Intended for healthcare professionals

Letters Playing hide and seek with structural racism

Structural racism hide and seek: only one of five official UK reports on health has found structural racism

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1340 (Published 26 May 2021) Cite this as: BMJ 2021;373:n1340
  1. Raj S Bhopal, emeritus professor of public health
  1. Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
  1. raj.bhopal{at}ed.ac.uk

Gopal and Rao’s editorial made me reflect on five important UK reports published in the past year, generating controversy about institutional and structural racism.1

The UK government commissioned Public Health England (PHE) to report on inequalities in covid-19, including ethnicity.2 The report was criticised for having no recommendations and no reference to extensive public consultations by PHE. A second report including the consultations with more than 4000 people by PHE emphasised racism.3 The paragraph preceding the recommendations stated: “Throughout the stakeholder engagement exercise, it was both clearly and consistently expressed that without explicit consideration of ethnicity, racism, and structural disadvantage in our responses to covid-19 and tackling health inequalities there is a risk of partial understanding of the processes producing poor health outcomes and ineffective intervention.”

The UK government then delivered two reports through the Race Disparities Unit of the Cabinet Office, demonstrating progress in tackling covid-19, but largely denying racism.45 Media coverage was dominated by arguments over such denials.

The fifth report, by the Commission on Race and Ethnic Disparities, included a detailed, comprehensive review of health status and healthcare.16 Again, the report downplayed the role of racism, leading to widespread criticism.

Four of five official reports have given insufficient consideration to whether the adverse social and economic circumstances of some ethnic and migrant minority populations are partially underpinned by racism, as most scholars currently emphasise.789 Whether racism is an important factor in causing health and healthcare inequalities or a mirage is difficult to demonstrate empirically, the strongest evidence being in mental health.7

The UK, like most countries, does not have large scale, ongoing quantitative data collection on racism that can be linked to health status databases to test hypotheses, a long recognised but largely unresolved problem.10 We should aim for progress towards validated questions on racism in our national social and health surveys, potentially for inclusion in the 2031 national censuses, to provide better evidence.

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