Ethnic inequalities in health: The interplay of racism and COVID-19 in syndemics.
Ethnic inequalities in health: The interplay of racism and COVID-19 in syndemics.
复制标题
DOI：
10.1016/j.eclinm.2021.100953
复制
发表时间：
2021-06
影响因子：
15.1
通讯作者：
Bhui K
中科院分区：
文献类型：
--
作者：
Bhui K
2019冠状病毒病大流行暴露并加剧了我们社会中的结构性不平等，特别是在边缘化、少数民族和种族化群体中。年龄、性别、种族、合并症以及工作场所位置、聚集性剥夺和地理位置在感染和死亡风险方面存在明显差异[1,2]。需要在公共服务、公共卫生行动和政策制定方面进行改革，以解决导致卫生不平等的疾病、结构性种族主义和脆弱性的社会决定因素。种族主义包括没有歧视意图的社会结构性劣势，但持续和持续的差异出现，当制度做法导致就业、招聘、教育方面的差异时，表现为欺凌和骚扰，对工作表现和奖励的看法，工作与生活的不平衡，以及有害的人际交往经历。微小的逆境、微小的侵犯、受挫的愿望、负面的评价、对工作或职业发展的反复拒绝、工作、教育和公共服务互动中细微的减少评论，每一个都导致生活机会不足，不利的住房、犯罪、失业和教育排斥，这些都是相互强化的差距。我们需要有依据的理论、行动框架和领导力来应对未来的危机，更好地重建家园。卫生保健和临床医学的运作往往脱离环境，然而，如果结构性病因和长期影响持续存在，患有多种形式逆境的患者不太可能从中受益或从疾病中康复。不解决健康不良的社会决定因素加深了对传染病和大流行病的脆弱性，因此解决社会不平等问题应成为政策和实践的优先事项。考虑到复杂性，有办法了解多种影响如何共同推动不平等和导致疾病是有用的。例如，最近在COVID-19背景下应用了一种交叉方法。克里格的生态社会方法考虑了空间、时间、政治和历史的影响，结合并扩展了生物心理社会视角。总之，这些认识到体现逆境的更广泛的决定因素：社会逆境和劣势如何从字面上影响导致疾病bbb的生物过程。2019冠状病毒病展示了我们的社会环境和生态如何始终与心理和生物过程对话；（所有的）相互作用使我们走向健康或疾病，功能或残疾。因此，如果要促进预防和社区复原力和恢复，就需要在生态和社会以及心理和生物层面采取行动。医学中的临床干预往往以生物医学为主。我们需要认识到生态、社会和心理因素之间的联系，并确保临床实践和医生技能关注个性化患者护理和公共卫生的系统驱动因素。症候群理论是在听到美国人感染艾滋病毒、滥用药物和生活在暴力中的故事后开创的；这种方法后来发展到糖尿病和抑郁症患者。这种方法需要综合护理系统和政策，以适应不平等驱动因素的复杂性和动态性。例如，精神病可以被认为是由基因引起的，或者是由创伤引起的，包括童年逆境经历、社会经济地位、暴力经历、刑事定罪、行为风险因素，包括……
The COVID-19 pandemic has exposed and escalated structural inequalities in our society, especially among marginalised, minoritized, and racialised groups. There are clear differences in risk of infection and mortality by age, gender, ethnicity, and comorbidities, as well as by work place position, clustered deprivation, and geography [1, 2]. Reform is needed in public services, public health actions, and policy development to address the social determinants of illness, structural racism, and vulnerabilities that lead to health inequalities. Racism includes societal structural disadvantage where there is no intention to discriminate, but persistent and consistent disparities emerge and when institutional practices drive disparities in employment, recruitment, education, expressed through bullying and harassment, perceptions of job performance and rewards, poor work-life balance, and experiences of harmful interpersonal interactions. Minor adversities, microaggressions, thwarted aspirations, negative evaluations, repeated rejections for jobs or career advancement, nuanced diminishing comments in work, education and public service interactions each lead to poor life chances, and unfavourable housing, criminalisation, unemployment and educational exclusion as mutually reinforcing disparities [3]. We need evidenced theory, action frameworks, and leadership to counter future crises and build back better. Health care and clinical medicine often operates as if free of context, yet patients presenting with multiple forms of adversity are unlikely to benefit or recover from illness if the structural aetiological and perpetuating influences persist. The failure to address social determinants of poor health deepens the vulnerability to infectious disease and pandemics, thus tackling social inequalities should be a priority for policy and practice [4]. Given the complexity, it is useful to have ways of understanding how multiple influences come together to drive inequalities and cause illness. For example, an intersectional approach has been applied recently to COVID-19 contexts [5]. Krieger’s eco-social approach considers spatial, temporal, political and historical influences, incorporating and extending the bio-psycho-social perspective. Together these recognise the wider determinants of embodied adversity: how social adversity and disadvantage literally influence biological process leading to disease [6]. COVID-19 demonstrates how our social environment and ecology are always in dialogue with psychological and biological processes; there are interactions (across all) to move us towards health or illness, function or disability. Thus action is required at the ecological and social as well as at the psychological and biological levels if prevention and community resilience and recovery are to be promoted. Clinical interventions in medicine tend to take a predominantly biomedical focus. We need to recognise the links between ecological, social and psychological antecedents and ensure clinical practice and physician skills attend to systemic drivers in personalised patient care and public health.Syndemic theory was pioneered from hearing the stories of people in the USA with HIV, substance misuse, and living with violence; the approach has since evolved to incorporate people living with diabetes and depression [7]. The approach calls for integrated care systems and policy that accommodate the complexity and dynamic nature of the drivers of inequality. As an example, psychosis can be seen to be caused by genes, or driven by trauma including childhood experiences of adversity, socio-economic status, experiences of violence, criminalisation, behavioural risk factors including …
登录
查看更多内容
影响因子：
168.9
作者：
Singer, Merrill;Bulled, Nicola;Mendenhall, Emily
通讯作者：
Mendenhall, Emily
影响因子：
5.4
作者：
Bhui K;Dein S;Pope C
通讯作者：
Pope C
影响因子：
2.8
作者：
Zuev, Dennis;Hannam, Kevin
通讯作者：
Hannam, Kevin
影响因子：
12.7
作者：
Krieger, Nancy
通讯作者：
Krieger, Nancy
影响因子：
2.9
作者：
Nazroo, James Y.;Bhui, Kamaldeep S.;Rhodes, James
通讯作者：
Rhodes, James