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• W4311663295 abstract "This Series shows how racism, xenophobia, discrimination, and the structures that support them are detrimental to health. In this first Series paper, we describe the conceptual model used throughout the Series and the underlying principles and definitions. We explore concepts of epistemic injustice, biological experimentation, and misconceptions about race using a historical lens. We focus on the core structural factors of separation and hierarchical power that permeate society and result in the negative health consequences we see. We are at a crucial moment in history, as populist leaders pushing the politics of hate have become more powerful in several countries. These leaders exploit racism, xenophobia, and other forms of discrimination to divide and control populations, with immediate and long-term consequences for both individual and population health. The COVID-19 pandemic and transnational racial justice movements have brought renewed attention to persisting structural racial injustice. This Series shows how racism, xenophobia, discrimination, and the structures that support them are detrimental to health. In this first Series paper, we describe the conceptual model used throughout the Series and the underlying principles and definitions. We explore concepts of epistemic injustice, biological experimentation, and misconceptions about race using a historical lens. We focus on the core structural factors of separation and hierarchical power that permeate society and result in the negative health consequences we see. We are at a crucial moment in history, as populist leaders pushing the politics of hate have become more powerful in several countries. These leaders exploit racism, xenophobia, and other forms of discrimination to divide and control populations, with immediate and long-term consequences for both individual and population health. The COVID-19 pandemic and transnational racial justice movements have brought renewed attention to persisting structural racial injustice. This is the first in a Series of four papers about race and health. All papers in the Series are available at www.thelancet.com/series/racism-xenophobia-discrimination-health Racism, xenophobia, and discrimination exist in every society, causing avoidable disease and premature death among groups that are already disadvantaged.1Phelan JC Link BG Is racism a fundamental cause of inequalities in health?.Annu Rev Sociol. 2015; 41: 311-330Crossref Scopus (599) Google Scholar Such discrimination underpins assaults on people seen as others, whether through institutionalised discriminatory policies, in communities where inequalities are entrenched, or through individuals playing a role in systemic oppressions and interpersonal aggressions. Although the types of discrimination take different forms across time and space, the root causes are situated in efforts to maintain historic power structures. Understanding and challenging discrimination and its underlying ideologies is central to public health and the promotion of social equity. Equally, by ignoring these realities, health professionals are complicit in the structural violence that leads to ill health.2Devakumar D Selvarajah S Shannon G et al.Racism, the public health crisis we can no longer ignore.Lancet. 2020; 395: e112-e113Summary Full Text Full Text PDF PubMed Scopus (65) Google Scholar, 3Richardson ET Epidemic illusions. The MIT Press, Cambridge, MA2020Crossref Google Scholar Racism, xenophobia, and discrimination can present in many forms, from microaggressions to interpersonal and state violence. As described in detail in the second paper of the Series, health outcomes are usually worse among minoritised groups, with strong evidence that racism plays a role.4Williams DR Lawrence JA Davis BA Racism and health: evidence and needed research.Annu Rev Public Health. 2019; 40: 105-125Crossref PubMed Scopus (770) Google Scholar For example, when managing a child with asthma, we know that it is important to consider the environment that they live in and their ability to access good-quality health care. However, the importance of structural racism as a determinant of health remains under-considered. The tragic death of Ella Kissi-Debrah in the UK, on whose death certificate air pollution was included, is a recent example of environmental racism, whereby minoritised communities are more likely than non-minoritised groups to be exposed to environmental hazards as a result of where they end up having to live.5Astell-Burt T Maynard MJ Lenguerrand E Whitrow MJ Molaodi OR Harding S Effect of air pollution and racism on ethnic differences in respiratory health among adolescents living in an urban environment.Health Place. 