A/HRC/56/68/Add.1 35. Individuals from racially marginalized groups are also more likely to experience the harmful effects of the systemic racism baked into a food system that is grounded in racially discriminatory land acquisition and use, exploitative labour, and corporate food dependence. In relation to such trends, the Special Rapporteur received concerning information about the severe exploitation of migrant workers who perform farmwork under H-2A visas, the exclusion of farmers of African descent from federal support to farmers, and some gaps and weaknesses in federal food assistance programmes. I. Health care and health outcomes 36. The racially inequitable morbidity and mortality rates witnessed during the coronavirus disease (COVID-19) pandemic laid bare the systemic racism in the health-care system of the United States. Inequities reportedly persist across the health-care system. Policy decision-making in the health sector, which impacts the social determinants of health, further establishes entrenched racial hierarchies in enjoyment of the right to health and access to health care in the United States. Despite research establishing the roles that physicians, hospital systems and others may play in the everyday manifestation of systemic racism, 18 the sector has not responded with urgency or immediacy in promoting accountability, remediation or reform. Years later, people of African and/or Latino descent continue to experience the same systemic deficiencies in their care. 37. Those from marginalized racial and ethnic groups experience higher rates of illness and death across a wide range of health conditions, including diabetes, hypertension, obesity, asthma and heart disease.19 These health outcomes are determined by various manifestations of systemic racism, including issues relating to access to quality food, access to health-care services, and racism and unconscious bias among health-care providers against people from marginalized racial and ethnic groups when they access services.20 The Special Rapporteur received many reports about the lack of access to health care, including mental health care, among marginalized racial and ethnic groups due to a lack of facilities, including in rural areas; racially inequitable health insurance coverage; and gaps within insurance coverage. The Special Rapporteur commends measures taken by the Department of Health and Human Services, such as the National Institutes of Health UNITE and Community Partnerships to Advance Science for Society (ComPASS) initiatives. She welcomes the fact that their work has recognized the racially inequitable impact of the COVID-19 pandemic and taken it as impetus to further apply a racial and ethnic equity lens to their work. She also appreciates that their work, including on disability, recognizes intersectional forms of discrimination and how these impact health outcomes. 38. The Special Rapporteur was deeply concerned by the racially inequitable impact of both the maternal mortality crisis and the federal Supreme Court decision in Dobbs v. Jackson Women’s Health Organization. It is shocking that women, particularly women of African descent and Indigenous women, can neither choose to safely have a child within the health-care system nor choose to freely have a safe, legal abortion. The Special Rapporteur welcomes measures taken by the Government to address this crisis, including the White House Blueprint for Addressing the Maternal Health Crisis; Executive Order 14076, entitled Protecting Access to Reproductive Health-care Services; and Executive Order 14079, entitled Securing Access to Reproductive and Other Health-care Services. 18 19 20 GE.24-08027 Tiffani J. Johnson and others, “The impact of cognitive stressors in the emergency department on physician implicit racial bias”, Academic Emergency Medicine, vol. 23, No. 3 (2016), pp. 297–305; Kelly M. Hoffman and others, “Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites”, Proceedings of the National Academy of Sciences of the United States, vol. 113, No. 16 (2016), pp. 4296–4301; and Salima H. Meghani, Eeeseung Byun and Rollin M. Gallagher, “Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States”, Pain Medicine, vol. 13, No. 2 (February 2012), pp. 150–74. Centers for Disease Control and Prevention, “Racism and health”, available at https://www.cdc.gov/minorityhealth/racism-disparities/index.html. Centers for Disease Control and Prevention, “Health disparities”, available at https://www.cdc.gov/healthyyouth/disparities/index.htm. 9