Sometimes I wonder what it will take to make the necessary changes in our world to improve race equality. The more I learn about the complexity and challenges inherent in the race equality agenda, the more impossible it seems that change is likely. Last week, Russia invaded the Ukraine and I along with the rest of the world watched in horror the incomprehensible difficulties faced by people trying to escape war, something I hope I never to have to do. It was noticeable and quite depressing that black and Asian people trying to leave Kyiv were having an even harder time of trying to escape the bombardments than their white counterparts. We saw in brilliant technicolour black people struggling to get out of the country and being turned back at railway stations and at border control checkpoints in Poland. Perhaps we are not seeing or hearing the whole story, who knows but some of the reporting has been interesting, highlighting the difference in language used for white people in this situation as opposed to black or brown people. Fleeing people are evacuees not refugees, asylum seekers or migrants like those fleeing from similar situations in Afghanistan and Syria. “How can this be happening to people that have blonde hair and blue eyes? one commentator asked, “people like us”. It seems that war zones in countries where European people live have a higher level of significance, because in the eyes of the predominantly white western world, it could be them.
Today, I read an article entitled, about Sun-down Towns This article put a shiver down my spine and made me think about the amount of energy we as black and brown people have to expend on keeping ourselves safe and out of harm’s way, it really does take its toll on us psychologically and physically.
This led me to thinking about The Ethnic inequalities in health care: A rapid Review https://www.nhsrho.org/wp-content/uploads/2022/02/RHO-Rapid-Review-Final-Report_v.7.pdf published in February by the NHS Race and Health Observatory, it highlighted the inequalities experienced by black and Asian people in getting the same treatment and outcomes as their white counterparts. Paper after paper, report after report, highlights and documents the inequalities experienced by some sections of the population and the question often asked is why? I believe we all know the answer, it is the elephant in the room that nobody wants to acknowledge, that fundamentally we live in a deeply racist, colourist world. I believe that changing the current situation will be harder than we might think. For a start it needs leaders to really believe that change needs to happen and that the current situation is untenable. David Olusoga Historian and TV personality wrote a piece in The Guardian responding to the NHS RHO report, he asked what was going to be done about the current situation in terms of health inequalities for black, some Asian and some minority ethnic groups. The silence of the response to this question has been deafening.
Over the last year or so we have heard about the unfairness and inequalities and its impact on people from black Asian and minority ethnic backgrounds, the old excuse of not knowing can no longer be used. George Floyd, disproportionate deaths from Covid, the European football tournament and the backlash received by those three black players that missed penalties, more recently the reports about racism in cricket, in the police and unfortunately even reports on the high levels of racism being rife in the health service, reports on black women being 4 times more likely to die in child birth and 40% more likely to experience a miscarriage, the list of inequalities goes on.
These reports and incidents are hard for anyone to hear and digest. It is particularly troubling that in 2022, in this society, there are people that will not like, value or appreciate others based on the colour of their skin. These reports have highlighted the negative and damaging treatment that people of colour receive as a consequence of this blatant and overt racism, from name calling and out and out discrimination to stopping people from boarding trains and not allowing them to cross borders or having sun down towns where black people cannot walk safely after dark. What is interesting about many of the incidents highlighted above is that they have been overt, it has been impossible to ignore them and you would have had to have been on Mars for the last few years not to know that this country and many parts of the world has a serious problem with race equality. No longer can we point across the Atlantic and say, ‘it’s them not us’.
The fact that the kind of racism that’s described above is still present is bad enough, however it’s the more insidious invisible racism that gets into your psyche and does the real physical and psychological damage. It’s curious that everyone I meet talks about the importance of equality and inclusion of fairness and equity, yet everything stays the same.
When Cressida Dick resigned from her role as Police Commissioner for the Metropolitan Police, the Health secretary’s brother Deputy Assistant Commissioner Bas Javid, admitted there was racism in the Metropolitan Police, but only went as far as to say that there were a few bad apples in the Met and that the organisation wasn’t institutionally racist. I would beg to differ from that view. Institutional or systemic racism are silent but extremely effective and can be deadly. A definition of systemic and institutional racism from the Macpherson report is that it is “The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin”. Institutional and systemic racism is developed in the places where policies are made and are shored up by leadership behaviours, human resource practices and procedures. It lives in the very depths of the cultures we have in our organisations, where racial slurs go unchallenged or dismissed as banter. It allows complaints about bullying and harassment that black Asian and minority ethnic staff experience to be seen as them playing the race card and not being believed. It lives in the places that enable the status quo to continue to exist so that some people are more able to thrive than others.
Why when as a society we have so much evidence that shows that people from black Asian and minority ethnic backgrounds have a worse experience during the course of their lives than their white counterparts, that black women are 40 times more likely to miscarry than their white counter parts, that black and Asian women more likely to lose their lives and or their babies in childbirth. That black men are more likely to end up in secure psychiatric hospitals and that many more black and Asian people died of Covid 19 than their white counterparts. The one statistic that particularly stood out for me was that black children are 10 times more likely to be referred to Child and Adolescent Mental Health services (CAMHS) via social services than white children. These are just a few of the facts and data we have that show health inequalities are, on the whole more prevalent amongst people from black Asian and minority ethnic backgrounds
When I read the Ethnic Inequalities in Health Report I reflected on the strength of the evidence in the report. Evidence pulled together from 13,161 references, 178 studies as well as focus groups and it seemed to me that some of the solutions to these inequalities were not that difficult to implement, for instance ensuring we have robust data collection systems to collect and analyse data, having zero tolerance policies in place that are adhered to. Having clear lines in the sand about what is acceptable behaviour and what is not.
One of the recommendations from the report highlights the need for serious commitment from NHS England and Improvement to tackle racist attitudes and behaviours amongst healthcare staff and to address structural dimensions of NHS Systems that discriminate against ethnic minority women and their babies.
I welcome and wholly recommend this excellent report by the RHO, its findings as well as the recommendations are excuse remover in terms of us not being more proactive and more determined to reduce these inequalities in the lives of a substantial number of people living in this country. The RHO have highlighted the fact that there are no lack of reports and their corresponding recommendations on the inequalities that exist in healthcare for black Asian and minority ethnic people. The steps that now need to be taken are to acknowledge their validity and openly accept and agree with what they are saying and to demonstrably put systems in place to make a real and tangible difference for people of colour.
I started this piece by saying that I sometimes wonder what it will take to make people sit up and take notice of the deeply complex and difficult issue of race inequality in our world, Sadly, I don’t have the answer. We can only hope that one day more people will want change than don’t and we can really start to make a positive difference for people of colour in healthcare and ultimately in the wider world.