Addressing health inequalities

By Claire Thomas

From the beginning, MRG has systematically focused on health services and the barriers that minorities and indigenous peoples face in accessing them. The disparities, while often overlooked, are striking: where statistics are available, health outcomes consistently show that members of marginalized communities are less healthy, die earlier and use health services less frequently than other groups. This is the case not only in contexts where services are limited and resources scarce, but also in affluent countries with well-funded health systems. In the UK, for instance, research suggests that black males have a life expectancy four years lower than their white peers.

As with education, health services are often difficult for minority and indigenous communities to access, with many barriers to equitable access in place. These include geography, with many communities situated in remote locations, far from capital cities and with little or no infrastructure in place. Language diversity and the frequent lack of comprehensible information also contribute to health inequalities. An added challenge is the widespread absence of disaggregated data on the specific situation of minority and indigenous communities – as a result, critical shortages of even basic health care can end up being concealed in national averages or overlooked altogether from official surveys.

But these challenges, which also reflect wider issues of discrimination and exclusion, can all be solved given political will. Sadly, minorities and indigenous people often have very little – if any – voice in political decision-making, including health budget allocations and priorities. At a local level, minority and indigenous communities often have no say in the design of services, which as a result can be established using a ‘one size fits all’ approach that may be culturally unacceptable: in Ethiopia, for example, painting clinics white (a colour associated with death among some communities) is one example of culturally insensitive design that was shown to have impacted on women’s willingness to access maternal health services.

Sadly, discrimination in health services can be even more direct. Minority and indigenous men and women still report first-hand experiences of explicit racism from clinic staff: from Batwa in the Great Lakes region to minority clan members in Somali IDP (internally displaced person) camps, MRG has documented numerous examples of members of marginalized communities being denied access by the very people who should be helping them. The treatment of Roma across Europe is especially disturbing. One area MRG has lobbied on was the practice of forced sterilization of Roma women in some Eastern European countries, after reports emerged on this shocking issue – a legacy of the Communist era that, while officially prohibited in the early 1990s, continued to occur more than a decade later.

Still, we have found that if we support and train activists to make advocacy claims in compelling ways, results can be achieved, against the odds. For instance, MRG was one of the first organizations to do extensive work on the practice of female genital mutilation (FGM). At the time, much of the limited coverage of this issue was coloured by stigma and misconceptions that did little to engage with the challenge of ending its devastating impacts on girls. FGM is not a minority and indigenous issue per se, as many majority community women have also been affected in different contexts. However, for communities whose culture and way of life more generally had long been dismissed or denigrated, anti-FGM campaigning could be seen as just another example of hostility towards them – even when the need in this case for urgent change was overwhelming.

Of course, we all know (now) that work to tackle FGM and similar practices needs to begin and be led by minority and indigenous women themselves, whose efforts are not dismissed as ‘yet another attack’ by outsiders. MRG’s policy of focusing on activists working directly with communities helped to achieve real impact here. This is illustrated by the legacy of Efua Dorkenoo, a highly respected British-Ghanaian campaigner who wrote one of the first reports on FGM, MRG’s Female Circumcision, Excision, and Infibulation (1980), and would later follow this with a full-length book with MRG in 1994, Cutting the Rose, when she was an MRG Council member. This book was selected by an international jury in 2002 as one of ‘Africa’s 100 best books of the 20th century’. While working with MRG, she coordinated the UK-based Women’s Action Group for Female Excision and Infibulation (WAGFEI) and travelled to a number of FGM-affected countries in Africa. Her example demonstrates how much more can be achieved in transforming health by engaging effectively, as Efua did, with those most affected.

MRG’s work on health builds on the ground-breaking research that we have undertaken over the years on behalf of communities, ranging from Palestinians in the Occupied Territories to asylum seekers in the UK. Unusually, from early on MRG also focused on mental health with reports like The Rights of Mentally Ill People (1987). This reflected our recognition that the experience of stigmatization and invisibility that many communities faced on a daily basis frequently exacted a heavy psychological toll. In more recent years, MRG has continued to develop research on health. In 2013, for instance, our flagship publication at the time, State of the World’s Minorities and Indigenous Peoples, was themed around health.

One issue that MRG has consistently championed is the need for inclusive, disaggregated data for minorities, indigenous peoples and other excluded groups. Developing clear evidence to show the reality of health inequalities on the ground is often the first step to achieving change. In 2017, we co-researched an analysis of indigenous women’s and girls’ access to maternal and sexual health services, commissioned and published by UN Women, UNICEF and UNFPA. This showed that even in the era of the SDGs and their call to ‘leave no one behind’, the limited statistics available showed that indigenous women were significantly less likely to access health services. For some communities the figures were particularly stark, with indigenous women more than three times more likely than other women to have received no ante-natal check-ups. What made this situation even more worrying was the fact that out of 90 major health surveys, only 16 had collected data on indigenous women – meaning that in many, many other states no information on this was available at all.

MRG’s latest work on health has focused on training minority and indigenous community activists to understand and challenge the health budgets that are decided upon for their communities. We believe this will allow them to demand services that work for them and budget allocations that are fair, allowing health services to reach those who need them.

Photo: Somali women walking in Mandera market on the Kenyan side of the Kenyan Somali border / Kim Haughton/Alamy