In this article, we examine how immigrants from eastern Africa to the Minneapolis and St. Paul metropolitan area understand and navigate the U.S. color line and its implications for nonwhites. Although these immigrants are subject to constraints based on their racial status as black, they mobilize other intersecting aspects of their identities to manipulate racial classifications in the hopes of attaining upward mobility in the United States, even when doing so creates other social costs for them. Eastern African immigrants draw on their ethnicity and, among Muslim immigrants, their religion to differentiate themselves from African Americans, who occupy the lowest position in the U.S. racial hierarchy. In challenging their categorization as racially black and seeking to move up the racial hierarchy, Eastern African immigrants refine the color line to distinguish between African‐American blacks and non‐African‐American blacks.
Background This article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients’ socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis. Methods Tanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases check-ups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients’ perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis. Results Median delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This “churning” required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients’ narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost. Conclusions Late diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania’s policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care.
Activists intervened to reduce the occurrence of female genital cutting practices (FGCs) on the basis of a right to health before the actual health consequences of the practices had been studied. This led to an exaggeration of the health consequences and a failure to differentiate among the different types of FGCs. In reaction, some scholars began to claim that the health consequences of FGCs were insufficient to justify eradication efforts. Others questioned whether countries should criminalize FGCs, arguing that this increased the potential harm by forcing the practices underground. Ultimately, a large‐scale, systematic study by the World Health Organization quieted the debate when it revealed that FGCs had serious health consequences, even in clinical settings.
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