2013; 23: 171-178Crossref PubMed Scopus (19) Google Scholar, 6Chowdhury A Gasping for air: the disastrous consequences of inaction against air pollution—human rights pulse.https://www.humanrightspulse.com/mastercontentblog/gasping-for-air-the-disastrous-consequences-of-inaction-against-air-pollutionDate: 2021Date accessed: November 2, 2021Google Scholar A systematic review of the literature found that racism was associated with worse mental health (mean weighted effect size r –0·23, 95% CI –0·24 to –0·21) and physical health (–0·09, –0·12 to –0·06).7Paradies Y Ben J Denson N et al.Racism as a determinant of health: a systematic review and meta-analysis.PLoS One. 2015; 10: e0138511Crossref PubMed Scopus (996) Google Scholar The situation worsened during the COVID-19 pandemic,8Devakumar D Bhopal SS Shannon G COVID-19: the great unequaliser.J R Soc Med. 2020; 113: 234-235Crossref PubMed Scopus (26) Google Scholar in which minoritised ethnic groups were more severely affected by the disease and the consequences of the responses. For example, in the second wave of the pandemic in the UK (Sept 12, 2020 and onwards), Bangladeshi women were 4·11 (hazard ratio adjusted for age, 95% CI 3·62 to 4·66) times more likely and Bangladeshi men 4·96 (4·49 to 5·48) times more likely to die from COVID-19 than the White British population. Higher mortality rates were also seen among Black African, Black Caribbean, Pakistani, and Indian ethnic groups.9Larsen T Bosworth M Nafilyan V Updating ethnic contrasts in deaths involving the coronavirus (COVID-19), England—Office for National Statistics.https://www.ons.gov.uk/peoplepopulation andcommunity/birthsdeathsandmarriages/deaths/articles/updatingethniccontrast sindeathsinvolvingthecoronaviruscovid19 englandandwales/24january2020to31march2021Date: 2021Date accessed: July 31, 2021Google Scholar Global inequity in vaccine access along racial lines has highlighted persistent racism in global power dynamics, rooted in legacies of colonialism and exploitation.10Committee on the elimination of racial discriminationStatement on the lack of equitable and non-discriminatory access to COVID-19 vaccines.https://tbinternet.ohchr.org/Treaties/CERD/Shared%20Documents/1_Global/INT_CERD_SWA_9548_E.pdfDate: 2022Date accessed: June 26, 2022Google Scholar Migrant groups and other groups, such as the scheduled castes in India, are often particularly disadvantaged by barriers to care imposed by governments.11Abubakar I Aldridge RW Devakumar D et al.The UCL–Lancet Commission on Migration and Health: the health of a world on the move.Lancet. 2018; 392: 2606-2654Summary Full Text Full Text PDF PubMed Scopus (346) Google Scholar, 12Thapa R van Teijlingen E Regmi PR Heaslip V Caste exclusion and health discrimination in south Asia: a systematic review.Asia Pac J Public Health. 2021; (published online May 24)doi.org/10.1177/10105395211014648Crossref PubMed Scopus (6) Google Scholar Similarly, Indigenous populations across the world have had poorer health outcomes than non-Indigenous populations, including lower life expectancy, higher infant and maternal mortality, and malnutrition.13Anderson I Robson B Connolly M et al.Indigenous and tribal peoples’ health (The Lancet–Lowitja Institute Global Collaboration): a population study.Lancet. 2016; 388: 131-157Summary Full Text Full Text PDF PubMed Scopus (510) Google Scholar These health consequences do not only affect minoritised people—as with social inequality, a society with widespread discrimination threatens the health of everyone.14Malat J Mayorga-Gallo S Williams DR The effects of Whiteness on the health of whites in the USA.Soc Sci Med. 2018; 199: 148-156Crossref PubMed Scopus (63) Google Scholar, 15Jonathan M Metzl Dying of Whiteness: how the politics of racial resentment is killing America's heartland. Basic Books, New York, NY2019Google Scholar Key messages•Racism, xenophobia, and discrimination are fundamental determinants of health and must be considered as such when considering approaches to public health•The health consequences of racism, xenophobia, and discrimination occur in every context that has been studied and can be similar for the related categories of caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour•History and current practice prove that discriminatory ideology has shaped science and research, and how they are interpreted•The precursors to discrimination are the two core structural processes of separation, whereby individuals see themselves as different from others, and hierarchial power•Ill health and health inequities are affected by racism, xenophobia, and discrimination through a host of structural factors and their historical and political roots; interpersonal discrimination cannot be tackled without addressing these complex processes•Populist leaders and policies can exploit populations using racist, xenophobic, and discriminatory ideologies that minoritise people and lead to poor health Although the importance of social and political factors and their effects on health are widely accepted,16The Health FoundationHealth