Introduction
Healthcare is never a guarantee. In the modern world, common diseases like the flu or the cold are minimized to a routine event that is merely an inconvenience, while every household has a closet filled with a stack of medicine. However,this is not the case for many. We overlook the most vulnerable in the world. We fail to realize that psychological desires and worries are a privilege in the first place. In fact, 4.5 billion people worldwide are not fully covered by health services, and progress in achieving these goals has slowed down. There has been little to no improvement in coverage for noncommunicable diseases and reproductive health services. (World Bank,2023) This stagnation in moving forward is not temporary; it reflects a discrimination that permeates both society and policies, which has persisted for centuries without resolution. The logic of colonialism and superiority has been reflected in both the development of systems and access to systems.
" Progress" is racist.
The distribution of governmental national funds is driven by a preference for race. Goods and services that give narrowly and specifically aimed benefits are provided to co-ethnic groups of the government in power. Favoritism has real effects on health, with infants born into an ethnic group in power having substantially higher chances of survival.(McGrath,2020).
This makes the only possible "solution" towards health funds and support through transnational cooperative organizations. Solvency of diseases in marginalized areas was never meant as a legitimate solution to alleviate suffering. Rather, any "solution" was only driven by economic extraction and benefits for colonizers. Military and business interests were compromised by the susceptibility of white settlers to pandemics and the mortality caused by contraction. At the same time, research was proposed as a method to yield greater pay and prestige, ignoring local research and objections of the indigenous.Unfortunately, these stories are not just tales from the past; Rather, it persists to this day, with invisible violence running deep through both scientific research and utilization of solutions. 53 percent of global health papers about Africa have a first author from the country of interest, compared to 23 percent for papers that had an author from the US, UK, or Europe. Donor programs, intended to help, have become yet another facade of the colonialism project, with long-proven solutions being ignored, just to be replaced by privately produced products manufactured elsewhere. In fact, this system of donor programs is unreasonable and racist in its own way. International health, or collaboration, is unequal, with organizations from high-income countries automatically set out to "help lower-income countries" deal with the health crisis, resulting in opinions of recipients of "support" being neglected. (Bump,2022) A simple example of this lack of coordination is COVID.
Unfortunately, "decolonization" efforts, at least in the status quo, are unhelpful and unsuccessful, being exclusionary and often worsening perceptions. Programs are presented as case studies with illuminating examples, yet this provides a misguided approach to decolonization, a project that involves multiple actors who frame the problem and find solutions differently. Furthermore, studies are prescriptive and not dialogical, leaving little room for dynamic thinking and tailoring of solutions. These guidelines are linear and are met with significant backlash and resistance when there is a limited opportunity for engagement.
This is only made worse when the international organizations intended to "help" perpetuate structures of racism themselves. Agency of non-white members in workforces is concentrated in less prestigious tiers of institutions, serving non-permanent roles, severely decreasing power in political affairs, and when pushing for human rights. Furthermore, non white members are distrusted and excluded from organizational processes. Credit for work done by local workers is claimed by white and international workers, while mistrust is explicitly expressed through direct disregard of opinions.(Von Billerbeck,2022)
This hindered and slow development of infrastructure only results in nationals of countries resorting to wealthier, richer nations for better opportunities, a phenomenon known as "brain drain". 55 African nations have significant health staffing shortages, classified as a "red list country" by the WHO. The West targets healthcare professionals from low-income countries, especially after COVID. These campaigns become more appealing when in these nations there is low support for the development of healthcare, poor pay, and poor conditions(Green,2023).Ultimately, this becomes a vicious cycle, where the quality of care in these already underdeveloped systems becomes worse, deepening poverty and disease. Medical tourism has become a common alternative for healthcare as a result of brain drain, while private clinics that charge exorbitant fees yet lack proper facilities are established to fulfill the gap caused by poor state healthcare. The middle class, squeezed by economic challenges, is driven further into poverty, while the vast majority who are not wealthy have to either rely on luck or simply accept death.
Access isn't Accessible
The act of verbal racism creates real health consequences for discriminated individuals. Racial and ethnic minority populations experience higher levels of poor health, while discrimination induces physical and mental health conditions, raising indicators for diseases, directly resulting in poorer sleep, depression, anxiety, and traumatic disorders.(White,2023)
Furthermore, structures of racism in policymaking are a direct cause of health issues. Structural racism refers to structures that work as scaffolding of systems. Due to a history of discriminatory lending practices such as redlining, which systematically denies access of financial services like loans to a certain area due to demographic composition. This creates a cycle where areas' decline caused by redlining is framed as a reason for further denying, as areas that are designated as definitely declining and red had 13 times higher rates of shooting compared to other areas. This redlining has led to systematic investment in infrastructure historically. Even when investment occurs, black communities become training grounds and farms for profit for insurers, legislators, and employers. There is also a higher amount of health issues to begin with due to poorer living quality, which also results in the area being unattractive for physicians.(Healthcity,2023)
State-sanctioned medical workers also constantly discriminate, with calls for equity and action going unheard. Historically, well-respected medical doctors framed Blacks as innately diseased and dehumanized, with eugenic efforts attempting to "sterilize undesirable races" for a Whiter nation. Disappointingly, those implicit biases still continue to this day. Stereotyping and enduring racist cultural beliefs lead to minorities receiving poorer quality of care 40% of the time, with no improvement when compared to the past. This is not a coincidence; this is discrimination leading to disrespect and denial. White medical students and residents hold beliefs about intrinsic biological differences between Black and White people, leading to assessments of Black patients having less pain than White patients.(Bailey,2020)Discrimination and bias in hiring are extremely common and prominent, with doctors advancing at varying paces, creating a cycle of constant violence.
