October is Black History Month (BHM). Before considering health, social care and nursing, it is just as important to reflect on the society within which these institutions exist and where people come from. I have often thought that nursing does not exist in a race-free vacuum. The socio-political constructs of society play an integral role in nursing and care delivery. So what is it like to be Black and British in the UK today?
Failure to call out racism
The treatment of a young Black female gymnast in Ireland who was ignored because she is Black has been receiving widespread circulation and comment in the media. It is 2023 and it has been described only as ‘alleged racism’ (Hegarty, 2023). This is clear evidence of the continued practice of not calling racism what it is, and letting racism continue. How can anything change if racism cannot be named but only alluded to?
If the White person inflicting racism on the gymnast did not mean to do it, or consciously do it, does that mean that the racism inflicted is less than if it was deliberate and overt? Is it even racism or unconscious bias? If that unconscious bias is constructed on negative racist stereotyping of Black girls and women, then it's racism. The intent behind an action may placate some but not others when it comes to racism and how it impacts on the daily lives of Black people in Britain.
Racism inflicted ‘casually’ has not hurt me personally any less than overt and institutional racism, all of which I have experienced both in the clinical environment and education. It does not reduce health inequalities, only worsens them for the Black community in Britain (Walker, 2021).
BHM is meant to highlight the positive attributes, contribution and history of Black people in Britain. It is hard this year to try to think positively. The story of the Black gymnast is one reason, the survey by Black British Voices published last month is the second reason, and the employment tribunal in Manchester of a Black woman who faced race-based discrimination, harassment and victimisation from her employer, is another.
‘The centrality of whiteness at the expense of the equitable treatment of Black British people continues in all aspects of British health care for those employed and those using the service’
Black British Voices
The survey results highlight the contradictory relationship with the UK that Black British people experience. More than 10 000 Black Britons from across the UK completed this extensive survey, covering a range of social and cultural issues, from media and politics to mental health. They found the following:
- Only 7% of research participants felt that Black people in Britain receive fair treatment from health professionals
- Some 68% of respondents said they or a family member has suffered from mental health problems
- 98% of those surveyed said they have compromised self-expression and identity to fit into the workplace – by adapting speech or hairstyles, for example – with appearance and cultural background cited as factors influencing lack of promotion or development (Lewsey, 2023).
The chapter in the report on wellbeing, including healthcare, is sombre reading. The overwhelming conclusion is that Black Britons do not feel safe in the NHS and when receiving care.
Clear racial discrimination
Michelle Cox faced racial discrimination, harassment and victimisation. The tribunal in February 2023 found Ms Cox, a Black woman who was an NHS continuing healthcare manager in NHS England's North regional team, had been ‘excluded at every opportunity’ by her line manager Gill Paxton (Royal College of Nursing, 2023). The fact that her manager, in a position of power, was able to do that to a Black member of her senior team shows the depth at which racism is embedded in practices, systems and processes in the NHS. It shows that power is given but can be taken away if it does not fit into the confines of maintaining White supremacy. The centrality of whiteness at the expense of the equitable treatment of Black British people continues in all aspects of British health care for those employed and those using the service.
True equity
I can only hope that there are enough of us in the UK who want true equity of treatment for all in society and healthcare to outnumber those who do not see the inequity that comes with racism. And I hope that BHM can be a part of making anti-racism stronger than racism.