The BMJ’s ‘racism in medicine’ issue prompted the NHS to announce the creation of the NHS Race and Health Observatory
At BMJ, we are determined to tackle racism at all levels. It’s important we help our audience understand how racism affects doctors’ working lives, the experiences of black and ethnic minority patients, and how healthcare organisations can take action. That’s why we have made this collection of articles free to read, and have also made efforts to raise awareness of the varied nuances of racism that exist within clinical settings.
The NHS Race and Health Observatory was established in 2020 after our special issue of The BMJ investigated the impact of racism in healthcare for Black, Asian and minority ethnic communities across England. The BMJ remains an influential resource in the extensive work of the Observatory, with a strong commitment to keeping ethno-racial injustices and inequalities at the heart of public conversations in medicine.
The Health, Race and Racism conference held by the Observatory recently exposed prominent issues regarding racism and its detrimental impact on healthcare quality for those it continues to affect most. A series of speeches were delivered by a panel of international experts and senior healthcare leaders. Each shared insights on how a shift in social attitudes, policies and practices are all integral to collectively driving out inequality in healthcare and medicine, for present and future generations.
Scroll down to read the most recent articles, and to learn about the vital investigative work and progress made by members and researchers within the Observatory. Highlights include the advancements prompted by our special issue and the July 2022 Health, Race and Racism conference.
The following articles were published in the aftermath of the NHS Race and Observatory Conference that took place in July 2022. These articles were written by authors of the Observatory’s international race and health experts’ group.
“As an employer and a leading voice in global medicine and health, we strongly oppose racism and support racial equality because more equal societies are healthier societies.”
Chris Jones, Chief Executive Officer, BMJ
The BMJ’s ‘racism in medicine’ issue prompted the NHS to announce the creation of the NHS Race and Health Observatory
The BMJ won the PPA Diversity and Inclusion Award 2021 for its high quality journalism and strong engagement
Our action led the University of Nottingham’s Medical Society to reverse a policy not to allow a representative from an ethnic minority group to sit on its committee
The BMJ’s claim that harassment of ethnic minority students was not being monitored, led to the British Medical Association launching a charter calling on medical schools to end this abuse
The Race & Health Observatory’s funding has been guaranteed until at least 2027
During its first year, the Observatory promoted change in policy on pulse oximetry, particularly relevant at the height of the covid-19 pandemic
Watch: Dr Kamran Abbasi discusses the first international NHS Race and Health Observatory conference on Race, Racism and Health
In this video, The BMJ’s editor in chief, Kamran Abbasi, voices support for those attending the NHS Race and Health Observatory’s first international conference on race, racism and health. Kamran gives insight into The BMJ’s role in the Observatory’s establishment, and pledges the BMJ’s commitment to diminishing the effects of inequalities in healthcare and medicine by continuing to publish vital evidence and solutions on how to tackle such issues.
Kamran reflects on his experiences with racism in all aspects of his personal and professional life. He reminds us just how deeply entrenched racism is in British society and the disheartening reality of its impact felt by whole communities on a daily basis. Yet he is adamant about the power of collective action, and calls on influential figures across the medical sector to be the change that others need to see.
The first of many international conferences held by the Observatory marks a pivotal step in the journey to building a more inclusive, equal healthcare system; one that is representative of all people and their healthcare needs.
In this insightful episode of the BMJ Podcast, Chief executive of the NHS Confederation and Professor Mala Rao joins us to discuss the NHS Race and Health Observatory’s central mission and how it will maintain independence, its role in synthesising, commissioning and implementing research, and where the organisation might begin in tackling the issue.
Structural racism is a fundamental cause and driver of ethnic disparities in health | The BMJ Opinion | The UK government report on race disparities is a missed opportunity and will lead to a worsening of systemic inequalities, say these authors.
Chaand Nagpaul: The lived experience of many ethnic minority doctors is not an equality success story | The BMJ Opinion | The Sewell report’s depiction of the NHS belies the systematic disadvantage and discrimination that so many ethnic minority doctors have faced.
