Today marks the 75th anniversary of the NHS. Since its foundation, the service has relied upon doctors, nurses and staff from Black, Asian and racially marginalised backgrounds, yet systemic racism and stark racial disparities in diagnosis and treatment remain entrenched, writes Dr Annabel Sowemimo.
The 75th anniversary of the National Health Service is upon us and we are being encouraged to celebrate. While I vehemently believe in maintaining access to healthcare that is free at the point of delivery, I am not in a particularly celebratory mood.
Since its inception in 1948, the NHS has been maintained by migrant labour from former British colonies, by individuals like my nana in the 1950s and my dad in the 1970s who travelled from Nigeria. Yet 75 years on from its foundation, the service is riddled with racism and has failed to provide adequate care for some of their descendants.
For those of us working to address racial disparities in healthcare, the last few years have made it even more obvious that the NHS’s problems go far beyond long waiting lists and staff shortages. This has been made clear by the stories of victims of the Windrush scandal such as Albert Thompson, who was denied cancer treatment, and the disproportionate mortality rates of racially marginalised people from Covid-19.
Racial disparities in diagnosis and treatment outcomes have been plain for some time. For example, Black women are four times more likely to die in childbirth compared to their white counterparts and Black patients are four times more likely to be detained in a secure mental health facility than their white counterparts. For the Gypsy, Roma and Traveller community there are also some truly terrifying statistics, notably life expectancy 10-25 years shorter than the general population.
‘Covid-19 revealed how racial hierarchies continue to operate within our healthcare system’
Covid-19 revealed how racial hierarchies continue to operate within our healthcare system, leading to disproportionate disease and death in some communities.
At the start of the pandemic, social media was awash with suggestions that Black people might be immune to the coronavirus as it initially appeared to be cascading through Europe but not Africa. Theories of Black people’s innate immunity to the virus circulated, with ludicrous suggestions that our darker skin may serve as a protective factor. The Black medical ‘super body’ is a well-established colonial trope, deployed to justify the use of Black people for labour while diminishing our humanity. To witness this much-debunked myth resurface during a pandemic was both disheartening and dangerous.
Of course, it would eventually be shown that racially marginalised groups, and Black communities in particular, were some of the hardest hit. Of the first 200 NHS workers who died of Covid-19, 60 per cent were from Black, Asian or other racially marginalised backgrounds. The disproportionate death toll of Black and racially marginalised healthcare staff would go on to mirror racial disparities among the wider British population: Black men were 3.5 times more likely to die of Covid-19 than their white counterparts and Black women were twice as likely.
Instead of the biomedical community focusing on the structural factors that bind such different communities together – such as racism – there was instead hypothesising that a faulty gene or a lack of vitamin D may be at play.
‘64 per cent of Black people believe the NHS provides preferential treatment to their white counterparts’
A government-commissioned survey by ClearView Research revealed that 64 per cent of Black people believe the NHS provides preferential treatment to their white counterparts. This echoes another survey by the Black Equity Organisation, which found that 65 per cent of Black people in the UK believe they have been discriminated against by a healthcare professional.
The story of Kayla Williams – a Black 36-year-old mother of three who died shortly after paramedics attended her home and advised her that ‘she is not a priority’ and should use ‘self-care, use pyrectics, increase food/fluid’ – resonated with many racially marginalised people. Whilst the ambulance service was stretched at the height of the pandemic, Kayla’s case shares parallels with those of several other Black people who died while accessing NHS services, including D’lissa Parkes, who died in labour. Her family maintains that she would be alive today if abnormal scan findings had been acted upon.
Racial disparities in healthcare have been traditionally reduced to socio-economic issues, yet this analysis is reductive and fails to account for the multiple ways in which race operates within healthcare. We continue to see well-educated, wealthier Black people subjected to poorer health outcomes and relay how they are silenced within healthcare settings.
The establishment of racial hierarchies meant constructing white people as the norm against whom all others are measured, as well as the group for whom medical devices are designed. There is a persistent use of poorly evidenced racial correctors – such as the eGFR to measure kidney function – while issues like the inaccuracy of the pulse oximeter (a device that measures oxygen function) on darker skin are ignored.
US-based research has suggested that having a Black physician can improve Black patients’ health outcomes, including overall life expectancy. One study showed that the death of Black newborn babies, which is up to three times higher than their white counterparts, reduced by almost 58 per cent when the physician was also Black. Whilst these findings may not be mirrored in the UK – although we do have similar racial disparities to the US in many other areas – it is important to acknowledge that there may be greater care and compassion extended to racially marginalised patients when treated by someone from their own background.
‘Diversity interventions alone cannot address the systemic racism within the health service’
The NHS employs 1.5 million people, making it the biggest organisational employer in the UK and one of the largest in the world. Compared to other health systems in Europe, the NHS has a much more racially and culturally diverse workforce, with approximately a quarter of its staff being Black, Asian or from a racially marginalised background.
Of course, there are far fewer in senior leadership positions: few racially marginalised nurses are in staffing grades at senior positions (band 6 and above) and the situation is similar across multiple cadres of staff. This leaves staff unable to progress, with less autonomy and frequently undertaking tasks that have deleterious effects on their health.
Racially marginalised staff are also far more likely to experience disciplinary action from regulatory bodies. Recent cases such as Cox versus NHS Employment and Improvement – where a Black nurse recruited into a senior diversity and inclusion post was found to have experienced racial discrimination and harassment – demonstrates that diversity interventions alone cannot address the systemic racism within the health service.
For far too long many have argued that racial disparities in the UK are not like they are in the USA – that it is not quite as bad over here. I wonder on what basis such assumptions are being made, as when it comes to health outcomes, the UK is doing exceptionally poorly. In many ways our racial disparities are even more striking given that we do not have an insurance-based system and those from lower socio-economic backgrounds can still access care.
To make sense of the racial inequities that continue to plague the NHS for patients and professionals alike, we need to dig a little deeper into the origins of our healthcare system and the origins of medicine itself. From the workers who uphold it to who receives what diagnosis, everything is entwined with colonialism and race science. I remain sincerely committed to the maintenance of the NHS, but on its 75th anniversary, I think it’s time to recognise that our national treasure is steeped in racism and maintained through colonial extraction.
Dr Annabel Sowemimo is the author of Divided: Racism, Medicine and Why We Need to Decolonise Healthcare, a sexual and reproductive health registrar in the NHS, and a PhD candidate and Harold Moody Scholar at King’s College London.
The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect those of the Runnymede Trust.
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