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Shannon G, Morgan R, Zeinali Z, Brady L, Couto MT, Devakumar D, Eder B, Karadag O, Mukherjee M, Peres MFT, Ryngelblum M, Sabharwal N, Schonfield A, Silwane P, Singh D, Van Ryneveld M, Vilakati S, Watego C, Whyle E, Muraya K. Intersectional insights into racism and health: not just a question of identity. Lancet 2022; 400:2125-2136. [PMID: 36502850 DOI: 10.1016/s0140-6736(22)02304-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022]
Abstract
Intersectionality is a useful tool to address health inequalities, by helping us understand and respond to the individual and group effects of converging systems of power. Intersectionality rejects the notion of inequalities being the result of single, distinct factors, and instead focuses on the relationships between overlapping processes that create inequities. In this Series paper, we use an intersectional approach to highlight the intersections of racism, xenophobia, and discrimination with other systems of oppression, how this affects health, and what can be done about it. We present five case studies from different global locations that outline different dimensions of discrimination based on caste, ethnicity and migration status, Indigeneity, religion, and skin colour. Although experiences are diverse, the case studies show commonalities in how discrimination operates to affect health and wellbeing: how historical factors and coloniality shape contemporary experiences of race and racism; how racism leads to separation and hierarchies across shifting lines of identity and privilege; how racism and discrimination are institutionalised at a systems level and are embedded in laws, regulations, practices, and health systems; how discrimination, minoritisation, and exclusion are racialised processes, influenced by visible factors and tacit knowledge; and how racism is a form of structural violence. These insights allow us to begin to articulate starting points for justice-based action that addresses root causes, engages beyond the health sector, and encourages transnational solidarity.
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Affiliation(s)
- Geordan Shannon
- Institute for Global Health, University College London, London, UK.
| | - Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Leanne Brady
- Emergency Medical Services, Western Cape Department of Health, Cape Town, South Africa
| | - Marcia Thereza Couto
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Ben Eder
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Ozge Karadag
- Center for Sustainable Development, Earth Institute, Columbia University, New York, NY, USA
| | | | | | - Marcelo Ryngelblum
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Nidhi Sabharwal
- Centre for Policy Research in Higher Education, National Institute of Educational Planning and Administration, New Delhi, India
| | - Amos Schonfield
- Oxford Department of International Development, University of Oxford, Oxford, UK
| | - Pamela Silwane
- Gugulethu Community Action Network, Cape Town Together Community Action Network, Cape Town, South Africa
| | - David Singh
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Manya Van Ryneveld
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Siyasanga Vilakati
- Phillipi Community Action Network, Cape Town Together Community Action Network, Cape Town, South Africa
| | - Chelsea Watego
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Eleanor Whyle
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kui Muraya
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Walsh R, Reath J, Gunasekera H, Leach A, Kong K, Askew D, Girosi F, Hu W, Usherwood T, Lujic S, Spurling G, Morris P, Watego C, Harkus S, Woodall C, Tyson C, Campbell L, Hussey S, Abbott P. INFLATE: a protocol for a randomised controlled trial comparing nasal balloon autoinflation to no nasal balloon autoinflation for otitis media with effusion in Aboriginal and Torres Strait Islander children. Trials 2022; 23:309. [PMID: 35421984 PMCID: PMC9009496 DOI: 10.1186/s13063-022-06145-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 03/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Otitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children. METHODS/DESIGN This multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3-16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken. DISCUSSION INFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12617001652369 . Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration.
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Affiliation(s)
- Robyn Walsh
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Amanda Leach
- Menzies School of Health Research, Darwin, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Deborah Askew
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Federico Girosi
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Timothy Usherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sanja Lujic
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, Australia
| | - Geoffrey Spurling
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service) Queensland Health, Brisbane, Australia
| | - Peter Morris
- Menzies School of Health Research, Darwin, Australia
| | - Chelsea Watego
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | | | - Claudette Tyson
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Sylvia Hussey
- Townsville Aboriginal and Islander Health Service, Townsville, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Sydney, Australia.