equity in England: the Marmot review 10 years on.https://www.health.org.uk/funding-and-partnerships/our-partnerships/health-equity-in-england-the-marmot-review-10-years-onDate: 2020Date accessed: September 13, 2020Google Scholar, 17Farmer P Sen A Pathologies of power. University of California Press, Berkeley2004Google Scholar racism and xenophobia are under-developed and under-recognised concepts in medicine and health around the world (with the possible exception of the USA7Paradies Y Ben J Denson N et al.Racism as a determinant of health: a systematic review and meta-analysis.PLoS One. 2015; 10: e0138511Crossref PubMed Scopus (996) Google Scholar). In this Series, we provide a global overview of the nature of racism, xenophobia, and other discriminatory ideologies and summarise potential interventions to tackle their effects on health and wellbeing. In doing so, we attempt to provide theories, data, and examples from across the world, and at times have chosen not to cite the most commonly known ones to avoid their over-representation. We cannot be comprehensive and cover all minoritised or persecuted groups. We do not wish to diminish the suffering or importance of groups not included, but we are limited in what we can include and believe that the concepts and health mechanisms are transferable. This first paper introduces our conceptual framework that underpins the Series. We propose contemporary definitions that we use throughout the Series (panel 1), then describe the theoretical basis for our model, before examining the layers of the model and the underlying reasons why discrimination exists. Finally, we focus on what happens at a structural level and include discussions of power, populism, and racialised capitalism and how they contribute to health. Throughout, we look back to history, including the role of colonisation. The health of minoritised populations is affected by the history that has led to their experiences of discrimination and their status in the social hierarchies of the states in which they live. A historically rooted approach shows the durability of racist beliefs and structures, and shows the ways in which racial logics continue to undergird social organisations and, by extension, affect health. We confront the legacy of science that has preserved the power hierarchies among different groups, and we highlight the extent to which colonial history has relied on racist ideologies, whereby an other or separate group was seen as uncivilised or inferior. The consequences play out over generations (eg, through intergenerational drag),38Gee GC Ford CL Structural racism and health inequities: old issues, new directions.Du Bois Rev. 2011; 8: 115-132Crossref PubMed Scopus (650) Google Scholar requiring contemporary public health policies to confront the legacy of past policies that result in persisting disadvantage based on group identity.Panel 1DefinitionsCasteCaste systems, most commonly found in the Indian subcontinent, are categorisations whereby people are stratified according to hereditary groups linked to occupations. These hierarchies determine access to resources and opportunities, based on the ‘innate superiority’ of higher castes.18Desai S Dubey A Caste in 21st century India: competing narratives.Econ Polit Wkly. 2012; 46: 40-49PubMed Google ScholarDiscriminationDiscrimination is differential treatments or outcomes that are unfavourable towards a group or an individual according to some aspect of their actual or perceived identity, such as race, religion, nationality, physical ability, gender, sexual orientation, class, or social status.Epistemic injusticeIn this Series paper, epistemic injustice refers to how knowledge and the production of knowledge are weighted, with credibility given to those at the top of an established racial or power hierarchy.19Fricker M Epistemic injustice: power and the ethics of knowing. Oxford University Press, Oxford2007Crossref Scopus (3161) Google ScholarEthnicityEthnicity is a social construct based on characteristics like language spoken, values, cultural factors, behaviours, and ancestral geographical locations.20Bhopal R Glossary of terms relating to ethnicity and race: for reflection and debate.J Epidemiol Community Health. 2004; 58: 441-445Crossref PubMed Scopus (334) Google Scholar There is overlap between racial and ethnic categories, since groups of people who share social characteristics are also likely to share physical phenotypes.Hierarchical powerA system where stratification of society occurs according to categories (eg, race), and people at the top are actively afforded privilege, capabilities, and capital.IndigeneityThe UN Declaration of the Rights of Indigenous Peoples (article 33) provides that Indigenous people themselves define their own identities; however, the following is a working definition of Indigenous communities, peoples, and nations by Martinez Cobo:21State of the world's Indigenous peoplesIntroduction.https://www.un.org/esa/socdev/unpfii/documents/SOWIP/en/SOWIP_introduction.pdfDate: 2022Date accessed: November 23, 2022Google Scholar, 22Martínez Cobo J Study of the problem of discrimination against indigenous populations. 