Drona P. Rasali, Brendan M. Woodruff, Fatima A. Alzyoud, Daniel Kiel, Katharine T. Schaffzin, William D. Osei, Chandra L. Ford, Shanthi Johnson
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The results link historical racism/casteism to health disparities occurring in Black and African American, Native American, and other ethnic groups in the US; in Indigenous peoples and other visible minorities in Canada; and in the Dalits of Nepal, a population racialized by caste, grounded on at least four foundational theories explaining structural determinants of health disparities. The evidence from the literature indicates that genetic variations and biological differences (e.g., disease prevalence) occur within and between races/castes for various reasons (e.g., random gene mutations, geographic isolation, and endogamy). However, historical races/castes as socio-cultural constructs have no inherently exclusive basis of biological differences. Disregarding genetic discrimination based on pseudo-scientific theories, genetic testing is a valuable scientific means to achieve the better health of the populations. Epigenetic changes (e.g., weathering—the early aging of racialized women) due to the DNA methylation of genes among racialized populations are markers of intergenerational trauma due to racial/caste discrimination. Likewise, chronic stresses resulting from intergenerational racial/caste discrimination cause an “allostatic load”, characterized by an imbalance of neuronal and hormonal dysfunction, leading to occurrences of chronic diseases (e.g., hypertension, diabetes, and mental health) at disproportionate rates among racialized populations. Major areas identified for reparative policy changes and interventions for eliminating the health impacts of racism/casteism include areas of issues on health disparity research, organizational structures, programs and processes, racial justice in population health, cultural trauma, equitable healthcare system, and genetic discrimination.","PeriodicalId":21795,"journal":{"name":"Societies","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cross-Disciplinary Rapid Scoping Review of Structural Racial and Caste Discrimination Associated with Population Health Disparities in the 21st Century\",\"authors\":\"Drona P. Rasali, Brendan M. Woodruff, Fatima A. Alzyoud, Daniel Kiel, Katharine T. Schaffzin, William D. Osei, Chandra L. 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引用次数: 0
摘要
我们大致按照 PRISMA-SCR 协议进行了一次跨学科快速范围审查,以研究历史上的种族和种姓歧视作为 21 世纪健康差异的结构性决定因素。我们从孟菲斯大学图书馆的数据库搜索中选择了 48 篇同行评审的全文文章,重点关注三个选定的案例研究国家:美国、加拿大和尼泊尔。作者阅读了每篇文章,摘录了重点内容,并将归因于种族主义或种姓主义的结构性健康差异的主题内容制成表格。研究结果将历史上的种族主义/种姓主义与美国黑人和非洲裔美国人、美国原住民和其他族裔群体、加拿大土著居民和其他明显的少数群体以及尼泊尔的达利特人(一个因种姓而被种族化的人群)的健康差异联系起来,并以至少四种解释健康差异结构性决定因素的基础理论为依据。文献证据表明,由于各种原因(如随机基因突变、地理隔离和内婚),在种族/种姓内部和之间会出现遗传变异和生物差异(如疾病流行率)。然而,历史上的种族/种姓作为一种社会文化建构,其生物差异本身并不具有排他性。撇开基于伪科学理论的基因歧视不谈,基因检测是实现人口更健康的重要科学手段。种族化人群基因 DNA 甲基化导致的表观遗传变化(如风化--种族化妇女的早衰)是种族/种姓歧视造成的代际创伤的标志。同样,世代相传的种族/种姓歧视造成的慢性压力会引起 "异位负荷",其特点是神经元和荷尔蒙功能失衡,导致慢性疾病(如高血压、糖尿病和精神健康)在种族化人口中的发生率过高。为消除种族主义/种姓主义对健康的影响,已确定的补偿性政策变革和干预措施的主要领域包括健康差异研究、组织结构、计划和流程、人口健康中的种族公正、文化创伤、公平的医疗保健系统和遗传歧视等方面的问题。
Cross-Disciplinary Rapid Scoping Review of Structural Racial and Caste Discrimination Associated with Population Health Disparities in the 21st Century
A cross-disciplinary rapid scoping review was carried out, generally following the PRISMA-SCR protocol to examine historical racial and caste-based discrimination as structural determinants of health disparities in the 21st century. We selected 48 peer-reviewed full-text articles available from the University of Memphis Libraries database search, focusing on three selected case-study countries: the United States (US), Canada, and Nepal. The authors read each article, extracted highlights, and tabulated the thematic contents on structural health disparities attributed to racism or casteism. The results link historical racism/casteism to health disparities occurring in Black and African American, Native American, and other ethnic groups in the US; in Indigenous peoples and other visible minorities in Canada; and in the Dalits of Nepal, a population racialized by caste, grounded on at least four foundational theories explaining structural determinants of health disparities. The evidence from the literature indicates that genetic variations and biological differences (e.g., disease prevalence) occur within and between races/castes for various reasons (e.g., random gene mutations, geographic isolation, and endogamy). However, historical races/castes as socio-cultural constructs have no inherently exclusive basis of biological differences. Disregarding genetic discrimination based on pseudo-scientific theories, genetic testing is a valuable scientific means to achieve the better health of the populations. Epigenetic changes (e.g., weathering—the early aging of racialized women) due to the DNA methylation of genes among racialized populations are markers of intergenerational trauma due to racial/caste discrimination. Likewise, chronic stresses resulting from intergenerational racial/caste discrimination cause an “allostatic load”, characterized by an imbalance of neuronal and hormonal dysfunction, leading to occurrences of chronic diseases (e.g., hypertension, diabetes, and mental health) at disproportionate rates among racialized populations. Major areas identified for reparative policy changes and interventions for eliminating the health impacts of racism/casteism include areas of issues on health disparity research, organizational structures, programs and processes, racial justice in population health, cultural trauma, equitable healthcare system, and genetic discrimination.