On 5 July 1948, Britain witnessed the physical manifestation of revolutionary thought. Recognising that the responsibility for health inequalities should not rest on those affected by it but on the societal structures that allow them to flourish, there was a call for those in power to take responsibility.
Fast forward to 2020. As we celebrate 72 years of the NHS we also celebrate its egalitarian core, which is reflected in its diversity. It is an organisation with personnel from different backgrounds - but where it really celebrates diversity is in the unyielding belief that regardless of creed, colour, nationality, sexuality, class, disability, gender and more, all people are equal and deserve equal access to healthcare.
However, celebrations also provide opportunities for reflection. The disproportionate death rates within Black and ethnic minority groups due to COVID-19 and the worldwide Black Lives Matter protests following the death of George Floyd have reminded society that racism still very much exists.
Within our healthcare system, ethnicity pay gaps exist, Black NHS staff report the highest incidence of bullying and harassment from colleagues and leaders, Black women are five times more likely to die in childbirth compared to white women, and children from Black and ethnic minority groups have been shown to receive inadequate analgesia for the same presenting complaint as white children.
...there is an inverse relationship between our level of implicit bias and quality of care
For us to truly celebrate diversity we need to confront these uncomfortable truths and take action. There is growing evidence that the racial and implicit biases held by healthcare staff are no different to the general population. You may argue that as we are also members of the general public this is acceptable. However, given our position and responsibility, we need to be better in recognising our biases as there is an inverse relationship between our level of implicit bias and quality of care.
The RCPCH takes great pride in being a College that isn’t just for its doctors but is an advocate for children’s health. However, that means we need to discuss racism and recognise its impact. Children by the age of four to five years already exhibit attitudes of racial prejudice. These attitudes are not inherent and aren’t just absorbed from explicit acts of racism but reflect the influence of implicit and structural racism in society.
By avoiding conversations and action around racism we go against our aim to achieve health equality for children. The impact of racism and discrimination has been shown to affect children’s mental health and influence high risk behaviour. Ignoring acts of racism, including micro aggressions, that can occur between colleagues, within consultations or in our personal lives means we give a silent yet powerful message of what is acceptable, and replicable, behaviour.
We need to... respect colour, celebrate it and recognise the societal constructs that oppress it
To truly celebrate diversity and the values our healthcare system was built on, we need to understand the diversity of experiences that our colleagues and patients face. We need to have uncomfortable conversations around race and our biases by creating spaces for disclosure and reflection. We need to stop being “colour-blind” and begin to respect colour, celebrate it and recognise the societal constructs that oppress it. We need to take responsibility for our biases, accepting that they exist but aren’t fixed, and therefore can be worked on through bias and allyship education. We need to challenge the structural aspects of racism by advocating for equality and diverse leadership.
This will lead to a system that celebrates our differences whilst being inclusive. This not only improves the quality of care for our patients and improves relationships between our colleagues but also models to those around us that diversity is truly something to strive for and be celebrated.