I’ve discovered. I have some figuring out and possibly some configuring to do. But I also had a sudden bout of sciatica, so I was cranky and occasionally yelping, which would have been an annoying distraction for the other participants anyway. That will pass. And I’ll find a way to solve my equipment problem.)