Credits: Julie Fraser. Used with permission. L to R: Eduardo Arenas Catalán, Leigh Kamore Haynes, Sarah-Jane Koulen, Linda Nooitmeer, Tina Stavrinaki, Machiko Kanetake.
By Julie Fraser, Firdes Shevket, and Tina Stavrinaki
The COVID19 pandemic underscored the vital importance of everyone’s right to health. The pandemic also shone a spotlight on all of the pre-existing structural inequalities in our societies, with disproportionate burdens falling to communities exposed to racial discrimination, in particular women and those of low socio-economic status. Jose Alvarez documented the racialised impacts in his article addressing the “color of COVID”. In the USA, victims racialised as black, Indigenous, or Latin American were more than twice as likely to die of COVID. There has since been increasing interest in health and its underlying determinants - particularly racism. The UN Special Rapporteur on the right to health wrote her 2022 report on racism, and the UN Committee on the Elimination of Racial Discrimination held a day of general discussion on the topic in 2022. That Committee (CERD Committee), lead by Tina Stavrinaki, has begun drafting a General Recommendation (n°37) on racial discrimination and the right to health under Article 5 (e)(iv) of the International Convention on the Elimination of All Forms of Racial Discrimination (CERD). A workshop, held on 16 November 2023 (sponsored by the NNHRR), brought together a diverse group of multidisciplinary experts who work at the intersection of health and racial discrimination.
Hosted by Julie Fraser in Utrecht, The Netherlands, the workshop commenced with a presentation by Tina Stavrinaki of the first draft of the CERD General Recommendation no 37. As undefined in CERD, the draft relies upon the concept of ‘health’ as elaborated by the World Health Organisation and the UN Committee on Economic, Social and Cultural Rights in their authoritative text on “the highest attainable standard of physical and mental health” (under article 12 of the International Covenant on Economic, Social and Cultural Rights). However, CERD’s draft situates ‘health’ within the context of the historical racial injustices of colonialism, slavery, and apartheid, which remain largely unaccounted for and have enduring consequences also in relation to health. The draft General Recommendation recognizes that these inequalities are so deeply embedded in social life that they may be defined as structural and ongoing. The draft also acknowledges that racial discrimination is not a departmentalized phenomenon, but that it often intersects with migratory status, gender, age, social class, disability, sexual orientation, gender identity and other grounds of discrimination.
Racism has several major implications for the right to health and is recognised as a structural determinant of health. Racial discrimination itself can have direct consequences for one’s health as hate speech and microaggressions (see here and here) can activate the body’s stress response, potentially leading to health problems. Leigh Kamore Haynes, Eduardo Arenas Catalán, and Vivek Bhatt addressed the impact of racial discrimination in health in the context of public services and migration. For example, across Europe, the health of Roma communities is endangered by being compelled to live and work in environmentally degraded and polluted sites - including contaminated industrial sites. These communities are furthermore not provided with access to clean water, sanitation, or waste collection - with obvious detrimental effects for their health - while neighbouring areas receive these public services. The health of Roma people has been the subject of CERD’s General Recommendation No. 27 and much case law before the European Court of Human rights.
Other groups, like refugees and migrants, are exposed to disproportionate health-related vulnerabilities in a range of settings, including due to lack of clear and comprehensive data on their health. In the Netherlands, privacy laws prevent it from collecting some disaggregated data (ie ‘ethnicity’), which the CERD Committee considers as hindering the State’s ability to elaborate and implement effective public policies. The way in which such data is captured, disaggregated or obstructed from existing balance sets must be carefully regulated in order to protect sensitive health and migration related information. It is also imperative that migrant and refugee populations are involved in discussions pertaining to their health-related data and the way in which that data is then communicated back to the public and the health and social care services.
Via insightful contributions by Bahar Goodarzi and Sarah-Jane Koulen, the workshop also focused on the domestic situation of racial discrimination in the Netherlands. Sarah-Jane presented general remarks on behalf of the Dutch National Institute for Human Rights, College voor de rechten van de mens. Bahar, a practicing midwife, addressed racism in maternal and newborn care from a critical intersectional perspective. While the Dutch population is rather diverse, standards in medical school continue to be based on the white male norm, to the obvious detriment of women and people of colour. For example, doctors and health professionals are not trained on how symptoms manifest for racialised groups also taking into account the effect of structural inequalities. A textbook for midwives (Williams Obstetrics) list factors that influence the success of vaginal labor, with one of these factors being in the ‘white race’ category. Women racialised as black in the Netherlands (ie those from Surinamese or Antillean descent) are more likely to have caesarean but tragically also more likely to die from them.
In the Netherlands, racialised patients reported bias by healthcare workers (see here and here), such as when they were vocally advocating for themselves or if they did not speak fluent Dutch. While interpreters were previously provided in healthcare settings, this policy was amended over a decade ago. A concerning consequence of the lack of interpreters is that children are often the ones to translate for family members, exposing them potentially to unsettling and unsafe situations. The UN Committee on Economic, Social and Cultural Rights and the CERD Committee expressed concern about the lack of interpreters as a barrier to good healthcare in the Netherlands. A general problem in the Dutch healthcare system appears to be the taboo on using the word ‘racism’ or talking about racial discrimination.
As these examples illustrate, there is a pressing and urgent need to address racial discrimination in the context of the right to health. This requires not only practical changes like funding translators and amendments to textbooks and curricula, but also special measures advancing equality in the enjoyment of the right to health for all and aiming at profound socio-cultural changes that address the root causes of racism. Greater awareness is required of how ingrained racial discrimination is in our institutions and societies, along with greater willingness to address it. This is particularly urgent given that the climate crisis is already impacting people’s health around the world – with disproportionate impacts for racialized groups. Accordingly, all relevant actors – both state and non-state – should take the necessary action to untangle their systems of racial discrimination to enable all persons to enjoy their right to “the highest attainable standard of physical and mental health”.
Participants in the workshop included experts Alay Llamas of UMC Utrecht; Linda Nooitmeer, the Chair of the National Institute of Dutch Slave History and Heritage (NiNsee); and Yvonne Donders, member of the UN Human Rights Committee.
The CERD draft General Recommendation on racial discrimination and health is due to be finalized in 2024.
Bios:
Dr Tina Stavrinaki is a member of the UN Committee on the Elimination of Racial Discrimination and an Assistant Professor with the Netherlands Institute of Human Rights at Utrecht University.
Ms Firdes Shevket is a junior lecturer in International and European Law at Utrecht University.
Dr Julie Fraser is an Assistant Professor with the Netherlands Institute of Human Rights at Utrecht University.