1987.https://digitallibrary.un.org/record/133666?ln=enDate accessed: November 24, 2022Google Scholar “Indigenous communities, peoples and nations are those which, having a historical continuity with pre-invasion and pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the societies now prevailing on those territories, or parts of them. They form at present non-dominant sectors of society and are determined to preserve, develop and transmit to future generations their ancestral territories, and their ethnic identity, as the basis of their continued existence as peoples, in accordance with their own cultural patterns, social institutions and legal system.”Intergenerational dragIntergenerational drag describes how current differences and disadvantages in the health and social status of a group can be based on historical events that accumulate and persist over generations.IntersectionalityA term coined by Kimberlé Crenshaw,23Crenshaw K Mapping the margins: intersectionality, identity politics, and violence against women of color.Stanford Law Rev. 1991; 43: 1241-1299Crossref Google Scholar intersectionality refers to the ways in which the categorisations of people, such as race, gender, class, and associated systems of oppression, such as white supremacy, patriarchy, and ableism, overlap and interact to create unique dynamics and effects.24Center for Intersectional JusticeWhat is intersectionality.https://www.intersectionaljustice.org/what-is-intersectionalityDate: 2021Date accessed: September 13, 2022Google ScholarMinoritisedMinoritised is defined as individuals and populations, including numerical majorities, whose collective cultural, economic, political, and social power has been eroded through the targeting of identity.25Selvarajah S Deivanayagam TA Lasco G et al.Categorisation and minoritisation.BMJ Glob Health. 2020; 5: e004508Crossref PubMed Scopus (17) Google Scholar, 26Gunaratnam Y Researching ‘race’ and ethnicity: methods, knowledge and power. Sage Publications, London2003Crossref Google ScholarRacial capitalismAn exploitative process, where economic and social value is extracted from someone with a different racial identity.RaceRace is a socially constructed classification that relies on someone's actual or perceived physical appearance and ancestry.27Lopez IH White by law: the legal construction of race. NYU Press, New York, NY2006Google Scholar The meaning and categories of race can change over time, location, and context.20Bhopal R Glossary of terms relating to ethnicity and race: for reflection and debate.J Epidemiol Community Health. 2004; 58: 441-445Crossref PubMed Scopus (334) Google Scholar, 28Saini A Superior: the return of race science. Fourth Estate, London2019Google Scholar Race has been used as a mechanism for assigning superiority and inferiority, and determining access to resources and human rights,29Mellinger WM Haney Lopez IF White by law: the legal construction of race.Contemp Sociol. 1997; 26: 588Crossref Google Scholar despite racial hierarchies being biologically baseless.30Institute of Race RelationsDefinitions.https://irr.org.uk/research/statistics/definitions/Date: 2014Date accessed: December 22, 2020Google ScholarRacismAn organised system that affords power and privilege according to an established hierarchy31Berman G Paradies Y Racism, disadvantage and multiculturalism: towards effective anti-racist praxis.Ethn Racial Stud. 2010; 33: 214-232Crossref Scopus (137) Google Scholar, 32Bonilla-Silva E Rethinking racism: toward a structural interpretation.Am Sociol Rev. 1997; 62: 465Crossref Scopus (1372) Google Scholar based on racial categories.33Gilmore RW Golden gulag: prisons, surplus, crisis, and opposition in globalizing California. University of California Press, 2007Google Scholar, 34Delgado R Stefancic J Critical race theory: an introduction. NYU Press, New York, NY2012Google Scholar, 35Ford CL Airhihenbuwa CO Critical race theory, race equity, and public health: toward antiracism praxis.Am J Public Health. 