You call it soccer, we call it football….but the true conversation we should be having is about migrant labourers and LGBTQ+ people.
On a recent visit to the USA, while we were watching the FIFA World Cup soccer currently being played in Qatar on TV, David Beckham appeared in an advertisement trying to explain the difference between soccer and football and chips and crisps to an American Football player.
The Twitter-sphere had been buzzing with views that due to Qatar’s human rights record, particularly the treatment of migrant labourers and LGBTQ+ people, audiences should boycott the World Cup and not watch it. This raises very interesting ethical questions.
In an episode of ‘Have I Got News For You’ (a British panel show), Gary Neville was put on the spot when the panel asked him whether he was going to Qatar to provide commentary and, rather sheepishly, he said that he was. There is no doubt that the persecution of LGBTQ+ individuals there is a major issue, but, around the world, private, consensual, same-sex activity is illegal in 68 jurisdictions. In 11 countries, same-sex activity is punishable by a death sentence.
Follow this link to an interactive world map providing more information about the criminalisation of LGBTQ+ people.
It has been shown that more secular and affluent countries are more accepting of same-sex activity.
The challenge is how do we, as psychiatrists, members of society, and advocates, deal with these situations?
If we were to boycott every country where same-sex activity is illegal, should we exclude playing cricket in and with countries like Pakistan and many Caribbean countries? Should we engage with countries where same-sex activities are illegal, whether it is to do trade deals, exchange academic activities or play sports, in the hope that jaw-jaw is better than no jaw? There are no easy answers.
There is impressive evidence even within the USA, where rates of psychiatric illnesses drop in states which have equal rights for their LGBTQ+ population in law. If we assume that 5% of the population is LGBTQ+, then 500 million people in the world belong to sexual minorities and providing equity to them is a significant and major task. The discrimination and stigma they face lead to psychiatric illnesses, confirming that as clinicians we need to be cognisant of the model of bio-psychosocial causation as well as management.
Vulnerable groups, be they women, LGBTQ+, religious minorities, or persons living with disabilities, all need equal rights. Regrettably, all these vulnerable groups face discrimination in one way or another. These negative attitudes are moulded by personal factors, family influences, community factors, and national policies.
Cultures mould, shape, and reflect negative attitudes, which then tend to get enshrined in law. Tragically, very often belonging to sexual minorities, even though they exist in all cultures, is seen as a Western condition which is perceived as being imposed upon non-Western cultures. Often, with a Euro-centric worldview, cultural relativism gets forgotten and other cultures are denigrated as inferior, backward, or traditional, without exploring the cultural factors which we may well disagree with.
The challenge for psychiatrists across the globe is how to advocate for vulnerable groups. Being aware of research evidence which confirms that vulnerable individuals have higher than expected rates of psychiatric disorders, which drop when equity and equality are introduced, is an important factor. Perhaps pilot studies in each individual culture may give further understanding of cultural norms and variations.
It is obvious that once people feel mentally well, and their physical and mental health is better, they function better and show better productivity. This in turn has a major impact on the economy and on the culture and country. Clinicians can work with all those who are sympathetic and understanding of the challenges and discrimination faced by vulnerable groups and may be able to advocate better. Using research evidence can help reduce discrimination, which in turn can lower rates of psychiatric disorders and consequent help-seeking.
Boycotting the World Cup on the grounds that human rights are being ignored is important and conveys a message. If all the teams had negotiated and gone with the love band, that would have been a significant act and a very clear message to politicians and rulers but also to players’ organisations and FIFA.
In managing the mental health and wellbeing of populations, political, cultural, and commercial determinants of mental health need to be understood and can be employed using a multi-layered approach, rather than a single angle. Clinicians need to learn about advocacy and working with patients in order to change the laws so that true equity can be achieved. It is important that all healthcare professionals are taught about how to advocate at community, regional, national and international levels.