Amid the rise of the Black Lives Matter movement in the UK and the disproportionate mortality rate amongst BAME (Black, Asian and minority ethnic) people during the Covid-19 pandemic, it’s never been more important to talk about what racism looks like in Britain.
Whether it’s the disproportionate impact of austerity measures on the income of Black British households, the wrongful detention and deportation of members of the Windrush generation, or the fact that Black men are more likely to be stopped and searched, arrested, prosecuted and held in high security conditions once convicted when compared to white men, it is undeniable that stark racial disparities exist across systems within the UK.
Unfortunately, as a healthcare professional, I’ve come to understand the healthcare system is no exception.
I have seen first-hand how racial and ethnic minority groups suffer from some of the poorest health outcomes in the UK. Compared to their white counterparts, Black people are over-represented in mental health institutions and are over four times more likely to be sectioned due to psychiatric illness. Black women are five times more likely to die post-birth, and infant mortality is highest amongst BAME groups. Black and south Asian subpopulations have also been found to be at least two times more likely to die of Covid-19.
It is well-known that social factors, like poverty, drive poor health outcomes amongst British minorities. However, the course of one’s health is also often dictated by race itself. I have witnessed colleagues work longer and harder to develop research and clinical care so that the health needs of racial minorities are addressed, but rather naively many of us have ignored the elephant in the room – the impact of racism on health outcomes.
“I can recall numerous Black patients with sickle cell disease who felt their complaints of pain were disregarded.”
In the UK, BAME groups persistently experience the lowest levels of satisfaction when engaging with healthcare. It is undeniable that implicit racial biases that exist within society are just as present in the healthcare setting.
These biases have the potential to worsen health inequalities by polluting our interactions with patients of colour.
This has never been more evident to me than when patients complain of subjective symptoms like pain. I can recall numerous cases of Black patients with sickle cell disease who felt their complaints of pain were disregarded, despite it being a typical characteristic of their condition.
I remember a particularly distressing example – a twenty-something man who came to our unit for pain management.
As a young, Black man actively seeking moderate pain relief, on a Saturday night sporting 90s-inspired street fashion in the inner city, my nursing colleague and I both knew that his proximity to racist media portrayals of Black men could taint his interaction with some staff.
Later that night, my nursing colleague was in tears as her patient’s successive requests for pain relief were met with excessive scrutiny as his condition worsened.
The mistreatment of this young Black man was a deeply disconcerting display of how unconscious biases can lead to substandard healthcare provision on our part. I was troubled not only by the hostility with which he was met, but by the potential repercussions that this negative experience may have on his health-seeking behaviours in the future.
In addition to these biases, policies like the Prevent strategy and the “hostile environment” policy may also exacerbate inequalities. Prevent imposes a statutory requirement on NHS staff to report patients who exhibit specific indicators of “radicalisation” which include “feeling persecuted”, “changing friends and appearance” and “converting to a new religion”.
Critics continue to voice concerns about the quality – and paucity – of evidence that the strategy was founded upon.
Amongst referrals from schools for perceived radicalisation, the majority of cases have been marred with racial and religious stereotyping.
Referrals from the NHS also disproportionately include Asian patients and those racialised as Muslim. One report even recounts the ill-suited referral of a young man, who was incapable of undertaking day-to-day tasks such as self-feeding or walking independently, to Prevent by his physiotherapist for watching videos of Islamic sermons online.
“I have asked immigration officers to pause their questioning of an elderly, Indian gentleman who was violently short of breath having just been carried out of an ambulance with an oxygen mask.”
The “hostile environment”, which makes it more difficult for those without leave to remain to access UK healthcare, also contributes to worsening health disparities based on race.
As a UN Special Rapporteur on Racism once reported in 2019, the policy “is destroying the lives and livelihoods of racial and ethnic minority communities”. This is due to harassment, racial profiling and misunderstandings between race, ethnicity and immigration status.
The impact of the policy on the ground is unsettling; I have recoiled as a colleague attempted to block an urgent referral for a young man with advanced cancer given her misunderstanding regarding eligibility to healthcare. I also have asked immigration officers to pause their questioning of an elderly, Indian gentleman who was violently short of breath having just been carried out of an ambulance with an oxygen mask.
Policing healthcare like this will impair the relationship between patients and the healthcare system with racial minority patients being worse off.
If we are truly committed to the fight against health inequities in the UK, it is time to refine our understanding of racism to include broader structures that have long underpinned deep-seated inequalities in the UK.
It is paramount that we not only acknowledge, but dismantle, racist structures in all of its forms within healthcare – including implicit biases and poorly-reasoned health policy – so that no-one in Britain is at a disadvantage based on their race. Only then will our efforts to improve the public health of racial minorities on the ground bear fruit.
Dr Harun Khan is a physician, public health researcher. Follow him on Twitter @haruunsays
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