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Racism: the other pandemic

BMJ 2020; 369 doi: (Published 11 June 2020) Cite this as: BMJ 2020;369:m2303

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Re: Racism: the other pandemic - Decolonising the NHS

Dear Editor

We agree with the editor's comments around racism, however when discussing issues relating to migration, ethnicity and race, although each subject contains unique issues, we believe the three are intrinsically linked. This overlap is particularity pertinent when discussing issues of colonialisation, and migration policies, as harmful policies can damage the health of migrants here and abroad, as well as black, asian and ethnic minority citizens within the UK, and around the world.

The NHS’s complicity in the anti-immigration hostile environment now embedded in our health care system is just one example of how Britain continues to benefit from its colonial past. Looking at the list of NHS staff from outside the EU: Indian (25,809), Filipino (22, 043), Nigerian (8,241), Pakistan (4,313), Zimbabwe (4192), Ghana (2863) – its easy to see that Britain’s ties with its ex-colonies are still strong. Health care professionals are often actively recruited to come and work in the NHS from these countries, thus strengthening our countries health system, whilst diminishing others. Human capital acting as the raw minerals of the day extracted for the benefit of the UK. We benefit from a greater number of health professionals per head of the population, and enjoy an average life expectancy of around 80 years, while in Nigeria it is only 53 years and India, 67. However, despite perpetuating these inequalities when patients from these countries are seeking healthcare in the UK, we charge them. This is through the health surcharge or at 150% cost of the treatment they seek, thus widening the global gap. An analysis of the nationalities of those charged as part of the “charging of overseas visitors guidance” has highlighted that patients from previous British colonies make a significant proportion of those targeted.

These toxic policies extend from causing harm to migrants to also being harmful to British foreign-born nationals and their families, as well as to the British black, asian and ethnic minority communities, as was laid bare by the Windrush scandal. This was not an accident: the Department of Health acknowledged these risks in 2015 in its equality assessment. Sparse damage limitation was undertaken however. Were these groups merely seen as a necessary collateral damage in the pursuit of ever more aggressive immigration policies?

Whilst it’s easy to point out faults, the difficulty comes in enacting change. The toxic mixture of personal biases (both conscious and unconscious), institutional silence, and the dearth of education on these topics create barriers to action. Whilst the prime minister “hears” the #BLM protests, he continues to hand out lucrative contracts to Serco for the “track and trace” system, whose track record on treatment of immigration detainees includes paying as little as £1/hour for cleaning. The Public Health England report on coronavirus deaths in the black and ethnic minority communities failed to mention institutional racism as a contributing factor. Another commission, a tool of inertia, under the pretence of action, is not what is needed. As health professionals, fleetingly elevated to the status of heroes during the pandemic, we need to use our voices to demand change.

Competing interests: No competing interests

18 June 2020
Joanna Dobbin
Academic clinical fellow in primary care and population health
Dr Rahma Abdi
Institute primary care & population health, Royal Free Hospital, London