2010; 100: S30-S35Crossref PubMed Scopus (448) Google Scholar Racism operates to protect the rights, power, and livelihoods of those at the top of the hierarchy.33Gilmore RW Golden gulag: prisons, surplus, crisis, and opposition in globalizing California. University of California Press, 2007Google Scholar Based on the model of Nazroo and colleagues, we subcategorise racism into interpersonal, institutional, and structural.36Nazroo JY Bhui KS Rhodes J Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism.Sociol Health Illn. 2020; 42: 262-276Crossref PubMed Scopus (69) Google Scholar Interpersonal racism occurs between individuals. Institutional racism occurs where institutional policies and practices result in discrimination based on race. Structural racism is at the core of other forms of racism,37Racial equity toolsGlossary.https://www.racialequitytools.org/glossaryDate: 2013Date accessed: October 2, 2021Google Scholar describing the macro-level processes and systems that maintain and perpetuate racial inequity.32Bonilla-Silva E Rethinking racism: toward a structural interpretation.Am Sociol Rev. 1997; 62: 465Crossref Scopus (1372) Google Scholar, 38Gee GC Ford CL Structural racism and health inequities: old issues, new directions.Du Bois Rev. 2011; 8: 115-132Crossref PubMed Scopus (650) Google Scholar, 39Ford CL Airhihenbuwa CO Commentary: just what is critical race theory and what's it doing in a progressive field like public health?.Ethn Dis. 2018; 28: 223-230Crossref PubMed Scopus (63) Google ScholarSeparationThe process by which some humans see themselves as being different from others (and from animals and nature).XenophobiaXenophobia is the fear or hatred of, or discrimination against, those who are considered to be foreigners.Further and more detailed definitions and explanations can be found in our appendix (p 1). Caste Caste systems, most commonly found in the Indian subcontinent, are categorisations whereby people are stratified according to hereditary groups linked to occupations. These hierarchies determine access to resources and opportunities, based on the ‘innate superiority’ of higher castes.18Desai S Dubey A Caste in 21st century India: competing narratives.Econ Polit Wkly. 2012; 46: 40-49PubMed Google Scholar Discrimination Discrimination is differential treatments or outcomes that are unfavourable towards a group or an individual according to some aspect of their actual or perceived identity, such as race, religion, nationality, physical ability, gender, sexual orientation, class, or social status. Epistemic injustice In this Series paper, epistemic injustice refers to how knowledge and the production of knowledge are weighted, with credibility given to those at the top of an established racial or power hierarchy.19Fricker M Epistemic injustice: power and the ethics of knowing. Oxford University Press, Oxford2007Crossref Scopus (3161) Google Scholar Ethnicity Ethnicity is a social construct based on characteristics like language spoken, values, cultural factors, behaviours, and ancestral geographical locations.20Bhopal R Glossary of terms relating to ethnicity and race: for reflection and debate.J Epidemiol Community Health. 2004; 58: 441-445Crossref PubMed Scopus (334) Google Scholar There is overlap between racial and ethnic categories, since groups of people who share social characteristics are also likely to share physical phenotypes. Hierarchical power A system where stratification of society occurs according to categories (eg, race), and people at the top are actively afforded privilege, capabilities, and capital. Indigeneity The UN Declaration of the Rights of Indigenous Peoples (article 33) provides that Indigenous people themselves define their own identities; however, the following is a working definition of Indigenous communities, peoples, and nations by Martinez Cobo:21State of the world's Indigenous peoplesIntroduction.https://www.un.org/esa/socdev/unpfii/documents/SOWIP/en/SOWIP_introduction.pdfDate: 2022Date accessed: November 23, 2022Google Scholar, 22Martínez Cobo J Study of the problem of discrimination against indigenous populations. 1987.https://digitallibrary.un.org/record/133666?ln=enDate accessed: November 24, 2022Google Scholar “Indigenous communities, peoples and nations are those which, having a historical continuity with pre-invasion and pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the societies now prevailing on those territories, or parts of them. They form at present non-dominant sectors of society and are determined to preserve, develop and transmit to future generations their ancestral territories, and their ethnic identity, as the basis of their continued existence as peoples, in accordance with their own cultural patterns, social institutions and legal system.” Intergenerational drag Intergenerational drag describes how current differences and disadvantages in the health and social status of a group can be based on historical events that accumulate and persist over generations. Intersectionality A term coined by Kimberlé Crenshaw,23Crenshaw K Mapping the margins: intersectionality, identity politics, and violence against women of color.Stanford Law Rev. 1991; 43: 1241-1299Crossref Google Scholar intersectionality refers to the ways in which the categorisations of people, such as race, gender, class, and associated systems of oppression, such as white supremacy, patriarchy, and ableism, overlap and interact to create unique dynamics and effects.24Center for Intersectional JusticeWhat is intersectionality.https://www.intersectionaljustice.org/what-is-intersectionalityDate: 2021Date accessed: September 13, 2022Google Scholar Minoritised Minoritised is defined as individuals and populations, including numerical majorities, whose collective cultural, economic, political, and social power has been eroded through the targeting of identity.25Selvarajah S Deivanayagam TA Lasco G et al.Categorisation and minoritisation.BMJ Glob Health. 