Much as we love the NHS, we can no longer ignore the ethnic inequalities that beset it
A new report shows that the health service, like other institutions, has a deep-seated problem, a blight that Covid has made harder to ignore
The pandemic has acted like a vast searchlight, sweeping across society, illuminating unpleasant truths that were lurking in the darkness. The potential for online misinformation to unleash a wave of cultish fanaticism, like the current anti-vax movement, long predated the pandemic. The glib libertarian tendency within sections of the Conservative party, a sentiment so often out of step with the public mood in its strident opposition to measures deployed to fight the virus, was similarly hidden in plain sight.
However, the truth most bluntly uncovered by the pandemic is the scale and the depth of inequality in 21st-century Britain. Ours is among the most unequal societies in Europe and among the many axes along which inequality runs is that of race.
In the blaze of the pandemic’s searchlight, ethnic inequalities in healthcare and health outcomes have been more widely publicised than ever before. Once it became clear that people from minority groups were at greater risk of contracting and dying from Covid, a broader debate about ethnic health inequality quickly followed. Today, two years after the first lockdown, the shocking statistic that black women in England are four times more likely to die in pregnancy or childbirth than white women is now well known within the black community. Other disturbing statistics about black people’s experiences of mental health services have also been brought to broader public attention.
In response, during the dark, lockdown days of 2020, the NHS established the Race and Health Observatory, an independent body tasked with researching ethnic health inequalities. The Observatory’s newly published report, built on research by the University of Manchester, in conjunction with the universities of Sheffield and Sussex, states a stark truth in the starkest terms: “Ethnic inequalities in health outcomes are evident at every stage throughout the life course, from birth to death.”
It is normally the case that at publication the authors of a report stress what is new about their findings. They emphasise how their work will change the debate or challenge earlier data. The authors of this report go out of their way to stress the opposite. As they state, little of the information they have carefully collected and collated is new, much of it being drawn from the 178 earlier studies that they identify or cite. The problem is not a lack of reports; it is, as they note, “that existing evidence hasn’t led to significant change”.
Among the factors that they conclude have negatively affected “the health of ethnic minority people” is “discriminatory treatment from healthcare staff”. As a result of such experiences, some from minority communities have delayed “seeking help for health problems due to fear of racist treatment”.
Another reality that has become better understood over recent years is that racism is personally damaging. Discrimination hurts, it is corrosive, it wears people down and, unsurprisingly, those who have experienced it seek to avoid further exposure. They choose not to place themselves in harm’s way even if, as this report shows, that is to the detriment of their health.
Talking about the NHS critically is difficult because the NHS is special, a unique and uniquely loved institution. It is held in such esteem that its failings seem to matter more than those of other institutions and the urge to praise the service can at times overwhelm the need for clear-eyed analysis. For that reason, the notion that, like other national institutions, the NHS has a problem with various forms of racism – “structural, institutional and interpersonal”, as the report categorises them – is for some difficult to accept.
The demographic who will have the least difficulty coming to terms with this are people of colour who work in the NHS. In 2021, I made a documentary about the history of the service, for which we interviewed doctors and nurses who had built their NHS careers from the late 1940s. Many spoke in detail about their experiences of the racism and discrimination within the service, a subject that is also tackled within the Observatory’s report.
The pandemic has further complicated the picture. For most of us, Covid has been among the most profound experiences of our lives. As the NHS became an epidemiological front line, our national affection for the service was heightened. The millions of children who in 2020 stood by their parents, as we banged pots and pans and cheered for the 1.3 million people who work in the NHS, will remember that experience for the rest of their lives. They will remember it in the same way that today’s octogenarians remember air-raid sirens and rationing.
Perhaps never in its history has the NHS been more publicly praised and at the same time never have its frailties, and the health inequalities that stem from them, been better understood. Our deep respect for the NHS should not blind us for the fact that it is in need of reform. Yet to even place “NHS” and “reform” in the same sentence feels transgressive. For decades, those whose ideological mission is to carve up and privatise the service have deployed the idea of reform as political camouflage for that politically toxic project. But it must surely be possible to devise needed reforms that are very different from those that linger in the minds of the small staters and disaster-capitalists.
