Racism and Health: A Public Health Crisis We Can Solve

Racism: A Multigenerational, Systemic Problem

Racism isn’t simply prejudice. It’s a system that unequally advantages or disadvantages individuals and communities based on race. Its impact transcends generations, affecting health through various mechanisms. From shaping health policies to influencing economic opportunities, racism’s insidious roots permeate every facet of society.

The evidence is undeniable. We witness its devastating effects in stark and persistent health inequalities. Black women are four times more likely to die in childbirth than white women. South Asians have a significantly higher risk of heart disease. Lack of trust and confidence of health and care system results in poor utilisation of effective health services and poor uptake of life saving interventions including cancer screening and vaccinations. These disparities aren’t random. They are a direct consequence of structural racism intersecting with other factors including poverty and socio-economic disadvantage, and other types of structural discrimination. These include sexism and homophobia, cultural beliefs and practices, and one’s understanding, ability and confidence to engage with healthcare systems.

Studies now show that structural racism uniquely impacts health and care through various routes, leading to inequalities in access, experience and outcomes. These pathways include:

• Access Barriers: Racism can lead to distrust in healthcare systems, hindering timely access to care.
• Clinical Decision-Making Bias: Studies show Black patients may receive less pain medication than white patients for similar conditions. This bias extends to maternity services and other areas, including how thoroughly patients are investigated and managed for their conditions.
• Unequal Outcomes: Racism leads to disparities in patient outcomes, with Black and Minority Ethnic (BAME) communities experiencing poorer outcomes, delays in diagnosis, and suboptimal treatment.
• Workforce Disparities: A healthcare workforce facing discrimination, bullying and harassment within the system not only negatively impacts the quality and outcomes of care provided but ultimately breeds distrust in the community it serves. This lack of trust creates a vicious cycle leading to worsening loss of confidence and unwillingness to engage.
• Lack of Diversity in Research: The underrepresentation of BAME communities in clinical trials not only hinders understanding of their relevant and specific health issues but also fuels hesitancy to engage with medical interventions e.g. vaccines, genomics, AI, when communities feel excluded from research.

The COVID-19 pandemic exposed these entrenched inequalities even further. Black and ethnic minority communities were disproportionately impacted at every stage, from infection rates to mortality. This wasn’t simply biological. Overcrowded housing, essential worker roles, and lack of trust in healthcare services all played a role. The pandemic served as a stark reminder of the urgency for change.

Moving Beyond Acknowledgement: Towards Anti-Racism

Simply acknowledging racism as a problem isn’t enough. We must actively become anti-racist. This demands introspection – understanding how racism operates in our systems and personal lives. Anti-racism acknowledges white privilege and its impact on perpetuating racial inequities.

So, how do we move forward? Here’s our five-point framework for building an anti-racist public health system in London:

1. Visible Leadership: Leaders must unequivocally name and address racism by establishing governance and programmes focused on dismantling it.
2. Empowering the Workforce: We can’t have an anti-racist system with a mistreated workforce. Combating racism, discrimination, and harassment within our institutions is crucial. Valuing diversity and inclusion, is neither a fad nor ‘woke’, but a necessity for creating a just and equitable environment.
3. Evidence-Based Interventions: Focus on culturally competent, health equity programmes with a proven track record of improving health outcomes and reducing health inequalities. Resources are limited, so prioritise interventions with the greatest impact.
4. Anchor Institutions: Hospitals and healthcare systems can be powerful community anchors. Invest in local Black and minority ethnic communities by directing apprenticeships, training and development, procurement and commissioning services towards them. This action directly address the social determinants of health and helps break down barriers between health systems and local communities.
5. Community Engagement: Rebuild trust by working alongside communities, co-producing solutions, and supporting the vital work of the voluntary sector. Fund these efforts – robust community participation and engagement isn’t free, and voluntary organisations and community members need to be reimbursed for their time, efforts and work in tackling these issues.

Racism may be deeply ingrained, but it’s not insurmountable. By honestly confronting it, adopting anti-racist practices, and working collaboratively, we can create a public health system that serves everyone equally. Let’s transform acknowledgement into action.

When we know better, we must do better. We owe it to ourselves and future generations to build a healthier, more equitable society.