The Sewell report risks turning the clock back on the fight against racism in the UK | The BMJ Opinion | After the worldwide Black Lives Matter protests last summer in the wake of the killing of George Floyd in the US, the UK government established the Commission on Race and Ethnic Disparities. Under the chairmanship of Tony Sewell, the commission was set up to investigate race and ethnic disparities in the UK. The Sewell report released on 31 March 2021 has significant implications for race relations in the UK.  While we acknowledge that there are elements in the report which provide a useful narrative, we are deeply disappointed that it seeks to ignore the reality of racism in the United Kingdom.
Ignoring systemic racism hinders efforts to eliminate health inequalities in childhood | The BMJ Opinion | Failure to address all drivers of health inequalities in childhood, including structural racism, means failing another generation of children, say Ian Sinha and colleagues.
Findings on racism in psychiatry underpin the importance of equality action | The BMJ Opinion | A recent survey by the Royal College of Psychiatrists found that almost six in ten Black, Asian and minority ethnic respondents had experienced racism in the workplace, affecting either themselves, their colleagues, or patients. Although the sample size was select (689 responses of which 233 were from ethnic minority psychiatrists), the findings are shocking, and align with other research and personal stories that we’ve both heard of in our time working in the health service.
Tackling racism in the NHS—we need to listen to the voices of ethnic minority staff | The BMJ Opinion | Staff should have a platform to communicate the discrimination happening throughout the NHS, says Nisha Aggarwal.
In February 2020 The BMJ published a themed issue in Racism on Medicine which was guest-edited by Victor Adebowale and Mala Rao. It aimed to highlight the discrimination and health inequalities related to race and ethnicity experienced by patients and doctors. The issue was a great success and led to the launch of the Race and Health Observatory in May.
We said that we wanted the Racism in Medicine issue to be the start of a conversation and wider coverage in the journal of the problems that face patients and doctors from black and ethnic minority backgrounds. This mission has become even more important since the covid-19 pandemic struck and highlighted that racism is a public health issue. It is the aim of The BMJ to continue highlighting new developments, research, and reports to our readers that helps to end racism in medicine and to provide our readers with regular updates on the topics explored in the themed issue.
How do we start a conversation about racism in medicine? | The BMJ Opinion | “Tackling racism in medicine can only come about with honest conversations.” Christine Ekechi suggests we can start that journey in three ways.
The BMJ’s special issue on racism in medicine reflects the working lives of doctors from ethnic minority backgrounds and the healthcare experiences of ethnic minority patients. This edition focuses on race and its impact on health. It is a timely reflection, as we in the UK try to make sense of the societal upheavals which have convulsed the country in recent times, and in which race, racism, and power have come under close scrutiny.
Racism: the other pandemic | “Racism is a public health issue because it kills people. It is the underlying driver that puts people from ethnic minority groups at the centre of the pandemic. It is a co-factor for covid-19 and a key social determinant of health,” writes Fiona Godlee, editor in chief.
Covid-19 and the rise of racism | “Over the past few months covid-19 has dramatically changed how we live. The media and the government have rightly been concerned with the global health and economic implications of this pandemic, but they have neglected to acknowledge the simultaneous spread of prejudice and xenophobia,” writes Melanie Coates, foundation year 2 doctor in emergency medicine.
There is no stopping covid-19 without stopping racism | “Doctors like us who have been working on the covid-19 response in the US have been told to “stay in our lane” as the murder of George Floyd has triggered the largest anti-racism movement since the 1990s,” writes Abraar Karan, internal medicine physician and Ingrid Katz, associate faculty director.
“Ethnic minority patients experience differential outcomes in healthcare. Maternity and infant mortality are stark examples, but there is also evidence of differences relating to race in cancer survival, life expectancy, and diabetes care. These were among the issues we thought could be aired and debated in a special themed issue.
