Racism in medicine: an intractable endemic in a separatist world
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r353 (Published 20 February 2025) Cite this as: BMJ 2025;388:r353
Black women are more than twice as likely as white women to die from pregnancy related causes (doi:10.1136/bmj.r226).1 This inequality isn’t fully explained by socioeconomic factors. The explanation is racism. Even among ethnic minorities, black people generally experience the worst health outcomes. Racism also explains the barriers that black and Asian staff encounter in their careers and the disproportionate abuse they experience. In a medical profession with around 40% representation from ethnic minorities, only 3% of UK trained “junior doctors” were black, said a 2021 report by the Institute for Fiscal Studies.2 In specialties such as anaesthesia, black doctors find it the hardest to progress to senior medical roles (doi:10.1136/bmj.r293).3
Five years ago a theme edition of The BMJ catalysed the conversation on racial discrimination in medicine, setting out a clear challenge to health systems. We didn’t start the conversation, and we certainly didn’t end it, but we brought fresh impetus to finding solutions, one of which was the UK’s Race and Health Observatory (doi:10.1136/bmj.m2191).4 The observatory’s impact is widely judged to be positive, starting to tackle racism with better data and evidence. But the verdict on systemwide progress is mixed: commentators agree that there are some improvements but disagree over whether they are sufficient.
The guest editors of that special 2020 edition, Mala Rao and Victor Adebowale, disagree so passionately on that point that we decided to turn their proposed new joint editorial into a head-to-head debate. Rao believes that the theme edition “marked a turning point in race equality in the NHS and changed the face of equality, diversity, and inclusion (EDI) in healthcare” (doi:10.1136/bmj.r291).5 True equity, she argues, will take many years to achieve, but the NHS has changed beyond recognition. Adebowale sees it somewhat differently, acknowledging a degree of progress but describing it as “glacial.” He pins the responsibility firmly on leadership: “We must see racial equity and equality as a core competence for leaders.”
Aneez Esmail and Sam Everington, who were once arrested for attempting to highlight racial discrimination in medicine, agree that more work is needed. Whatever progress was made is largely confined to acknowledging racism, they argue, and we have failed to build systems that “ensure equitable opportunity and the selection of the best candidate for every role, regardless of background” (doi:10.1136/bmj.r337).6 Partha Kar is even more forthright in his disappointment at “little, if any, progress” in the past five years (doi:10.1136/bmj.r327).7 Attempts to achieve fairness and justice for all discriminated groups are in retreat under the assault of a misguided “anti-woke” agenda, now globally legitimised and emboldened by Donald Trump and Elon Musk. The answer is not to cower and acquiesce to these malign forces, argues Kar, but for medical and political leaders to embrace “leadership with the mettle to confront this heinous generational problem.”
The importance of data
In short, we need people to tackle health inequalities through data. This is something that Azeem Majeed, head of primary care and public health at Imperial College London, has devoted his career to. Making health policy without data, he says, is “like driving a car with a blindfold on” (doi:10.1136/bmj.r118).8 It’s also akin to allowing complaints about racial discrimination without collecting data on the complaints or their outcomes. A follow-up BMJ investigation finds that most UK medical schools are now collecting data on complaints about racism but that the number of reported incidents remains small (doi:10.1136/bmj.r312),9 supporting the argument of Esmail and Everington that racism remains endemic. Medical schools and specific specialties such as reproductive health, as Danielle Solomon outlines (doi:10.1136/bmj.r277),10 might be good places to start to grapple, informed by data, with the sensitive issues that discrimination throws at us.
It may now be unfashionable and politically damaging to stand for EDI, but it is important to do exactly that. It is also evidence based, creating a more satisfied workforce and a healthier population. Supporting an end to discrimination is now akin to fighting for a rebel alliance against the onward march of imperial forces—which creates a neat resonance with people who say that we should move on from EDI and instead argue for JEDI (justice, equality, diversity, and inclusion). Our collective failure to tackle racism in medicine remains a scandal, and it is particularly damning that the experience of black people, as patients and as professionals, is barely acknowledged and merits no special attention. Where is the justice, when the injustice stares us in the face? How is it that the forces of separatism are in ascendance? I can confidently state, after more than 50 years of experiencing and fighting racism, that our work has only just begun—and racism, driven by populist politics, remains institutionalised and worryingly mainstream.