We know. We’ve known for years that the health and social injustices experienced by Black, Asian and Minority Ethnic (BAME) people is worse than for white people.
In 2010 The Marmot Review “Fair Society, Health Lives” identified that health inequalities are a matter of social justice. Those who live in the most deprived neighbourhoods, those who experience social injustice have poorer health.
Ten years later the Marmot review team published “Health Equity in England” in March 2020, just as COVID-19 was arriving in the UK. Shockingly this showed that in ten years health inequalities in England had got worse. The more deprived the area the shorter the life expectancy. For women in the most deprived 10% of areas life expectancy fell. It also identifies, although not in the headlines, that the life expectancy of Black, Asian and Minority Ethnic people continued to be worse than white people.
We know. We’ve known for years that BAME people are at comparatively higher risk of mental ill health, and are disproportionately impacted by social detriments associated with mental ill health. Race Equality Foundation published a shocking report in 2019 but I bet you never heard about it.
We know. We’ve known for years that black people are more likely to be stopped and searched by the police. Between April 2018 and March 2019, there were 4 stop and searches for every 1,000 White people, compared with 38 for every 1,000 Black people. The data is published here by the Government.
We know. We’ve known for years that Black men are over-represented in the prison population. Black men are 26% more likely than white men to be remanded in custody. They are also nearly 60% more likely to plead not guilty. Analysis conducted for the Lammy Review (2017) found a clear direct association between ethnic group and the likelihood of receiving a custodial sentence. The Prison Reform Trust have been tracking this for years.
We know. We’ve known for years that Black students achievement levels at school are lower than their White peers. The data is published regularly by the Government.
I could go on as there is research and evidence from every aspect of public policy that shows the disparities and inequities that we know exist.
So why haven’t we changed things. What have we been doing? I think we’ve been tinkering around the edges without facing the more fundamental and challenging things that would really make a difference.
There’s loads of training out there but does it actually change anything? The majority of people who rock up to equality and diversity training appear to be those who already ‘get it’. What about those in positions of power and authority?
A few years ago I undertook the NHS Leadership Academy’s Nye Bevan programme. It’s a programme for people working at a senior level in health and care who want to progress to executive leadership roles. One of the most controversial sessions was led by the fabulous Eden Charles. It focussed on race and ethnicity in leadership. There was an outcry from many white participants of “but what about sexism … what about ableism … what about homophobia … what about …”
Why were we only focussing on race?
Eden showed us The Doll test. Originally done in the 1940’s this psychological experiment was repeated in the 2000’s. Watch it. Please. This is why we need to talk about race and racism. I’m not sure the session was challenging enough and I’m pretty sure that lots of people switched off as someone else in their organisation ‘does’ equality and diversity so they don’t really need to worry about it.
If we look at the positions of power across our society, in politics, in the public sector, the NHS, the voluntary sector, religious institutions … the common theme is well educated, middle class, white men. The NHS probably has the best data on diversity thanks to tireless work over many years by people like Yvonne Coghill and the introduction of the Workforce Race Equality Standard (WRES). The WRES, introduced in 2014, was a wakeup call that shone a light on the lack of BME staff in leadership positions. But progress is slow. In the period 2016 – 2019 the number of BME people in the most senior (Very Senior Manager (VSM) being the most senior leadership banding in the NHS) only increased by 1%. That’s an additional 33 people in 3 years. There’s a total of 2,212 VSM positions with only 143 BAME people in these VSM positions in the NHS. The disparity between the number of BAME staff in more junior positions and those in leadership positions is stark.
In 2019 a small group of People of Colour (POC) formed Charity So White. Set up to challenge the racism in the Voluntary, Community and Social Enterprise sectors they initially faced a backlash from white people who failed to see or listen to what they were advocating for. There is institutional racism in the Charity sector. That’s a fact and the sector needs to take systemic action to address it rather than continue to put their heads in the sand and deny it exists.
We do need to talk about all the other forms of discrimination and oppression but we also need to learn to talk openly and honestly about why we as white people really struggle to talk about racism. There are two books I’d really encourage you to read: White Fragility: Why it’s so hard for white people to talk about racism, Robin Diangelo and Why I’m No Longer Talking to White People About Race – Reni Eddo-Lodge. Once you’ve read them find some time to talk with your peers, your teams, your friends about how you feel and what you’ve learned. As white people we have to take responsibility to listen, learn and understand without expecting our BAME colleagues and friends to answer all our questions. White privilege is real. If you’re white you didn’t choose it, but you have to accept it. You are born with privilege even if you live in a very deprived area, even if you didn’t have a good education. Your whiteness affords you privilege because of the way society has been constructed and the history of generations before you.
There’s a term more commonly used now – intersectionality – it basically means that we need to look at and understand the complex identities people have which lead to multi-layered discrimination and oppression. Imagine being a Black Lesbian or a South Asian Gay Muslim. Maybe rejected by your family and rejected by the LGBT community and ostracised by your religious community. You live in the grey space between every community.
It’s essential that we start to redesign our public policy to recognise the systemic racism that is inbuilt. Of course, it’s not just about race, it’s about intersectionality and a society that perpetuates discrimination. But race is an essential starting place. Funding formulas that allocate public funding for services are biased – the Carr-Hill formula used to allocate funding to General Practice is weighted in favour of areas with older populations. This means that very deprived communities get less funding as the life expectancy if you live in the most deprived areas is significantly lower so you die before your GP benefits from the funding formula. Before you all rage at me – I know this is incredibly complex but we have to do better. All of the evidence is there from the Deepend work that started in Scotland and is being developed in many areas of England. It’s the inverse care law – those that need the most get the least.
COVID-19 has highlighted the disproportionate impact it has had on three groups: –
- BAME communities (including Gypsy, Roma and Traveller people*)
- Socio-economically deprived communities
- Inclusion Health groups (e.g. people who are homeless / living in temporary and multi-occupancy accommodation, Gypsy, Roma, Traveller communities, people in contact with the justice system)
If you go back to the beginning of this blog … we knew this before COVID-19. Of course, it’s had a disproportionate impact on these communities. They already experience greater health inequalities, reduced access to services etc.. etc.. Of course, some of us knew it and have been banging on about it for years but maybe now those in positions of power can really hear and see it so we can start to do more than an equality impact assessment that sits on a shelf alongside the policy that perpetuates these inequalities.
So, what should we be doing?
- Educate yourself. Talk about it.
- Look at your organisation – is there bias and blindness in decision making borne from who’s making the decisions?
- Make time in your teams to talk about it, honestly and with kindness. It’s OK to not know and to seek to find out. It’s not OK to stay silent and leave it to others.
- Involve people from diverse backgrounds and communities. We have to stop ‘doing to’ and start ‘working with’ (read Hilary Cottam’s Radical Help) people who have first hand lived experience.
- Speak up and act – it’s everyone’s responsibility, especially if you’re White.
 Intersectionality is a theoretical framework for understanding how aspects of a person’s social and political identities might combine to create unique modes of discrimination
*Gypsies and some Traveller ethnicities are recognised in law as being ethnic groups protected against discrimination by the Equality Act 2010