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Campbell L, Reath J, Hu W, Gunasekera H, Askew D, Watego C, Kong K, Walsh R, Doyle K, Leach A, Tyson C, Abbott P. The socioemotional challenges and consequences for caregivers of Aboriginal and Torres Strait Islander children with otitis media: A qualitative study. Health Expect 2022; 25:1374-1383. [PMID: 35297133 PMCID: PMC9327870 DOI: 10.1111/hex.13476] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/14/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Living with ear disease can have extensive impacts on physical, emotional and social well-being. This study explored otitis media (OM) and its management from the perspective of caregivers of Aboriginal and Torres Strait Islander children. METHODS Semi-structured interviews were conducted from 2015 to 2020 with caregivers of Aboriginal and Torres Strait Islander children with OM. Thematic analysis of transcripts was undertaken using a constructivist grounded theory approach through the leadership and the cultural lens of an Aboriginal community-based researcher. RESULTS Caregivers described OM as having profound impacts on their child's physical, developmental, and emotional well-being, with long waits for specialist treatment contributing to extra strain on families. Children's well-being suffered when OM was mistaken for poor behaviour and children were punished, with caregivers subsequently experiencing strong feelings of guilt. Concerns were conveyed about the social implications of having a sick child. The variable nature of OM symptoms meant that caregivers had to monitor closely for sequelae and advocate for appropriate treatment. Success in navigating the diagnosis and treatment of OM can be strongly impacted by the relationship between caregivers and health professionals and the perceived access to respectful, collaborative and informative healthcare. CONCLUSION OM may have substantial social and emotional consequences for children and their caregivers. A holistic understanding of the way in which OM impacts multiple facets of health and well-being, as well as recognition of challenges in accessing proper care and treatment, will aid families managing OM and its sequelae. PATIENT OR PUBLIC CONTRIBUTION Governing boards, managers, staff and community members from five Australian Aboriginal Medical Services were involved in the approval, management and conduct of this study and the wider clinical trials. The caregivers of Aboriginal and Torres Strait Islander patients at these services informed the interview study and guided its purpose.
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Affiliation(s)
- Letitia Campbell
- Kalwun Development Corporation, Gold Coast, Australia.,Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Jennifer Reath
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Wendy Hu
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Hasantha Gunasekera
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Deborah Askew
- Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Chelsea Watego
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Robyn Walsh
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Kerrie Doyle
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Amanda Leach
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
| | - Claudette Tyson
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Metro South Health, Brisbane, Australia
| | - Penelope Abbott
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
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Abbott P, Askew D, Watego C, Hu WC, Campbell L, Tyson C, Walsh R, Hussey S, Doyle K, Gunasekera H, Leach AJ, Usherwood T, Armstrong-Kearns J, Reath J. Randomised clinical trial research within Aboriginal and Torres Strait Islander primary health services: a qualitative study. BMJ Open 2021; 11:e050839. [PMID: 34952874 PMCID: PMC8710871 DOI: 10.1136/bmjopen-2021-050839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To better understand how to undertake valuable, ethical and sustainable randomised controlled clinical trial (RCT) research within Aboriginal and Torres Strait Islander primary health services. DESIGN In a qualitative approach, we utilised data collected between 2013 and 2020 during the planning and implementation of two RCTs. The data comprised agreed records of research meetings, and semistructured interviews with clinical trial stakeholders. The stakeholders were parents/carers of child participants, and site-based research officers, healthcare providers and community advisory groups. Our thematic analysis was informed by constructivist grounded theory. SETTING The RCTs investigated the management of otitis media in Aboriginal and Torres Strait Islander children, with the first RCT commencing recruitment in 2014 and the second in 2017. They took place in Aboriginal Medical Services (AMSs), large primary health services for Aboriginal and Torres Strait Islander people, based in urban and regional communities across two Australian states and one territory. RESULTS We analysed data from 56 meetings and 67 interviews, generating themes on making research valuable and undertaking ethical and sustainable RCTs. Aboriginal and Torres Strait Islander leadership, and support of AMSs in their service delivery function were critical. The broad benefits of the trials were considered important to sustainability, including workforce development, enhanced ear healthcare and multidirectional research capacity building. Participants emphasised the long-term responsibility of research teams to deliver benefits to AMSs and communities regardless of RCT outcomes, and to focus on relationships, reciprocity and creating positive experiences of research. CONCLUSION We identify principles and strategies to assist in undertaking ethical and sustainable RCTs within Aboriginal and Torres Strait Islander primary health services. Maintaining relationships with AMSs and focusing on mutual workforce development and capacity building creates opportunities for long-term benefits so that health research and RCTs work for Aboriginal and Torres Strait Islander peoples, services, communities and researchers. TRIAL REGISTRATION NUMBER ACTRN12613001068752 (Pre-results); ACTRN12617001652369 (Pre-results).
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Affiliation(s)
- Penelope Abbott
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Deborah Askew
- Primary Care Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Chelsea Watego
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Wendy Cy Hu
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Letitia Campbell
- Kalwun Development Corporation, Gold Coast, Queensland, Australia
| | - Claudette Tyson
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Brisbane, Queensland, Australia
| | - Robyn Walsh
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Sylvia Hussey
- Townsville Aboriginal and Islander Health Service, Townsville, Queensland, Australia
| | - Kerrie Doyle
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | - Amanda Jane Leach
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Tim Usherwood
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Jennifer Reath
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
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