Antiracist language is one way to explicitly consider ethnicity and racism within our institutions, both during the pandemic and beyond

Millions of people have been deeply moved by the Black Lives Matter protests that took place all over the world following George Floyd’s horrific death at the hands of the police in Minnesota on the 25 May 2020. Calls for equality were made by so many people of all backgrounds. “I can’t breathe” has become a global call for justice. It is obvious and has been for a long time—the colour of your skin and where you or your parents were born have a lasting effect on your life chances. 

The covid-19 pandemic has made this even clearer. We have seen how ethnic minorities are disproportionately affected by this virus and are more likely to die from it. Back in March and April, the names and the photos of the health and care professionals who died from the virus started emerging. They were mostly from ethnic minorities. Stakeholder engagement in Public Health England’s report on Understanding the Impact of covid-19 on BAME Groups identified “racism and discrimination experienced by communities and more specifically by BAME key workers as a root cause affecting health, and exposure risk and disease progression risk”. The report calls for the “explicit consideration of ethnicity, racism, and structural disadvantage.” How can we do this in the context of our institutions? What language can we use to make a change? 

A BMA survey of over 16,000 doctors about personal protective equipment (PPE) published in early May found that 65% felt either partly or not at all protected. I could not help but think how I, an ethnic minority woman, would have reacted to not getting adequate PPE when I was still a junior doctor on the hospital wards. I would have hesitated to raise a concern and felt shy to ask for protection. I would have spent sleepless nights worrying about being labelled lazy or a trouble-maker. I was already the “different” one in the team under the banner of diversity and inclusion. To my mind, speaking out, even about exposure to a potentially deadly virus, would have meant that I may be seen as not grateful for the opportunity to be included where I can prove my merit and progress my career. Many of us were raised with the notion that being grateful means not complaining, so we feel guilty if we demand protection, equality, and fairness. The institutional language commonly used in our surroundings may reinforce such feelings and make us feel unworthy of what others are worthy of.

I would like to reflect on why I find the words we use to express antiracism in our institutions problematic. “Diversity” and “inclusion” imply charity from a position of power and superiority. They give the impression that the group who is opening the door to diversify and include others still holds the key. The point of antiracism is that there should not be a key in the first place. The door should be widely open to all. Clubs with locked doors should not exist in an equitable society. Once that is achieved, the natural result of equity is diversity. It is the end not the means. 

Let’s now come to “tolerance” which I find the most problematic. The dictionary definition of “tolerate” is to “put up with.” On a population level, it refers to the majority tolerating the minority. In the context of people living together in the same society, having the same rights and responsibilities, why should some accept to be “tolerated” because of the colour of their skin or where they/their parents were born?

I have lived, worked, and actively engaged with this terminology for years. My conscious mind has always taken it in a good sense, but my feelings disagreed. It is not nice to feel tolerated. It is painful to feel included as an outsider where you feel you rightfully belong. It is uncomfortable to think of yourself as a colourful crayon brought in to prettify a finished painting, when you actually want to be part of the drawing team. What I want to feel is simply equal. This is what everyone deserves to feel. To me, it is not just semantics. It is the foundation of how I see myself and how others see me as part of society.

Antiracist language is one way to explicitly consider ethnicity and racism within our institutions, both during the pandemic and beyond. We must review the words we regularly use to express our good intentions. Language is important because it shapes our feelings, thoughts and expectations, which in turn shape our actions. Let’s equalise it and remove from it any inference of superiority of one group over another. My plea to you reading this is to consider using alternative words such as equity, justice, and belonging to bring more fairness into the actions shaped by our words. 

Nisreen A Alwan is an Associate Professor in Public Health at the University of Southampton and an Honorary Consultant of Public Health at University Hospital Southampton NHS Foundation Trust. @Dr2NisreenAlwan 

Competing interests: None declared