The NHS Race and Health Observatory—its time has come

On 30 May 2020, NHS England and the NHS Confederation launched the NHS Race and Health Observatory, a new centre to investigate the impact of race and ethnicity on people’s health and to identify and tackle the specific health challenges facing people of black and ethnic minority origin. [1]

The background to this announcement was that in February 2020, The BMJ published a special issue focusing on racism in medicine. [2] The edition drew on a wide spectrum of research on racial inequalities in health and on the experience of healthcare staff, illustrating how differences permeate every aspect of the NHS—from ethnic disparities in maternal mortality, and genetic counselling, to the experience of medical students, and career progression of junior doctors. [3-6] In stark contrast was the lack of any evidence of action to address these inequalities, leading to a call in the issue, for the establishment of a race and health observatory as a means to achieving an NHS free of racism and discrimination. [7]

The covid-19 pandemic followed hot on the heels of the special edition, and lent an unanticipated urgency to the establishment of the Observatory. As the disproportionate impacts of this novel infection on ethnic minority communities and healthcare workers became apparent, a dismayed nation was confronted with the uncomfortable truth about how the disadvantage and deprivation which define the lives of people from ethnic minorities in England has put them at such greatly increased risk of serious illness and mortality. [8]

As highlighted by Simon Stevens, the Chief Executive of NHS England in the announcement of the Observatory

Ethnicity and race have been shown systematically to influence our health, independent of factors such as age, sex, and socio-economic status. The coronavirus pandemic has injected stark urgency into the need for more action to both understand and tackle deep-seated and longstanding health inequalities facing people from black, Asian and ethnic minority backgrounds.

“While the NHS has made some strides in workforce race equality, and although tackling wider inequalities cannot fall to the NHS alone, the health service has to both listen and lead as part of the solution. This new centre will therefore bring together expertise to offer practical, useful suggestions for change.

What will the Observatory aim to do? It will seek to achieve not only equality of access to services, but equal health outcomes irrespective of race. While discussions as to its functions and structure have only just begun, the Observatory’s aims are clear, and build on lessons of successes and failure from the past. It will 

  • provide a unified source of policy relevant evidence and information which would explain how and why racial disparities in health occur. While the evidence would be principally aimed at enhancing the knowledge and understanding of healthcare leaders, its outputs are intended to be publicly accessible.
  • target outcomes, by translating the research into practical guidance, so that new and existing policy and programmes are renewed, designed and delivered to reduce disparities and
  • begin with reviewing the impact of policy practice and programmes on the health and wellbeing of the ethnic minority health workforce, in collaboration with NHS England’s Workforce Race Equality Strategy. Eliminating the adverse outcomes of racism and discrimination in the NHS’s own workforce is not optional, if the Observatory is to be a credible authority in race equality into the future.

Leaders involved in the planning of the Observatory are agreed that to achieve the necessary respect, legitimacy and public confidence, it must be independent and transparent in its accountability. As its title suggests, it also needs to be extensive in what it views, because some of the answers to improving health outcomes will be found in interactions between the NHS and the socio-economic environment in which ethnic minority communities live. The Observatory will need to set an appropriate remit which strikes the right balance between focusing exclusively on the NHS and, for the first time, deepening our understanding of how socioeconomic and cultural factors interact with NHS delivery to impact on the health and wellbeing of ethnic minority communities.

Those involved in planning the Observatory are also minded that it needs to establish a clear identity which distinguishes it from academic institutions, as well as government policy departments. It will need to build strong partnerships with stakeholders including academia, government and the public. 

The Observatory will principally aim to translate data and evidence into better practice and outcomes, and much evidence is already available to enable rapid action. But the need for better data and more research cannot be ignored. The pandemic compelled policy leaders to become aware for the first time, that the analysis of deaths by ethnicity is hampered because death certificates do not include this detail. Yet this gap in data had been highlighted as a barrier to evidence-based race and health strategies by academics as far back as in 1999. [9] The tension between the demand for quick answers and the challenge of overcoming decades of underinvestment in research on the health of ethnic minorities will need to be managed. 

The protests in recent weeks, following the death of George Floyd in the US (10), add another layer of urgency to the task of improving the health, wellbeing and circumstance of ethnic minority communities in the UK. [10] The Observatory will face many challenges, as well as naysayers. But no worthy enterprise is without its risks, and this is one which we have moral responsibility to shape into an enduring influential driver of health equity. We must do so to ensure that our healthcare colleagues who have died from covid-19 before their time have not died in vain.

Mala Rao, professor, Department of Primary care and Public Health, Imperial College London, London, UK

Victor Adebowale, chair of NHS Confederation, London, UK

Competing interests: None declared


  1. NHS England 30 May 2020
  2. British Medical Journal Racism in Medicine Special Issue 13 February 2020
  3. Anekwe L. Ethnic disparities in maternal care BMJ 2020;368:m442 
  4. Khan N, Salway S. Communities that prefer close blood marriages need more help to access genetic services. British Medical Journal 2020;368:
  5. Kmietowicz Z. Are medical schools turning a blind eye to racism? British Medical Journal 2020;368:m420 
  6. Woolf K. Differential attainment in medical careers. BMJ 2020;368:m339
  7. Adebowale V, Rao M. Racism in medicine: why equality matters to everyone. BMJ 2020;368:m530
  8. Khunti K, Singh AW, Pareek M, Hanif W. Is ethnicity linked to outcomes of covid-19? BMJ 2020;369:m1548
  9. McKenzie K. Something borrowed from the blues? BMJ1999;318:616-7
  10. Moberly T. Hospital staff take the knee in Boston. BMJ 2020;369:m2278