Racism as a determinant of health: a systematic review and meta-analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.

Child soldiers in the east of the Democratic Republic of Congo

According to the academic literature, the most widely used estimate is that approximately 300,000 children are part of regular and irregular armies worldwide, either as combatants or as support personnel. Moreover, most scholars believe that their numbers are growing. However, the truth is that no one really knows the actual number of child soldiers fighting in some seventy-two government or rebel forces in about twenty countries. This is simply because field work on this subject is notoriously difficult. And as it is in breach of international humanitarian law to engage a child under the age of 18 years, regular armies and guerrilla forces are hardly going to publicize the number of child soldiers in their ranks. Whatever the true number of child soldiers may be, the fact remains that child soldiers have become a principal component of military forces across Africa, Asia, and Latin America. For Africa alone, estimates suggest that there are 120,000 children, 40 per cent of all child soldiers. Moreover, not only has Africa experienced the fastest growth in the use of child soldiers, but the average age of the children enlisted in some African countries is declining as well. And this is despite the fact that there are a number of international treaties and principles that prohibit the use of child soldiers. Successfully bringing peace, security, and the rule of law in the Kivu provinces, in the Democratic Republic of the Congo (DRC), will be a massive challenge that will require domestic and regional measures implemented over probably several years. This will necessitate the continued active political and financial support of the international community.