However, this discrimination might not be caused solely by personal beliefs; rather, it reflects broader flaws in the medical education system. For example, it is common to teach that the presenting symptoms of a disease are different from those of the opposite race, describing them as "atypical", using white supremacy as a universal norm.(Razack,2024)
Steps moving forward
To solve racism, we have to start from the root–education and training for workers. Only perspectives from these minorities and students will provide a real solution. This requires incorporating Afro-Indigenous facilitators into discussions to review curricula, with barriers in actualizing practices being identified by minority students. This reformed curriculum is then enacted in training sessions with medical students(Warnock,2023).Specifically, fundamental concepts on cultural awareness and community engagement is taught, but most importantly, essays serve as a site of self-assessment and review about biases about communities. The progress of improvement in local health is also evaluated through community partners providing feedback through surveys(Walker,2023).
Solvencies are also possible on the policy level. State-level solutions are already being implemented, but to coordinate a broader, global effort, only action taken by governments is going to work. For example, legislators have enacted laws to require the inclusion of equity education and anti-bias training, while governors have established task forces to implement strategies to eliminate racism in systems. Funding has been provided to address systematic racism, but policy or funds without implementation are useless. Therefore, specific guidance and detailed education with the involvement of minorities is key(Evans,2022).More broadly, the forging of race-conscious policies is crucial, since race-neutral practices inevitably ignore the trends of how racialization drives racial differences in non-racial factors. Community voice is institutionalized through hiring, directly providing minority authority for determining the policy agenda, while policymakers have up-to-date, neutral evidence when developing policies, addressing dilemmas relating to a lack of evaluation and progress of policy implementation in the status quo. This way of policy making is both more engaging and politically more possible, as it broadly addresses problems and downstream manifestations of racism(Fashaw-Walters,2023).
Furthermore, a mindset shift is effective and necessary. When individuals don't share the same culture, building trust and understanding is more difficult since implicit bias and prejudice are more likely. Individuation aims to focus on the individual attributes of another person during communication to have a more neutral foundation, rooted in commonalities that build rapport rather than perpetuating differences. An emotional link is built with the patient, decreasing biases(Brown,2023)
A range of solutions can also be used to make aid and international organizations more diverse and transparent. The step to be taken is simply localizing funds and making them accessible to the people who need them. This represents a process of recognising, respecting, and strengthening the leadership of local authorities and local civil society in actions, in areas such as power, financing, and accountability. These local humanitarian responders are involved in the entire program from the start, customizing support to needs. Organizations are complementary rather than being a complete replacement, while the transparency and openness of specific allocation of resources is publicized, increasing pressure to act rightfully because of the public serving as checks and balances(Barbelet,2021)
Conclusion
Right now, action in healthcare to support racial minorities and the vulnerable in general is not being taken, not because we don't have the capability to do so, but simply because it is easier to continue colonial trends and to earn profit. On the national level, ethnicity serves as a guidance to group funds, while on the international level, the issue is even worse."Support" is a pretty facade, but the underlying logic are racist, colonialist, and only caused by interests of the privileged, while "decolonization" projects have no local involvement and are done by institutions that fundamentally exclude minorities. Even worse, the fundamental concept of international aid is wrong, as less wealthy countries are framed as "needing" help from wealthier ones. However, this only creates a vicious cycle, with this lack of infrastructure sucking local workers to higher paying countries, worsening workforce crises, while racism creates psychological diseases itself.
Even when healthcare systems are built, they are unequal in access. Historical stereotypes continue to this day, leading to minority patients receiving poorer quality of care 40% of the time, while being assessed to experience less pain than white patients. This problem starts from a racist education curriculum.
Yet progress is always possible. Specifically, a reform of education needs to occur, with cultural awareness and indigenous perspectives being the core of the curriculum, while also employing individualization strategies to improve doctor-patient trust. This is also cross-applicable to broader state policies, as minorities and indigenous peoples need to be involved in the decision process to ensure actual results. Finally, localization is used in international organizations, shifting the power of allocation and determining which programs local leaders target.
Healthcare is framed as healing,yet its colonial and racial foundations reproduce the very injustices it aims to resolve.
References
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