Intended for healthcare professionals

Feature Interview

Harnessing the outrage: it’s time the NHS tackled racial bias

BMJ 2020; 368 doi: (Published 11 February 2020) Cite this as: BMJ 2020;368:m341

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

  1. Lilian Anekwe, assistant news editor
  1. New Scientist, London, UK
  1. lilian_anekwe{at}

To call itself fair and equitable, the NHS must act on racism, says David Williams, the global expert on the effects of race on health. Lilian Anekwe reports

There comes a tipping point in all campaigns when the evidence is irrefutable and the only way to proceed is with action. According to David Williams, global expert on societal impacts on health, the time to tackle the disproportionate effects of race on patients in the UK is now.

It was Williams’s Everyday Discrimination Scale that, in 1997, launched a new scientific approach to assessing social influences, such as racism, on health. Its use has shown that people who experience everyday acts of discrimination—like getting poorer service in a bank or a restaurant, or being treated with less courtesy—will over time have worse health outcomes, including higher rates of heart disease, lower life expectancy, and greater infant mortality.

While he has been spreading this message globally, and calling for policy changes to tackle it, Williams has also been watching NHS England’s efforts to put its house in order in terms of race equality.

Call for research

Williams says that he would like to see a health observatory or similar body established in the UK to look at the disproportionate effects that race is having on patients. Research in this area is currently lacking, he says, and is crucial to bring about the scale of organisational change the NHS needs.

“It takes commitment and deliberate concerted action to change an organisation’s culture and make a difference,” he says. “The rhetoric must be matched by behaviour and policies that have teeth and the authority to implement change.”

It will require investment too: “The most successful programmes in the US are those with money—and leadership that puts that money where its mouth is.”

The UK may not be …

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