Taking origins into account in medical reasoning in infectious and tropical diseases? A critical look

Abstract

Healthcare discriminations based on one's ethnic background is increasingly being studied in medicine. The scale of the Covid-19 pandemic has played an important role in bringing them to light. Data, although scarce, exist in France. These discriminations have an impact on the care pathway and contribute to the renunciation of care by the most affected populations. The issue of discrimination is particularly relevant in infectious diseases. Although the epidemiology of infectious diseases is unevenly distributed worldwide, erroneous social representations are prevalent and expose to a harmful prejudice against migrants with regard to infectious diseases. The transmissible nature of some infectious diseases reinforces their stigmatizing potential. In this context, it seems important to discuss the dimension to be given to social determinants, geographical origin, phenotype, and ethnicity in teaching and medical reasoning. The English-speaking world uses the concept of "race" in a structural way, whereas this "international standard" has not been applied in France until now. To improve the care of people from minority groups, it seems important to better document and teach a more nuanced clinical reasoning based on origin, without neglecting the importance of collecting and taking into account social determinants of health and environmental factors.