2020; 5: e004508Crossref PubMed Scopus (17) Google Scholar, 26Gunaratnam Y Researching ‘race’ and ethnicity: methods, knowledge and power. Sage Publications, London2003Crossref Google Scholar Racial capitalism An exploitative process, where economic and social value is extracted from someone with a different racial identity. Race Race is a socially constructed classification that relies on someone's actual or perceived physical appearance and ancestry.27Lopez IH White by law: the legal construction of race. NYU Press, New York, NY2006Google Scholar The meaning and categories of race can change over time, location, and context.20Bhopal R Glossary of terms relating to ethnicity and race: for reflection and debate.J Epidemiol Community Health. 2004; 58: 441-445Crossref PubMed Scopus (334) Google Scholar, 28Saini A Superior: the return of race science. Fourth Estate, London2019Google Scholar Race has been used as a mechanism for assigning superiority and inferiority, and determining access to resources and human rights,29Mellinger WM Haney Lopez IF White by law: the legal construction of race.Contemp Sociol. 1997; 26: 588Crossref Google Scholar despite racial hierarchies being biologically baseless.30Institute of Race RelationsDefinitions.https://irr.org.uk/research/statistics/definitions/Date: 2014Date accessed: December 22, 2020Google Scholar Racism An organised system that affords power and privilege according to an established hierarchy31Berman G Paradies Y Racism, disadvantage and multiculturalism: towards effective anti-racist praxis.Ethn Racial Stud. 2010; 33: 214-232Crossref Scopus (137) Google Scholar, 32Bonilla-Silva E Rethinking racism: toward a structural interpretation.Am Sociol Rev. 1997; 62: 465Crossref Scopus (1372) Google Scholar based on racial categories.33Gilmore RW Golden gulag: prisons, surplus, crisis, and opposition in globalizing California. University of California Press, 2007Google Scholar, 34Delgado R Stefancic J Critical race theory: an introduction. NYU Press, New York, NY2012Google Scholar, 35Ford CL Airhihenbuwa CO Critical race theory, race equity, and public health: toward antiracism praxis.Am J Public Health. 2010; 100: S30-S35Crossref PubMed Scopus (448) Google Scholar Racism operates to protect the rights, power, and livelihoods of those at the top of the hierarchy.33Gilmore RW Golden gulag: prisons, surplus, crisis, and opposition in globalizing California. University of California Press, 2007Google Scholar Based on the model of Nazroo and colleagues, we subcategorise racism into interpersonal, institutional, and structural.36Nazroo JY Bhui KS Rhodes J Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism.Sociol Health Illn. 2020; 42: 262-276Crossref PubMed Scopus (69) Google Scholar Interpersonal racism occurs between individuals. Institutional racism occurs where institutional policies and practices result in discrimination based on race. Structural racism is at the core of other forms of racism,37Racial equity toolsGlossary.https://www.racialequitytools.org/glossaryDate: 2013Date accessed: October 2, 2021Google Scholar describing the macro-level processes and systems that maintain and perpetuate racial inequity.32Bonilla-Silva E Rethinking racism: toward a structural interpretation.Am Sociol Rev. 1997; 62: 465Crossref Scopus (1372) Google Scholar, 38Gee GC Ford CL Structural racism and health inequities: old issues, new directions.Du Bois Rev. 2011; 8: 115-132Crossref PubMed Scopus (650) Google Scholar, 39Ford CL Airhihenbuwa CO Commentary: just what is critical race theory and what's it doing in a progressive field like public health?.Ethn Dis. 2018; 28: 223-230Crossref PubMed Scopus (63) Google Scholar Separation The process by which some humans see themselves as being different from others (and from animals and nature). Xenophobia Xenophobia is the fear or hatred of, or discrimination against, those who are considered to be foreigners.Further and more detailed definitions and explanations can be found in our appendix (p 1). There are many different ways in which people are categorised. Each method responds to the population and history of a specific location, and none encompass all groups adequately.25Selvarajah S Deivanayagam TA Lasco G et al.Categorisation and minoritisation.BMJ Glob Health. 2020; 5: e004508Crossref PubMed Scopus (17) Google Scholar The terms we use can never capture the complexity of an individual. We acknowledge the extensive discourse surrou" @default.
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