Intended for healthcare professionals

Analysis Racism in Medicine

Transforming the health system for the UK’s multiethnic population

BMJ 2020; 368 doi: (Published 11 February 2020) Cite this as: BMJ 2020;368:m268

Read all of the articles in our special issue on Racism in Medicine

  1. Sarah Salway, professor of public health1,
  2. Daniel Holman, research fellow1,
  3. Caroline Lee, research associate2,
  4. Victoria McGowan, research associate3,
  5. Yoav Ben-Shlomo, professor of clinical epidemiology4,
  6. Sonia Saxena, professor of primary care5,
  7. James Nazroo, professor of sociology6
  1. 1Department of Sociological Studies, University of Sheffield, Sheffield, UK
  2. 2Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
  3. 3Institute of Health and Society, Newcastle University, Newcastle, UK
  4. 4Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
  5. 5School of Public Health, Imperial College London, London, UK
  6. 6Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
  1. Correspondence to: S Salway s.salway{at}

The UK health system must take urgent action to better understand and meet the health needs of migrants and ethnic minority people, say Sarah Salway and colleagues

Ethnic diversity is a global phenomenon resulting from historical and contemporary movements of people. However, healthcare policy makers, practitioners, and researchers have been slow to wake up to this reality. We urgently need to improve our understanding of, and responses to, the health needs of mobile and ethnically diverse populations.

As a country with a colonial past, a long history of migration, well established minority ethnic groups, and high investment in health related research, the UK should be leading the way in evidence informed, equitable healthcare. In reality, however, the UK has significant shortcomings. We believe the health system’s failure to respond to ethnic diversification reflects a deeper, politically led, ambivalence towards the notion of multiethnic UK. Policy makers, practitioners, and researchers can and should challenge the persistent marginalisation of this agenda.

Failure of policy and practice

There is widespread evidence that UK policy responses to ethnic diversity are ambivalent, fragmented, confused, and often harmful. This is despite the apparently strong legal framework of the 2010 Equalities Act.

Initiatives such as the Race Disparity Unit, established in 2018 by the former prime minister Theresa May, suggest a desire to tackle inequalities. However, other policy strands undermine equality. For instance, the “community cohesion” policy adopting the language of “British values” has legitimised concerns about imagined threats to cultural identity and security posed by ethnic minority communities.1 Hostility from nationalist politicians and the press encourages the scapegoating of migrants and ethnic minority people as the root of society’s problems.2

Health policy and practice do not exist in a vacuum. It is therefore unsurprising that we find a similarly patchy and ambivalent picture. Recent policy documents relating to dementia …

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