Intended for healthcare professionals

Editor's Choice

How do we tackle structural racism and inequality?

BMJ 2021; 373 doi: (Published 22 April 2021) Cite this as: BMJ 2021;373:n1035
  1. Fiona Godlee, editor in chief
  1. The BMJ
  1. fgodlee{at}
    Follow Fiona on Twitter @fgodlee

Two separate events in recent weeks have focused minds on the issue of structural racism. The first was last month’s suspension of JAMA’s editor in chief, after widespread condemnation of a podcast that sought to press the view that structural racism in US healthcare didn’t exist.1 The second was this month’s public outcry about the Sewell report, commissioned by the UK government, which concluded that structural racism in the UK did not exist.23

If there is any doubt in people’s minds about the existence of structural racism, let alone its damaging effects on health, several recent BMJ articles should help. The BMA’s Chaand Nagpaul leads the charge.4 Structural race inequality is a major factor affecting outcomes and life chances for many in the UK, he says. While the Sewell report lays claim to the NHS as a success story because of the number of ethnic minority staff it employs, Nagpaul highlights the disadvantage and discrimination faced by ethnic minority doctors, evidenced by reports of bullying and harassment, unwillingness to raise concerns, increased risk of referral to the General Medical Council, differential attainment, and the ethnicity pay gap. These serious charges are, sadly, confirmed in the recent “shocking but not surprising” report into racism, sexism, and homophobia at the Royal College of Surgeons.5

The pandemic has served only to magnify the damage that structural racism does to health, with worse outcomes among ethnic minority groups because of their riskier occupations and worse housing, finances, and access to healthcare. Testing and vaccination programmes have sharpened this dire convergence of risk factors: only people who can afford it will come forward for tests and be able to self-isolate; and most vaccination programmes favour people with private transport and flexible jobs.6 The ultimate danger is that covid will entrench these inequalities and become a disease of poverty.7

What can be done to tackle these race inequalities? The NHS Race and Health Observatory was launched last year after The BMJ highlighted the sustained impact of racism in medicine ( Its focus is on the “causes of causes” of health inequalities, looking for the reasons that ethnic minorities are more at risk of poor health outcomes and less well served by healthcare.8 Tackling health inequalities is a job that the UK’s public health professionals are eager and ready to take on,9 although the country’s proposed new structures seem designed to hinder rather than help.1011

Healthcare organisations, including medical journals, have a long way to go before they can be part of the solution rather than the continuing problem.12 We know this is equally true of The BMJ, and we are starting that journey. We are actively reviewing the diversity of our editorial teams and advisory boards; we have joined the Journalism Diversity Fund13 and the Royal Society of Chemistry initiative to make research publishing more inclusive and diverse14; and we are reviewing our policies on publishing research into racial inequalities in health. We will report on our progress and welcome your views.