{"id":741,"date":"2024-04-29T13:23:54","date_gmt":"2024-04-29T13:23:54","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=741"},"modified":"2024-05-01T11:55:06","modified_gmt":"2024-05-01T11:55:06","slug":"part-three-challenging-healthcare-inequalities-and-social-justice-by-dr-nagina-khan","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2024\/04\/29\/part-three-challenging-healthcare-inequalities-and-social-justice-by-dr-nagina-khan\/","title":{"rendered":"Part three \u2013 Challenging Healthcare Inequalities and Social Justice. By Dr. Nagina Khan"},"content":{"rendered":"

\u201cThe purpose of knowledge is action, not knowledge\u201d Aristotle<\/p>\n

However, it is also possible that this action, sanctioned by Aristotle can prove advantageous for some sections of society because of the concept of social engineering, which is a form of social planning. It can be understood as –\u00a0 using knowledge and resources \u2018to better\u2019 certain citizens and exclude other from benefitting in society. We have ample evidence for the impacts of social determinants of health, health inequalities, inequity<\/a>, and racism<\/a>, yet, we have little action that makes a difference to the lives of individuals and groups who have protected characteristics<\/a> who are being impacted every day in our organisations and society. Even now, especially now, the impacts of colonialism still affect our society, our institutions and our organisations and still provide rules that structure our existence.1<\/sup> Despite accumulating, over decades, literature and evidence of the different kinds of injustices and their manifestations, our knowledge has not translated into organised action or accomplished the needed reform in our society. Health inequalities and multiple conditions are both strategic priorities for the Government and the NIHR<\/a>. \u00a0The underlying drivers have been identified as socioeconomic disadvantage and reinforcing factors. These factors are intersect and create ethnic inequalities in multiple conditions. \u00a0The NIHR has highlighted in the quote below that:<\/p>\n

\u201cIt is possible that racism and multiple forms of discrimination can intersect with demographic factors (e.g. age, gender, and\/or sexual orientation) resulting in disadvantage in accessing key economic, physical and social resources for some, thereby, leading to socioeconomic and health inequalities. In turn, these inequalities can result in higher prevalence of some health conditions which may then accelerate the development of MLTCs in some minoritised ethnic group populations.\u201d2<\/sup><\/p>\n

Racism and consequential discrimination, this includes people from disadvantaged backgrounds, minority ethnic groups, and those with serious mental illness. Experiences of health services also differ. The individual needs of disadvantaged groups are often neglected or even made worse by services\u2019 responses. Racism which will be utilised as a lens to understand how much needs to be done in just one of these areas.<\/p>\n

Adwoa Danso and Yaa Danso<\/a>, suggest that bias and false beliefs are built on stereotypes that stream into the networks within our society. See table. 1 for the racism and its various manifestation definitions.<\/p>\n

Table. 1 Racism and its various manifestations <\/strong>(table adapted from information <\/strong>Future Learn<\/strong><\/a>) <\/strong><\/p>\n

\"\"<\/p>\n

In my conclusions and quest for evidence throughout this series on social justice which ran through 2023-2024; I look to Susan T. Fiske, in her chapter Are we born racist?<\/a> She writes that in her own lab, she showed white study participants a series of photos, some of white faces and some of black ones. She gave them two seconds to answer of the three questions about the people in the photos \u2013 whether they were over 21 years, whether they had grey dot on their face, or whether they liked a certain vegetable. When participants had to decide if the people in the photos were over 21, she saw a spike in their amygdala activity, similar to what had been found in other studies.9,10<\/sup> But when they looked at these faces to judge what kind of vegetable the person would like, or when they were looking for a grey dot, their amygdala activity was the same as when they saw white faces. So, Susan\u2019s work indicates that in her study, when participants had to place others into a social category \u2013 even if it was by age, not race \u2013 they saw black faces differently than white faces. But the grey dot exercise showed it was possible for whites to look at black faces without getting this effect. She further showed that, more importantly for everyday interactions, when participants were prompted to judge these people as individuals \u2013 individuals with their own unique tastes and preferences \u2013 they reacted no differently to black faces than they did to white ones. Similarly, in Susan\u2019s Lab – brain scans indicated that people stop dehumanising homeless people and drug addicts when they are made to guess what these people would like to eat, overriding the fear produced by the amygdala by triggering empathy – and making the people seen as people<\/p>\n

So, to summarise, what this research is telling us – is that individuals and \u00a0the environment can interact\u00a0 for good or ill, therefore producing social conditions which can reduce prejudice, just as they can foster or exarchate it. Simply, the study showed an overriding of fear which was produced by the amygdala by triggering empathy – and making the \u2018people be seen as people.\u2019<\/p>\n

What is scarily true about our society is that \u2013 these negative attitudes are often automatically activated and can influence a person’s behaviour without conscious volition.<\/a> The inequality will inevitably lead to poor \u00a0outcomes in health and social care \u00a0for certain groups impacted by racism, not just seen within healthcare establishments. Clearly, this can have widespread and stark implications on healthcare outcomes within minority communities we see today. (Please see table. 1 for racism and its various manifestations. Susant T. Fiske, also suggests that both science and history have shown that people will nurture and act on their prejudices in the worst ways when they are under stress, pressured, or need approval from authority.<\/p>\n

Why we should fight? <\/em><\/p>\n

When reading to the complete end of Are we born racist, I felt it deeply poor of our society to be so segregated, and like sociologist Doug Massey, (the husband of Susan T. Fiske), concludes \u2013 if our society is \u00a0to remain so segregated \u2013 then all else follows!<\/p>\n

I too feel from a healthcare lens – segregation is a mechanism for one section of society to use against another to protect against their fears, perhaps to let others \u201cbe equal\u201d in this system and so all else does follow, see below:<\/p>\n