We wanted this themed issue to be the start of wider coverage in the journal of the issues that affect people from ethnic minority backgrounds. We want it to be an ongoing conversation about how to tackle racism in the NHS and medicine more generally and how to make everyone’s lives better by improving the environment for ethnic minority doctors and patients.
It is an issue that affects us all, and we can all play a part in reducing the disparities and inequalities faced by patients and doctors,” writes Zosia Kmietowicz, The BMJ news editor. Read more…
Victor Adebowale and Mala Rao (pictured) called for an observatory to tackle the ethnic health inequalities in the UK in a special issue of The BMJ that they co-edited in February. NHS England confirmed at the end of the May that the centre would go ahead.
NHS launches Race and Health Observatory after BMJ’s call to end inequalities | “A new NHS centre to investigate the effects of race and ethnicity on people’s health has got the go ahead after a special issue of The BMJ in February focused on the continuing problem of racism in medicine,” writes Zosia Kmietowicz.
New observatory will set out actions to tackle racism “within months,” say campaigners | “The architects behind the new NHS Race and Health Observatory have vowed that it will deliver actionable recommendations within months to tackle the structural racism that exists throughout healthcare,” writes Zosia Kmietowicz
The NHS Race and Health Observatory—its time has come |“The Observatory will seek to achieve not only equality of access to services, but equal health outcomes irrespective of race,” write Mala Rao,professor, Department of Primary care and Public Health, Imperial College London, London, and Victor Adebowale, chair of NHS Confederation, London.
The Observatory will be launching an interactive digital platform, designed to provide public access to data on health inequalities across the country
People are confident in the Observatory as an independent health body; which guarantees objectivity of research, recommendations and in implementation support
The Observatory’s recent review has been commended for representing lived experiences of patients and staff, linking structural racism to poor health outcomes.
NHS Race and Health Observatory to stage first international conference | The NHS Race and Health Observatory will stage its first international conference on race, racism, and health later this year. The inaugural event, which is being supported by The BMJ, will take place virtually on 7 and 8 July 2022.
NHS Race and Health Observatory funding is renewed for five years | News | NHS England has guaranteed funding for the NHS Race and Health Observatory until at least 2027, which was announced at the observatory’s first international conference on race, racism, and health at BMA House in London on 8 July.
NHS Race and Health Observatory conference: leaders give their views | News | International experts and senior healthcare leaders, Victor Adebowale, Yvonne Coghill, Tinuke Awe and Clotilde Abe give their view on crucial changes needed in health education over the next five years and beyond, to create for inclusive and equal healthcare for all.
Race, racism, and health: global learning for national action | Editorials | David R Williams, Yvonne Coghill, Kamran Abbasi and Habib Naqvi shed light on the global reach of the Race and Health Observatory’s work and research, and its commitment to collaborating globally to identify cross cultural commonalities; integral to reducing health inequalities for ethnic minority and majority on a global-scale.
NHS Race and Health Observatory appoints global experts on inequalities to its board | News | Gareth Lacobucci writes on the world’s leading experts on health inequalities, recently added to the Race and Health Observatory’s board of non‐executive directors.
Now is the time for radical action on racial health inequalities | Opinion | Mohammad S Razai, Doug McKechnie, Mala Rao and Azeem Majeed call for urgent and large-scale action needed to stamp out rampant inequalities in the medical sector, and how the recent NHS Race and Health Observatory review highlighting the true depths of inequities within health services, is just the start of changes needed.
Racial health inequality is stark and requires concerted action, says review | News | “For too many years the health of people from ethnic minorities has been negatively affected by a lack of appropriate NHS treatment for health problems, poor quality or discriminatory treatment from healthcare staff, missing data on ethnic monitoring; and a lack of appropriate interpreting services, the report said.” Jacqui Wise writes on key findings and conclusions of the Race and Health Observatory’s recent review.