The NHS is special but its failings are not unique. It needs reform in the same way that the Met police and the wider criminal justice system need reform. Both sectors – healthcare and policing and criminal justice – have manifestly failed minority communities and in both cases there is no shortage of data detailing the nature and consequences of those failings. The question now is whether a government that largely ignored the previous reports on which the Race and Health Observatory’s work is built will be willing to contemplate anything like the level of change shown to be necessary. Our love for the NHS cannot be unconditional. It can only truly be a national health service if it treats all the communities that make up the nation equally.
However, the truth most bluntly uncovered by the pandemic is the scale and the depth of inequality in 21st-century Britain. Ours is among the most unequal societies in Europe and among the many axes along which inequality runs is that of race.
In the blaze of the pandemic’s searchlight, ethnic inequalities in healthcare and health outcomes have been more widely publicised than ever before. Once it became clear that people from minority groups were at greater risk of contracting and dying from Covid, a broader debate about ethnic health inequality quickly followed. Today, two years after the first lockdown, the shocking statistic that black women in England are four times more likely to die in pregnancy or childbirth than white women is now well known within the black community. Other disturbing statistics about black people’s experiences of mental health services have also been brought to broader public attention.
In response, during the dark, lockdown days of 2020, the NHS established the Race and Health Observatory, an independent body tasked with researching ethnic health inequalities. The Observatory’s newly published report, built on research by the University of Manchester, in conjunction with the universities of Sheffield and Sussex, states a stark truth in the starkest terms: “Ethnic inequalities in health outcomes are evident at every stage throughout the life course, from birth to death.”
It is normally the case that at publication the authors of a report stress what is new about their findings. They emphasise how their work will change the debate or challenge earlier data. The authors of this report go out of their way to stress the opposite. As they state, little of the information they have carefully collected and collated is new, much of it being drawn from the 178 earlier studies that they identify or cite. The problem is not a lack of reports; it is, as they note, “that existing evidence hasn’t led to significant change”.
Among the factors that they conclude have negatively affected “the health of ethnic minority people” is “discriminatory treatment from healthcare staff”. As a result of such experiences, some from minority communities have delayed “seeking help for health problems due to fear of racist treatment”.
Another reality that has become better understood over recent years is that racism is personally damaging. Discrimination hurts, it is corrosive, it wears people down and, unsurprisingly, those who have experienced it seek to avoid further exposure. They choose not to place themselves in harm’s way even if, as this report shows, that is to the detriment of their health.
Talking about the NHS critically is difficult because the NHS is special, a unique and uniquely loved institution. It is held in such esteem that its failings seem to matter more than those of other institutions and the urge to praise the service can at times overwhelm the need for clear-eyed analysis. For that reason, the notion that, like other national institutions, the NHS has a problem with various forms of racism – “structural, institutional and interpersonal”, as the report categorises them – is for some difficult to accept.
The demographic who will have the least difficulty coming to terms with this are people of colour who work in the NHS. In 2021, I made a documentary about the history of the service, for which we interviewed doctors and nurses who had built their NHS careers from the late 1940s. Many spoke in detail about their experiences of the racism and discrimination within the service, a subject that is also tackled within the Observatory’s report.
The pandemic has further complicated the picture. For most of us, Covid has been among the most profound experiences of our lives. As the NHS became an epidemiological front line, our national affection for the service was heightened. The millions of children who in 2020 stood by their parents, as we banged pots and pans and cheered for the 1.3 million people who work in the NHS, will remember that experience for the rest of their lives. They will remember it in the same way that today’s octogenarians remember air-raid sirens and rationing.
Perhaps never in its history has the NHS been more publicly praised and at the same time never have its frailties, and the health inequalities that stem from them, been better understood. Our deep respect for the NHS should not blind us for the fact that it is in need of reform. Yet to even place “NHS” and “reform” in the same sentence feels transgressive. For decades, those whose ideological mission is to carve up and privatise the service have deployed the idea of reform as political camouflage for that politically toxic project. But it must surely be possible to devise needed reforms that are very different from those that linger in the minds of the small staters and disaster-capitalists.
The NHS is special but its failings are not unique. It needs reform in the same way that the Met police and the wider criminal justice system need reform. Both sectors – healthcare and policing and criminal justice – have manifestly failed minority communities and in both cases there is no shortage of data detailing the nature and consequences of those failings. The question now is whether a government that largely ignored the previous reports on which the Race and Health Observatory’s work is built will be willing to contemplate anything like the level of change shown to be necessary. Our love for the NHS cannot be unconditional. It can only truly be a national health service if it treats all the communities that make up the nation equally.
