Intended for healthcare professionals

Rapid response to:

Editor's Choice

It’s time to act on racism in the NHS

BMJ 2020; 368 doi: (Published 13 February 2020) Cite this as: BMJ 2020;368:m568

Rapid Response:

Re: It’s time to act on racism in the NHS

Dear Editor

Racism: Yearning for Utopia and Loss aversion

There is without any iota of doubt that racism, both conscious and unconscious, continues to be prevalent in NHS.[1]. A middle aged Asian male at a Hospital entrance is more likely to be presumed a Taxi Driver rather than a highly experienced hospital consultant.

But the constant blanket calls for eradicating racism and the currently fashionable call-out culture is worrying. It has to be acknowledged that there are lot of good people in NHS, some of whom fret about even inadvertently appearing anything other than a just person. There is a risk of offending good and decent people by unintentionally throwing blanket institutional insults.

A society free of discrimination does not exist anywhere. Discrimination is rife in South Asian counties and discrimination based on language, ethnicity, religion, sex, and caste is widely prevalent.[2] [3] [4].

While aiming to create a Utopian society with no discrimination, there is a significant risk of losing the good things that are taken for granted in British society now. There is respect for law of land and a general consensus that discrimination of any kind is not good.

There might be an cognitive element of “loss aversion” with this line of thinking but it would be naive to assume societal progress is inevitable.[5]. The recent political events in western democracies are worrisome and there is a real risk of reversal of the progress made towards a more enlightened and just society.


1 Esmail A, Everington S. Racial discrimination against doctors from ethnic minorities. BMJ 1993;306:691–2. doi:10.1136/bmj.306.6879.691

2 Kapoor M, Agrawal D, Ravi S, et al. Missing female patients: an observational analysis of sex ratio among outpatients in a referral tertiary care public hospital in India. BMJ Open 2019;9:e026850. doi:10.1136/bmjopen-2018-026850

3 Kabir A, Maitrot MRL, Ali A, et al. Qualitative exploration of sociocultural determinants of health inequities of Dalit population in Dhaka City, Bangladesh. BMJ Open 2018;8:e022906. doi:10.1136/bmjopen-2018-022906

4 Zarocostas J. Serious human rights breaches occurred in more than 50 countries in past year, says UN. BMJ 2011;342. doi:10.1136/bmj.d3658

5 Yechiam E. Acceptable losses: the debatable origins of loss aversion. Psychol Res 2019;83:1327–39. doi:10.1007/s00426-018-1013-8

Competing interests: No competing interests

17 February 2020
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospitals NHS Trust
Nottingham NG5 1PB