Together we can challenge the racism that persists in healthcare

Five years ago, The BMJ led a national conversation in its Racism in Medicine issue.1 It shone a much needed light on the deeply entrenched biases in our healthcare services and the structural inequities that drive them. In the wake of that conversation, we founded the NHS Race and Health Observatory, an organisation with the mission of identifying racial inequity in healthcare and pressing the NHS and the government to meaningfully tackle it. This means looking not just at the harms of racism in healthcare, but also to the inequities that have persisted for centuries. The fight against racism is often a fight against the status quo, and we need unified anti-racist action to overcome it.

In 2020, black, Asian, and ethnic minority people were dying disproportionately from covid-19 and the Black Lives Matter movement spurred a global conversation about racism.2 Soon after, the NHS rolled out the covid-19 vaccine and quickly found that many ethnic minority communities lacked trust in the healthcare service and vaccines. Only by starting to build those trusting relationships, did the NHS manage to meet its goals for the vaccination programme.

The Observatory was established in 2021, just in time to support the healthcare system in this difficult period. The events in those years appeared to mark a shift in the nation’s collective understanding of, and willingness to confront, structural racism. The Observatory’s work involved intervening in questions of national policy during the pandemic and publishing analysis of racism in the NHS, concluding that ethnic inequalities in health outcomes were evident at every stage throughout the life course.3

In recent years, we’ve spearheaded policy changes in pulse oximetry, maternity and neonatal care, and mental health services.4 We’ve launched a national pilot programme, working with integrated care systems across the country to test anti-racism practices.5 We’ve launched resources to support diagnosis of jaundice in black and brown babies,6 to adapt communications for Jewish communities,7 and to advance the provision of mental health services for Gypsy, Roma, and Traveller communities.8 Most encouragingly, we’ve seen real world impact from these pieces of work,9 even during the short time we’ve been in operation.

We work with a growing network of communities, leaders, and practitioners, united in their commitment to create a more equitable NHS. Many of whom have readily adopted resources and engaged with our research, including most recently our seven anti-racism principles.9

We must accept that anti-racism work comes with challenges. We’ve so often seen that whenever there’s a push to tackle racism, there is a countermovement. In the UK in the summer of 2024, a wave of far-right violence and rioting gave physical form to a swell of anti-immigration sentiment. In the US, the new president Donald Trump has signed a series of executive orders that have turned culture-war rhetoric into policy.10 From my experience, the fight for race equity has often felt like two steps forward and one step back, as those who benefit from an unequal status quo fight to sustain it. Over the past four years, we’ve seen attempts by sitting health ministers to divert money away from equality, diversity, and inclusion initiatives, and care systems absorbing ringfenced money into their running costs at the expense of equity activities. 1112

Despite these challenges, I remain heartened by what I see daily when I work with communities. NHS leaders—nationally and locally—are taking action to tackle race inequity in healthcare but often need support in implementing evidence based interventions. It is also encouraging that we now have a government committed to producing a Race Equality Act and tackling health inequalities.13 In the current political climate—where many leaders seek to make gains by denigrating equality, diversity, and inclusion initiatives—these early signals are a cause for optimism.

This wave of pushback against race equity will only make us work harder. The existence of the Observatory is testament to this. In 2025, we will release our second strategy, which will contain a series of ambitions regarding prevention, community care, and digital communication that could make important differences to all the communities we exist to serve.

The Observatory will continue to work alongside the government and the NHS to enhance community participation in the design and delivery of services and to rebuild trust between healthcare services and racialised communities. We will invest in research and work to improve the quality of data on ethnicity and health inequalities. We will seek to ensure that new advances in genomics, sickle cell disease, and precision medicine are available and suitable for all. Our work will continue to drive forward equitable practice in maternal and neonatal care, and in mental health care. For the first time, we’re also launching an ambitious programme of work looking at the healthcare workforce, exploring ethnicity pay and progression gaps in the NHS and tackling disproportionate experiences of bullying and harassment in the workplace.14

The movement for race equity in healthcare is not straightforward. Progress is often met with resistance, but we have learnt that this resistance can be overcome if we remain united in our vision for a more equitable healthcare system. With the government soon releasing its 10 Year Health Plan for the NHS, we’re here to remind leaders that, without properly engaging with racialised communities and having a focused evidence driven body like the Observatory to provide support, no plan for the system will work. The NHS must work for everyone.