How can we talk about racism to improve health equity?

Since absorbing the must-read report Contains Strong Language from Reframing Race, I’ve been reflecting on how public health can talk about the ideology of racism and better explain how experiencing racism impacts our physical and mental health. How can we talk about racism in health outcomes, policy and practice in ways which will lead to ‘new ways of listening’, and in turn inspire action to deliver greater health equity?

When it comes to the building blocks we all need for good health – access to education and housing, a job that pays enough to cover the bills, being part of our community – experiencing racism can wear away at every block.

More research is needed to uncover how we can best switch the dial and build greater understanding of the many ways experiencing racism impacts health, and in turn build support for action to address this, but that doesn’t mean we should avoid the conversation. We can – and should – call out racism now.

Here are three things to consider if you are a public health professional or, indeed, anyone, wanting to draw attention to the harms of racism and how it impacts health.

1. Don’t use terms like systemic/structural racism without explaining what you mean.

Calling out institutions, systems, and policies as racist, without adequate explanation of what we mean, can backfire. Most people think of racism as one individual being prejudiced against another and reject the idea that British society is racist by design. We need to give specific examples to show the way that certain systems and institutions perpetuate the ideology and practice of racism, and how that leads to worse health outcomes for some people.

For example, in a healthcare setting, you can talk about how medical textbooks have historically used illustrations of patients with white skin, which means doctors weren’t trained to see how conditions present, and may look different, on different skin types. This has led to incorrect or missed diagnoses.

Or explain how name biases in hiring mean people with a “foreign sounding” name are often less likely to be invited for interviews. This impacts job prospects, the ability to earn a good wage, and, in turn, the ability to pay for the things we all need for good health – like a warm home and enough, healthy food.

Additionally, Reframing Race suggest that you can use the metaphor of a birdcage to help people understand the systemic nature of racism. For example:

‘Underlying racism is a system of ideas, laws and customary ways of doing things. Together this system is like a birdcage. Each wire of the cage represents one aspect of how society limits key opportunities and freedoms – such as whether someone can leave school hopeful about the future, live in a decent home, or get a good job.’

2. Do talk about how the ideology of racism amplifies broader societal issues we all experience to avoid “us vs. them” thinking. 

To avoid zero-sum thinking, we need to be clear that the factors that shape health impact all of us, but that racism makes life even harder for some of us.

Lead by talking about how too many of us don’t have the building blocks we need for good health – money, a stable job, a warm home to call our own – and this is leading to lives being cut short.

Explain that the practice of racism amplifies these challenges and makes life even harder for some of us, denying us the same freedom of opportunities. Use specific examples to illustrate this.

Conclude with the need to fix the crumbling building blocks, and root out racism, so that we can all lead healthy lives.

3. Do put health data in context.

Data doesn’t speak for itself, and when we present numbers without explaining them people will often fall back onto inaccurate assumptions. When it comes to differences in health outcomes for Black, Asian or White populations, without adequate explanation, people will often assume the differences are down to genetic factors or perceived differences in cultural practices – like the food we eat – rather than as the result of the practice of racism. Because of this we must always put data in context and explain what it shows, to help people understand the connection.

Instead of saying:
People from all ethnic minority groups had higher rates of death involving COVID-19 compared with the white population.

Try:
Experiencing racism in school and the job market, limits our job prospects and income. As a result, people from Black, Asian and other minoritised backgrounds, are more likely to live in crowded accommodation, use public transport and have jobs that can’t be done from home; which increased the risk of exposure to COVID-19. This led to higher COVID-19 related deaths compared with the white population.