Darryl Adjei - Medical Student deconstructs and analyses covert racism embedded in the Healthcare System.
Milk Exhibition at the Wellcome Collection in London
In all honesty, I did not have high expectations as I walked through the Milk Exhibition being held at the ground floor of the Wellcome Collection in London (2022). While I wanted to consider myself mature, I honestly felt I would receive strange looks as I studied the piece I had stumbled upon, Chocolate Milk Goddesses (Cohill, 2017). I was flooded with so many thoughts and memories; in hindsight I think anybody would have been at least slightly awestruck if they were in my position. The mothers clad in all black with highlights of gold as they breastfed their young gave an initial aura of empowerment but also one of sadness that was unravelled as I took a deeper look at the context, history, and significance of the piece. Cohill, the photographer, wanted to portray them as goddesses to ‘empower’ and encourage breastfeeding amongst African American women who, at the hands of the American system, have significantly reduced breastfeeding rates and lactation support postnatally (Milk, 2017). I knew that ethnic minority women in the UK suffered similar systemic biases that have left them worse off within our healthcare system and this was something I wanted to explore in more detail.
Racism in the UK vs the US
With age, I have come to realise a key difference between racism in the UK and the US: In the US, racism is more ‘in your face’ with physical and verbal abuse coupled with racial slurs, but in the UK, it is more of a systemic issue that keeping ethnic minorities at an overall disadvantage. And because the racism here has a more subtle and discrete effect, it can be harder to call out, or more cynically, it is easier for society to tag as a non-issue. If not for elite athletes or TV personalities, black people only ever seem to be at the forefront of news during discussions of race. At the time of writing, a statistic has been floating around the media for several weeks that black women were found to be 3.7x more likely than white women to die post-partum in a study carried out between 2018 and 2020 (Hinton, Abe, Awe et al, 2022, p. 2). This figure seems to put into perspective the sort of issues that can go unnoticed. It begs the question of what tangible efforts are being made to support ethnic minority women within our healthcare system.
While I by no means wish to dilute the struggles of other minority groups, I cannot help but feel at a loss when issues of gender and sex are being so rapidly addressed within government with policies being debated all the time. I see these things and wonder why racial disparities are not being quashed at the same rate. When looking at the differences in continuities of care with GPs between ethnic groups in the UK, it was found that ‘continuity of care was lower for all Black ethnic groups and for Pakistani and Bangladeshi ethnic groups than for the White ethnic group’ (Stafford, Becares, Hayanga et al, 2023). Black ethnic groups are also more likely to live within areas of lower socioeconomic status (Francis-Devine, 2020), thus will have less access to support services for their chronic/complex health issues. As low socioeconomic status is associated with lower continuity of care and poorer health outcomes (Stafford, Becares, Hayanga et al, 2023). Thus, the combination of being black and impoverished paints a damning picture for potentially millions who may need health care across the nation.
For me, it is very easy to see how these epidemiological findings can translate into unconscious biases, stereotyping, and stigma of ethnic minority groups and in particular black women within our healthcare system. The stereotype I always hear is of black women being described as ‘rowdy’ and ‘ghetto’ with those choosing to wear their hair in braids or locs, as with the women in my selected piece, being described as ‘unkempt’ and ‘unprofessional.’ What I see as fiery passion and utmost beauty, others can be quick to tag as unsightly and jarring.
My mother is a midwife who works within the NHS, and out of all her anecdotes, the most disturbing thing to hear was that my mother would sometimes have to berate members of her team who were not acting (or were very lethargic) to address the needs of black and ethnic minority women on the antenatal and labour wards. Most notably, according to her, black women were asked to endure for longer than their white counterparts before receiving pain relief. This idea that black women have significantly higher pain tolerances or did not experience pain in the same way as white women was the very basis with which the ‘Father of Modern Gynaecology’ chose to experiment on enslaved women sans anaesthesia in attempts to perfect his surgical techniques while opting to use anaesthesia with white women (Dayo, Christy, Habte, 2006). Though this was centuries ago and perhaps people may not be swayed by the words of one midwife, it is still being seen to this day that many black people, especially young adults, experience discrimination at the hands of healthcare staff in the UK with the ‘strong black woman’ stereotype evidently present (Iacobucci, 2022).
