Racism in healthcare is real and it matters

The Commission on Race and Ethnic Disparities report makes some bold claims, from denying that institutional racism exists, to advocating for a “new story” on how we view the slave trade. On healthcare, its findings also appear somewhat removed from the everyday experiences of many.

It is surprising to see the report appearing to play down the inequalities that are known to exist between different ethnic minorities and their experiences and access to healthcare. The commission suggests there is no racism at play and instead points to wider more complex reasons such as deprivation, education, employment and so on.

The report says: “The commission rejects the common view that ethnic minorities have universally worse health outcomes compared with White people, the picture is much more variable.”

It highlights that ethnic minorities have better outcomes for some key measures like life expectancy, overall mortality and key diseases and conditions, adding: “This evidence clearly suggests that ethnicity is not the major driver of health inequalities in the UK but deprivation, geography and differential exposure to key risk factors.”

But this is a strange analysis, for most experts agree that structural racism within society is one of the factors that contributes to deprivation. It is a cycle which affects social mobility, your life chances, where you live, what sort of house and lifestyle you can adopt.

Racism is woven through many of the ingredients that make up the complex factors that contribute to health inequalities, whereas the report seems to argue they are separate contributors.

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Coming so soon after the Covid pandemic, where black men were three times more likely to die than white men, these conclusions seem almost indecent.

The Commission more broadly and explicitly denies the UK is institutionally racist, but there is little doubt among those in the NHS that the health service certainly does have a race problem. Being an ethnic minority employee for the NHS, the country’s biggest employer, can be a difficult experience for many.

The report uses the fact that almost half of doctors are from an ethnic minority as a positive. This is correct and it is welcome but it’s also true that ethnic minority NHS staff are more likely to be disciplined, more likely to be referred to their professional regulator and less likely to shortlisted for jobs.

The latest data from NHS England shows that for more than 80 per cent of NHS trusts, a higher proportion of Black, Asian and minority ethnic staff compared to white staff experienced harassment, bullying or abuse from colleagues in the last 12 months.

There is a welcome recognition of the pay gap within the NHS, which sees white staff earn more than other groups – but the report avoids calling this out for what it is.

To describe the NHS as a “success” story on race is an extreme interpretation of the facts.

Racism in the NHS and healthcare is very real.

NHS England has been brave enough to admit this is a problem and is trying to do something about it.

Saffron Cordery, deputy chief executive of NHS Providers, which represents hospital trusts, said: “We disagree with the conclusions of this report. Within the largest employer in the country – the NHS – there is clear and unmistakable evidence that staff from ethnic minorities have worse experiences at work and face more barriers in progressing their careers than their white counterparts.

“While some progress has been made, to pretend that discrimination does not exist is damaging as is denying the link between structural racism and wider health inequalities.”

The report makes some valuable recommendations for an independent Office for Health Disparities as well as suggesting NHS England should review the NHS pay gap to understand why staff from ethnic minorities earn less.

Of course health inequalities are complex and there are many factors at play but it seems odd to try and argue that everyone is equal but for all the things that make them unequal.