Ebola as an Instrument of Discrimination

Nov 21, 2014, 1:00 PM, Posted by Allison Aiello

Jennifer Schroeder, Stephanie M. DeLong, Shannon Heintz, Maya Nadimpalli, Jennifer Yourkavitch, and Allison Aiello, PhD, MS, professor at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. This blog was developed under the guidance of Aiello’s social epidemiology seminar course.

Ebola is an infectious disease that the world has seen before in more moderate outbreaks in Africa. As the devastating Ebola outbreak in West Africa has taken a global turn, fear, misinformation and long-standing stigma and discrimination have acted as major contributors to the epidemic and response. Stigma is a mark upon someone, whether visible or invisible, that society judgmentally acts upon. Ebola has become a significant source of stigma among West Africans and the Western world.

In many ways, the source of this discrimination can be traced back to the legacy of colonialism and the western approach to infectious disease response in Africa. The history of foreign humanitarian aid has sometimes dismissed cultural traditions and beliefs. As a consequence, trust in westerners has eroded and has been compounded by a disconnect between western humanitarian aid approaches and a lack of overall infrastructure investment on the part of African national health systems. This is apparent in the Ebola epidemic in West Africa. Some don’t actually think that Ebola exists; instead they believe that it is a hoax carried out by the Western world. All of these factors are facilitating the rapid spread of the disease.

In addition to being stigmatized and discriminated against, some infected with Ebola are afraid to utilize the already fragile health care infrastructures within their countries. Has Ebola hit this region so hard because the disease is more virulent or susceptibility has increased? Clearly the answer is no.

This disease is being spread socially within families and communities, because without adequate hospital facilities, families—especially women—are the primary caregivers of the sick.  Needed humanitarian aid money will hopefully flow into affected West African countries. Nonetheless, this is akin to putting bandages on a hemorrhaging health care infrastructure. This devastating epidemic must be a wake-up call to donor nations and African leaders to focus inputs on strengthening infrastructure and adequately equipping the health workforce. Additionally, tamping down this epidemic cannot be the only focus. Working in concert with governments and local communities to lead and assist in building strong health care infrastructure from the ground up may help reduce the legacy of colonialism’s broken system responses.

These issues of stigma and discrimination also transcend oceans as individuals deal with travel and immigration into the United States. Who wants to be “marked” at airport screening points just because you are West African or have recently traveled there? If you are a health care worker like Kent Brantley, MD, shouldn’t you be able to come home and receive the best health care treatment you can, to try and live? If you are traveling to another part of Africa, outside the outbreak, should you be made to stay home from work upon returning to the United States, like a woman in North Carolina? Is it fair to politicize by conflating disease spread with Hispanic/Latin American immigrants crossing the United States-Mexico border, as has been done in the popular media?

Despite the science involved, and repeated statements by health officials about Ebola transmission, public fear in the United States has driven stigmatization and discrimination against individuals traveling into the United States from the Western African countries most affected by the Ebola outbreak, other African nations, and Latin American countries. We need to act on sound science, not fear in America, when dealing with Ebola.

Unfortunately, an ever-growing culture of fear and misinformation in the United States is slowing the pace of quelling the outbreak and is promoting the stigmatization of certain groups, regardless of facts. Indeed, children of Senegalese descent in New York City were recently beaten and called “Ebola” by their peers, yet school authorities refused to call the incident more than a schoolyard fight. A teacher in Kentucky was recently forced to resign after frightened parents claimed she could transmit Ebola to their children after a mission trip to Kenya, a country that has reported no Ebola cases and is thousands of miles away from West Africa.

We saw the same fear and misinformed reactions play out 30 years ago during the HIV/AIDS epidemic. What is it about Ebola that makes us ignore the facts, and think we are justified in promoting a culture of discrimination rather than addressing the route problems of the outbreak? In order to stop the spread of Ebola, the history of corruption due to colonialism and the actual problems created by paternalistic power structures (e.g. dependence on foreign aid, health spending priorities determined by foreign aid donors rather than national health ministries, etc.) must be broadly recognized.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.