The Race Health Observatory (RHO) was established to assist the National Health Service (NHS) in England to enhance healthcare and tackle inequalities for people from non-White ethnic backgrounds. One of the key initiatives undertaken by the RHO to deliver this is the publication of the ‘Seven Principles of Anti-Racism’. These principles serve as a foundation for healthcare organisations and systems to begin addressing health inequalities.

In this blog, Dalvir shares how she has implemented elements of the anti-racism principles in her area of work.

Principle 1: Naming racism

Racism is a difficult subject to tackle as it often evokes discomfort and anxiety. Without naming racism, it is easy for us to deny its existence and accountability. Whilst naming racism is essential, health care services must also create tangible ways to address it. By leading on the implementation of a staff focussed anti-racism framework such as that developed by Capital Midwives, organisations can critically review interviewing and disciplinary processes, as well as examine the diversity of senior leadership. By doing this, an organisation can create an action plan to address disparities.

Principle 2: Understand and acknowledge

There also must be tangible ways to address racism. A key element of this is to ensure that staff feel comfortable to raise concerns and that this is addressed. Raising awareness of Freedom to Speak Up Guardians and supporting their visibility in the clinical areas is one of the many routes to assist with raising concerns. In addition working with organisations which can offer support to staff such as Trauma Risk Management (TRiM) which help staff who have experiences traumatic events and acknowledge, this not dismissing what the person has been through.

Principle 3: Involving racially minoritised communities

Establishing community connections such as via voluntary sector organisations and places of worship, supports visibility and builds trust, which is low in many communities with protected characteristics.

By sharing information on critical topics known to contribute to disparities in maternity outcomes this approach enabled outreach to the communities most affected. This included sharing information on the importance of vitamin D for maternal and neonatal health. The MBRRACE – UK Perinatal Confidential Enquiry in 2023 showed that women from Asian backgrounds had less of an uptake of Vitamin D in pregnancy than White women. Vitamin D is important in improving perinatal outcomes by reducing risks of pre-term birth and gestational diabetes. Whilst it is important educate midwives in this element of practice, it is equally important to empower women to be aware of the benefits and therefore sharing this at community events is an ideal way directly involve and share with communities.

Additionally, for many years now, maternity units across England have celebrated Christmas through offering a Christmas hat to all babies born on the day. In Leicester, where a large proportion of the community celebrate Diwali, the maternity team secured funding from Leicester Hospital Charity to offer each and every baby born on Diwali a battery operated tealight and a happy Diwali card. This supported a culture of belonging and enabled our staff to be educated in different celebrations. This was very successful and positively received by families in the hospitals and the surrounding community.

Principle 4: Collect and publish data

Ethnicity data informs many areas of practice. However, one area where utilising such data needs improving is when reviewing clinical incidents involving patients. Through working with the healthcare services patient safety team, data can be collected on the reporting and analysis of incidents by breakdown of ethnicity. This is really important because it provides a holistic review of the incident and avoids overlooking factors which could have made a difference.

Whilst many organisations may use dashboards to monitor trends, they provide only quantitative data. For example, dashboard data may demonstrated that women from Asian backgrounds are more likely than any other ethnic group to experience perineal trauma involving the anal sphincter. However, the data will not explain why this is the case. Understanding the reasons requires qualitative information, which can only be obtained through detailed reviews of clinical investigations. Without this deeper analysis, assumptions may arise such as attributing the issue to anatomical differences, when in reality, these women’s bodies are not inherently flawed. A closer examination might uncover contributing factors, such as the lack of interpreters during childbirth, which could significantly impact communication during delivery.

Principle 5 & 6: Identify racial bias & Apply a race critical lens

This can be achieved through implementing a Health Equity Assessment Tool (HEAT) for all guidelines, process, quality improvement projects and service designs. The assessment provides a series of prompts to ensure that there are no adverse effects of such processes on particular groups of people and the assessment requires clear documentation of strategies to mitigate these impacts. An example of such a tool can be found via the Office for Health Improvement and Disparities here

Principle 6: Evaluate and reflect

The NHS Staff Survey is an example of metrics which involve racism. The survey informs elements of the Workforce Race Equality Standard and supports us to review at a local level, how many staff have reported that they have been unfairly treated as a result of discrimination. Through reviewing this data on a yearly basis, one can evaluate and reflect if the actions taken to address discrimination in the workplace is making a difference.

Addressing ethnic equity in healthcare is a key priority for the NHS as indicated through the Core20Plus5 approach. Initiatives need to be multifaceted and the examples above provide some ideas of how such challenges can be addressed.

Author

Dalvir Kandola – Consultant Midwife; Lead for Inclusivity at University Hospitals of Leicester NHS Trust.

Dalvir has 15 years’ experience in healthcare. She specialises in cultural diversity, supporting one of the most diverse cities in England to provide inclusive care within perinatal provision.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.