Placing third in our writing competition, Dr Seema Pattni on the racial health inequality woven into the very fabric of the NHS
‘I want to be white.’
I didn’t know how to respond. I looked back at him. He was serious and waiting for me to continue the conversation.
He was only eight years old, with an asthma flare up. Perhaps I should never have asked him what he wanted to be when he grew up. It’s a silly question which I never liked being asked.
I’ve thought a lot about his answer in the years that followed. I sometimes wonder what he might be doing these days. I wonder whether he still wants to be white instead of black.
As a patient, the healthcare experience as a black or brown person is profoundly different to someone who is white. There is a deep and complicated history to this, and the repercussions are still being felt today. In fact, it’s not just historical repercussions – there is a huge active wave of racism working through the NHS today on every level.
From cradle to grave, the outcomes are worse for black and brown patients. Black pregnant women are five times more likely and Asian women twice as likely to die during pregnancy and childbirth than white women. Black babies have the highest rate of stillbirths and deaths in their first 28 days, and Asian babies over one and a half times more likely than white babies. Asthma outcomes are worse. Black and South Asian dementia patients die younger.
If you are a patient from an ethnic minority, then health inequality holds your hand and accompanies you wherever you go, whichever service you use. Even the starting point of accessing primary care is harder.
Despite this, the crisis of racial health inequality was not part of my curriculum in medical school or GP training. It is rarely discussed at educational CPD events in more than a footnote or an aside. It is not discussed in staff training at GP practices or in clinical/practice meetings. It is usually people who already care about it who seek out training or opportunities to raise awareness.
I’m so fed up with all the official talk and recommendations about making things better – it feels like lip-service. Patients are dead because of their skin colour. This is a health emergency. It is not a subject for debates or flashy headlines.
Of course, the solutions aren’t simple. It is not easy to truly tackle embedded racism and its associated socio-economic factors. But where is the sense of urgency? This emergency requires much more than the glacial pace – the signature speed of the NHS.
We all deserve the best medical treatment possible; we all deserve fair treatment. And we all deserve to be treated well at work with fair opportunities. But the experience of doctors is not equal. Doctors face racial discrimination constantly in the NHS and general practice, from patients and colleagues.
In the NHS, around 60% of GP registrars, 50% of junior doctors and 40% consultants are from ethnic minority backgrounds (a lot of this driven by international recruitment); shrinking to 11% at executive level. And let’s face it, the real power to finance and effect real change sits in the C-suite, and in the Government, via health and socio-economic policy reform.
Authentic action against racial health inequality, its history and as it is today, is required urgently to stop young black patients wishing they were white.
I can’t remember my exact reply to ‘I want to be white’. I think I cowardly and awkwardly changed the subject. I was shocked. But given how things are, I shouldn’t have been.
What would you have said?
Dr Seema Pattni is a GP in London
Worse health due to overall socio-economic disadvantage (faced by patients of all colours) seem to have the largest and always the same effect on health outcomes (bad). Focussing on ethinicity alone on health may be limiting, the effects are complex and can work in different ways depending on which indicator you cherry pick, although for life expectancy the effects might be surprising to some (see table 1, ONS). And the effects of race on health are quite different in Europe than the USA, whose politics can intrude on many of our sensitive debates!
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/articles/ethnicdifferencesinlifeexpectancyandmortalityfromselectedcausesinenglandandwales/2011to2014
If your lived experience has seen you the victim of racism then I that is inexcusable. However it is simplistic to point to adverse health outcomes in the NHS for BAME people as being a consequence of racism within the NHS, and likely to piss-off dedicate professionals who are skin-colour-blind in their practice. The causes are societal and historic. And that’s a hope other debate.
I would like to have heard what the boy had to say, would have made a more worthwhile and readable article.
Reading the comments with great interests. As and ethnic minority with my formative years and primary medical education being in a country where I was not in the minority gives me a different perspective. Having spent many years pondering the realities for ethic minorities ( in particular the plight of the African diaspora) in the western world a few basic facts come to light. At the root is disproportionate financial and educational disenfranchisement. This appears to be the legacy that has it’s origins in racial discrimination. Racial discrimination and racism at its worst can be traced to chattel slavery. It was used as a tool to underpin the slave trade ( without its existence the trade could not have been as successful. It would have been psychologically difficult to commit the industrialised abuse of a group of people with dehumanising them. The idea of racial superiority was in part maintained after the end of slavery in 1830s in the form of colonialism. This tread to aid in maintaining the economic status quo has continued though diminished in covert and overt forms often denied by some those who are the beneficiaries of this status quo. The legacy of economic, political and educational disenfranchisement underpin the poor health outcomes of African ethnic minorities. The NHS in it relatively short existence has a very long way to go to make a mark on redressing this imbalance. However, is reach is going to be limited by the realities of the disenfranchisement previously mentioned.
Whilst sad and painful I think it is easy to understand why the young child wished to be white (for that child they were clearly visible benefit and disadvantages linked to race). Children call it as they see it and are free of many of the social shackle to limit our pure and unbridled honesty. The old story of the emperor’s new clothes comes to mind.