Covid-19: Racism may be linked to ethnic minorities’ raised death risk, says PHE | “Racism, discrimination, and social inequality may have contributed to the increased risk of death from covid-19 among ethnic minority groups, a review commissioned by the government has acknowledged,” writes Gareth lacobucci.
Covid-19: PHE review has failed ethnic minorities, leaders tell BMJ | “A government review promised to discover why covid-19 has a disproportionate effect on people from ethnic minorities, but advocacy groups say their input was ignored,” Gareth lacobucci hears.
Covid-19: Government will belatedly publish recommendations for protecting ethnic minorities | “The UK government will belatedly publish recommendations for protecting minority ethnic groups from covid-19, amid claims that parliament was misled about the existence of additional material produced alongside a much criticised review by Public Health England (PHE),” writes Gareth lacobucci.
Ending US health inequalities needs multiple approaches, panel says | “Deaths from covid-19 among black Americans are almost double those of whites, and black, brown, and indigenous people face structural racism and health inequalities, an expert panel has said,” writes Adrian O’Dowd.
New observatory will set out actions to tackle racism “within months,” say campaigners | “The architects behind the new NHS Race and Health Observatory have vowed that it will deliver actionable recommendations within months to tackle the structural racism that exists throughout healthcare,” writes Zosia Kmietowicz.
NHS blood unit is “systemically racist” and “psychologically unsafe,” investigation finds | “An independent investigation into working conditions at a unit of the NHS’s blood and organ transplant service has concluded that it is “systemically racist” and “psychologically unsafe,”” writes Gareth lacobucci.
All diversity is not created equal | “The hard truth is that while all physicians from ethnic minorities may experience discrimination, it doesn’t always look the same,” says Arundhati Dhara, Assistant Professor at Dalhousie University in the Department of Family Medicine.
Are medical schools turning a blind eye to racism? | A BMJ investigation finds that medical schools are failing to monitor racial harassment and abuse of ethnic minority students, Zosia Kmietowicz reports.
Fast tracked but still unseen: Black and minority ethnic doctors must no longer be overlooked | The BMJ Opinion | “All medical schools need to look inwards at the structural anti-blackness and racism that dominates every aspect of our culture,” writes Nazanin Rassa, Interim Foundation Year doctor at the Royal Free Hospital.
We all need to be open to conversations on race, even though they may not be easy to hear | The BMJ Opinion | “The NHS faces significant challenges in the years ahead, not least dealing with the fall-out of covid-19 and preparing for the threat of a second wave. With so many competing pressures, you might ask why the service should prioritise tackling inequalities? The answer is simple: it’s the right thing to do,” writes Joni Jabbal, Policy Researcher, The King’s Fund.
The role of medical students in student activism: decolonising the medical curriculum | The BMJ Opinion | Institutions must work with students to bring about positive changes to the medical curriculum, say Abigail Clynch, Jayden Gittens, and Portia Amoako-Tawiah.
The conversation on race, covid-19, and #BLM matters more than ever | The BMJ Opinion | Discussing racism, inequality, and the impact this has on our health has crashed into the mainstream; but it’s a conversation that is getting confusing, particularly for those who have never needed to invest in understanding these issues. We need to get the conversations right, says Keerti Gedela.
My experiences of racism: five minutes with . . . Zana Khan | The London GP talks about her personal experiences of racism, and the need to be bold in tackling racism and discrimination in the NHS
Ethnic minority doctors are less likely to gain consultant posts, survey finds | Doctors from ethnic minority groups have to apply for many more consultant posts than white doctors to secure a job, a survey of applicants’ experiences from 2018 by the Royal College of Physicians of London has found.
Black babies are less likely to die when cared for by black doctors, US study finds | Black newborn babies who are cared for by black doctors are more likely to survive than those cared for by white doctors, reports Elisabeth Mahase.
New indicators will track doctors’ careers to expose racism | NHS England has launched a new set of indicators to expose ethnic disparities in the medical workforce, with data set to be presented to trusts later this year, reports Elisabeth Mahase.