Black and other ethnic minority groups make up 30% to 40% of the staff that patients are likely to meet during their patient journey, yet we make up only 13% of the most important roles within the most senior levels (NHS WRES report, 2022). Although the report suggests that this proportion is steadily on the incline, I cannot help but feel that black and ethnic minority NHS works have been allowed to take a large bulk of the direct patient contact and manual labour while not necessarily being trusted or enabled to operate at a higher level to make important decisions that have positive implications for the healthcare of all within the UK.
Throughout the countless hours I’ve spent reflecting on this photographical piece I have been left with a lingering feeling of despondency. I see campaigns that advocate for ethnic allyship and healthcare equity; I know people in my personal life that are huge drivers of these sorts of efforts, but I’ve felt as though they can only do so much. The would-be beneficiaries of these campaigns receive their limelight for a moment but are shortly thereafter caught up in the same issues as always. The lingering thoughts are one of a future of the same systemic patterns and disproportionalities that have always suffocated my people. It is almost as if the discrimination is being cloaked under the guise of the very campaigns that black and ethnic minority doctors and allied professionals are so valiantly leading to fight it. I am aware that this is a pessimistic outlook of the times to come, but it isn’t one that I am going use to make decisions going forward. Even if it’s just a single step, I am left wondering if I am someone who can help the country take another step towards healthcare equity for black and other ethnic minority patients within the NHS.
References:
Cohill, L. (2017). Chocolate Milk Goddesses. [Photograph] Available at: https://www.instagram.com/p/CEe_TrSpeDV/.
Dayo, E., Christy, K. and Habte, R. (2022). Health in colour: Black women, racism, and maternal health. The Lancet Regional Health - Americas, [online] 17(100408), p.100408. doi: https://doi.org/10.1016/j.lana.2022.100408.
Francis-Devine, B. (2020). Which Ethnic Groups Are Most Affected by Income inequality? commonslibrary.parliament.uk. [online] Available at: https://commonslibrary.parliament.uk/income-inequality-by-ethnic-group/#:~:text=Significant%20income%20inequality%20exists%20between [Accessed 29 Apr. 2023]
Hinton, L., Abe, C., Awe, A., Green, M., Holly, J., Kenyon, S., Kitchen, K., Knight, M., Kurinczuk, J., Thomas, L. and Woodman, T. (2022). Saving Lives, Improving Mothers’ Care 2022: Lay Summary. [online] MBBRACE-UK, p.2. Available at: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2022/MBRRACE-UK_Maternal_Report_2022_-_Lay_Summary_v10.pdf [Accessed 28 Apr. 2023].
Iacobucci, G. (2022). Most Black People in UK Face Discrimination from Healthcare staff, Survey Finds. BMJ, [online] 378, p.o2337. doi:https://doi.org/10.1136/bmj.o2337
Stafford, M., Becares, L., Hayanga, B., Ashworth, M. and Fisher, R. (2022). Continuity of Care in Diverse Ethnic groups; a General Practice Record Study in England. British Journal of General Practice, [online] 73(729), p.BJGP.2022.0271. doi:https://doi.org/10.3399/bjgp.2022.0271
Milk (2023) [Exhibition]. Wellcome Collection, London, England. March 30, 2023 - September 10, 2023. Available at: https://wellcomecollection.org/guides/exhibitions/ZD01LBQAAC4ZiY95/captions-and-transcripts (Accessed: 24 April 2023).
www.england.nhs.uk. (2023). NHS Workforce Race Equality Standard (WRES)2022 data analysis report for NHS trusts. [online] Available at: https://www.england.nhs.uk/long-read/nhs-workforce-race-equality-standard-wres2022-data-analysis-report-for-nhs-trusts/ [Accessed 29 Apr. 2023].
Written by Darryl Adjei | Medical Student