Medicine is always a reflection of society as a whole. Therefore, racism, discrimination and equality are also important, often taboo and highly emotionalised topics. We, as medical professionals, but also as citizens, have a duty to identify deficits and to jointly search for solution strategies. Of course, this can only succeed in a strongly transprofessional, transdisciplinary and intersectoral approach.
Various studies show that innovations do not reach certain groups in our society adequately. The latest medical methods are therefore not equally available to all. In concrete terms: People with a migration background, for example, are less likely to be offered participation in studies with innovative medicines - this is the result of our Berlin study on women with gynaecological malignancies, such as breast and ovarian cancer. Reasons for this disadvantage, which can also influence patient safety and prognosis, are repeatedly discussed in the scientific international literature. However, scalable and area-wide programmes to overcome these barriers are lacking for most diseases.
Disadvantaged groups can include different people, this concerns ethnic aspects, demographic and socio-cultural characteristics.
Prejudices or the creation of stereotypes is part of the human day to day. Everyone knows that. But we have to understand and consciously overcome this, especially in medicine. In medicine, all people are to be treated equally. That is our basic attitude and it is not negotiable! There are very many good examples of overcoming barriers and disadvantages with different approaches, but we need to network these islands to scale them and learn from each other.
We started this at the Charité University Hospital about 10 years ago. And now we have been able to transfer certain further education and training formats into standard care. We have representatives for intercultural competence in every centre, which was a milestone. We have recently conducted a nationwide survey among patients with a migration background on the topics of living wills, health care proxy and testaments. There is a great need for information and education, even on such sensitive issues as dying or sexuality. There is still a lot to do. New concepts such as video or audio formats may be needed.
In 2021, an analysis on the risks of discrimination and protection against discrimination in the health care system was published on behalf of the German Federal Anti-Discrimination Agency (German acronym: ADS) (Susanne Bartig et al, 2021), criticising, among other things, risks of discrimination due to a lack of spatial and communicative accessibility in the health care system, insufficient specialist knowledge, and insufficient sensitisation of medical staff to the specific needs of certain groups of female patients.
We should not see these results as an affront, but as valuable criticism and use them as an opportunity to look for solutions together. There are many practical fields that concern both clinical and scientific practice.
For example, it is absolutely incomprehensible that the information and educational materials of clinical studies are usually only submitted to the ethics committees in German, so that people who speak only Turkish, Ukrainian or Arabic, for example, can only be included in the respective study with considerable additional effort - this is perhaps also a reason for the clear underrepresentation of people with a migration background. Yet it would be so easy to implement the principle that ethics committees demand multilingual documents.
My parents came to Germany as political refugees from the port city of Tangier in Morocco. They were illiterate. I was born in Berlin, I love this city, I love our country, and I think that we physicians in particular should deal with all important socially relevant issues, because health, as we know, is more than just looking at illness - after all, the WHO definition of health describes physical, mental, and social well-being as health.
I am very happy that I am now part of a great team: in our project "Empowerment for Diversity - Alliance for Equal Opportunities", with which we have launched a new opportunity for co-design. This project, funded by Mercator Foundation, is really about "empowerment" and establishing a nationwide network for training, as well as further training and qualification in intercultural competence.
So it's about networking these kinds of projects in the clinics with each other, in order to break down barriers. Intercultural competence, in my opinion, can only be acquired with biological and social aspects in real human dialogue. I look forward to that!
Yours truly,
Jalid Sehouli