Presenting clinical features on darker skin: five minutes with . . . Malone Mukwende | The medical student who created a handbook presenting clinical features on darker skin describes the ambition behind it
The critical role of the NHS Race and Health Observatory | BMJ Leader | Habib Naqvi, Marie Gabriel and Victor Adebowale explore the ground-breaking establishment of an independent health body such as the Race and Health Observatory, and the cruciality of its research and recommendations in helping build a healthcare system based on equality, and with it, the potential of a more equal and united country as a whole.
Student perspectives on barriers to performance for black and minority ethnic graduate-entry medical students: a qualitative study in a West Midlands medical school | BMJ Open | Nariell Morrison, Michelle Machado and Clare Blackburn explore graduate-entry medical students experiences of undergraduate training in the context of academic underperformance of medical students from ethnic minority backgrounds.
Decomposition of the US black/white inequality in premature mortality, 2010–2015 | BMJ Open | Decomposing the US black and white inequality in premature mortality into shared and group-specific risks to better inform health policy: an observational study by Mathew V Kiang, Nancy Krieger, Caroline O Buckee, Jukka Pekka Onnela, Jarvis T Chen.
Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England | BMJ Open | In most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic (BME) populations. Anjum Memon, Katie Taylor, Lisa M Mohebati, Josefin Sundin, Max Cooper, Thomas Scanlon, and Richard de Visser sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in healthcare in this qualitative study.
Negro, Black, Black African, African Caribbean, African American or what? Labelling African origin populations in the health arena in the 21st century | Journal of Epidemiology & Community Health | Charles Agyemang, Raj Bhopal and Marc Bruijnzeels call for debate on appropriate terminologies for African descent populations.
In the fight for racial justice, the sidelines are no longer an option | British Journal of Sports Medicine | “Our journal global community and partnership network includes over 10,000 sport and exercise medicine physicians and sport physiotherapists—each with an ethical obligation to athlete health, safety, and well-being embedded in their duty,” writes Dr Tracy Blake.
The foreign gaze: authorship in academic global health | BMJ Global Health | “Recent bibliometric analyses (some of which have been published in BMJ Global Health) confirm patterns that are largely explained by entrenched power asymmetries in global health partnerships,” writes Dr Seye Abimbola, senior lecturer in Global Health at the University of Sydney, editor in chief of BMJ Global Health, and the newest member of the Global Health 50/50 Advisory Council.
Ethnic inequalities in health: should we talk about implicit white supremacism? | Postgraduate Medical Journal | “If you live in the United States or the United Kingdom and have black or brown skin, your health is likely to be poorer on average than if you have white skin. You are also likely to receive healthcare of a lower standard. The statistics are dismal,” writes John Launer.
Decolonising ideas of healing in medical education | Journal of Medical Ethics | Amali U Lokugamage, Tharanika Ahillan, and D C Pathberiya explore decolonising ideas of healing within medical education following recent events including the University College London Medical School’s Decolonising the Medical Curriculum public engagement event, the Wellcome Collection’s Ayurvedic Man.
Racial disparities in preterm birth in USA: a biosensor of physical and social environmental exposures | Archives of Disease in Childhood | H Burris, Scott A Lorch, et al, propose that racial disparities in PTB are a cumulative biosensor of exposures that vary by race, arising from long-standing inequities.
Essential(ist) medicine: promoting social explanations for racial variation in biomedical research | Medical Humanities | Iliya Gutin examines the deep social origins and social implications of the essentialist viewpoint in biomedicine and how it relates to the broader construction of social and scientific knowledge.
What is intersectionality and what promise does it hold for advancing a rights-based sexual and reproductive health agenda? | BMJ Sexual & Reproductive Health | “Amid challenges, adoption of the Sustainable Development Goals (SDGs) is promising for its explicit recognition of the importance of SRH rights for development,” writes Anuj Kapilashrami.
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