{"id":2064,"date":"2020-11-22T14:28:19","date_gmt":"2020-11-22T14:28:19","guid":{"rendered":"https:\/\/blogs.bmj.com\/ebn\/?p=2064"},"modified":"2020-11-23T11:21:54","modified_gmt":"2020-11-23T11:21:54","slug":"confronting-race-inequality-with-an-open-mind-and-open-heart","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/ebn\/2020\/11\/22\/confronting-race-inequality-with-an-open-mind-and-open-heart\/","title":{"rendered":"Confronting Race Inequality with an Open Mind and Open Heart"},"content":{"rendered":"

Yvonne Coghill (@yvonnecoghill1) is the former Director of the Workforce Race Equality Standard in NHS London, and the former Deputy President of the Royal College of Nursing.\u00a0 Amelia Swift (@nurseswift) was an Associate Editor of Evidence Based Nursing and is a Senior Lecturer in Nursing at the University of Birmingham.\u00a0They met to discuss race inequality in the NHS, and specifically in nursing.\u00a0 This blog is the result of that interview. \"\"<\/a><\/p>\n

Context<\/strong><\/p>\n

The unlawful death of George Floyd at the hands of the police force of Minneapolis in the United States of America was a watershed moment in the continued efforts of people of colour to gain equality. Across the world people of different races, ethnicities and colours have come together to denounce the lack of fair treatment based in the colour of a person\u2019s skin and to declare their allegiance to that cause.\u00a0 At the same time, we have seen that people of colour are disproportionately affected by coronavirus disease, which has similarly led to increased awareness of inequality and injustice.\u00a0 But George Floyd and coronoavirus disease are the events of 2020.\u00a0 The history of inequality is long and shameful.\u00a0 Perhaps the mirror that these events holds up to our society can finally do some good.<\/p>\n

What is the \u2018correct\u2019 vocabulary to use when we discuss issues related to race?<\/strong><\/p>\n

We have become very used to grouping everyone with darker skin together using the term Black and Minority Ethnic (BaME), or Black Asian and Minority Ethnic (BAME).\u00a0 Yvonne prefers the term people of colour or non-white groups.<\/p>\n

We all have different amounts of melanin in our skin.\u00a0\u00a0 If you have more melanin in your skin you stand out, and the more melanin you have the poorer treatment you get from society in general. <\/em>YC July 2020<\/p>\n

Putting people into different groups creates divisions and can feed hierarchies.\u00a0 While some do not like the term people of colour, it is probably the better term for the time being.\u00a0 One of the things we must do is talk about the issues.\u00a0 Being anxious about what the correct terms might be, which will depend on personal preference to a large degree, stifles the discussion.\u00a0 It is better to talk than to say nothing, and it is necessary to talk to be an ally.<\/p>\n

Can we talk about race?<\/strong><\/p>\n

Having a conversation about issues to do with race can take courage.\u00a0 Many of us run the risk of exposing our ignorance, offending someone with a prejudicial attitude, or demonstrating a racist attitude.\u00a0 We tend to avoid the potential to expose ourselves in this way because racism is considered irrational, immoral, mean and bad 1<\/sup>.<\/p>\n

The staff of the National Health Service are a microcosm of society. It is inevitable that our collective attitudes will range across that same normal distribution, including the extremes at either end.\u00a0 However, while surfacing racism and having the conversation is important, it is equally important for the individual to protect themselves.\u00a0 Apply your energy to changing the rhetoric and challenging inequality where it is most likely to have an effect, with those who have an open mind and are willing to have a conversation.<\/p>\n

What is white privilege?<\/strong><\/p>\n

The term white privilege<\/em> has become almost ubiquitous but can be unhelpful in promoting dialogue. \u00a0The term social capital<\/em> may convey the principle in a less divisive way.\u00a0 All else being equal, being born white confers an advantage \u2013 this is inarguable but uncomfortable to accept.\u00a0 Using the term white privilege can provoke defensiveness, and for many the need to point out their own disadvantage.\u00a0 We see this in the arguments provoked by the phrase Black Lives Matter<\/em>.\u00a0 To some this is inflammatory because they feel that by making this statement what is implied is that black lives matter more \u2013 or that while we pay attention to this issue we will not be able to continue to pay attention to your unmet needs and grievances.<\/p>\n

Renni Eddo-Lodge described the way that white people\u2019s \u2018eyes shut down and harden\u2019 when a person of colour articulates their experience2<\/sup>.\u00a0 The reasons for this are many and varied but one is the position that white people occupy in society. Robin DiAngelo describes the way that white people are \u2018insulated from racial stress\u2019<\/em>.\u00a0 Having never seen themselves in terms of race leads to perplexity when others describe their experiences in such terms.\u00a0 Racism is seen as deeply immoral and so we tend to deny that we have racist thoughts or attitudes.\u00a0 When we become aware that what we have said, done, or thought is racist we can learn and change.\u00a0 Instead we can react defensively, falling back to an individualistic perspective 1<\/sup><\/p>\n

I am not a racist,\u00a0 I am White Italian and I have experienced racism, I have Black friends therefore I am not racist<\/em>. 1<\/sup><\/p>\n

This prevents the person from exploring and accepting the general and pervasive racism that is present in our society.<\/p>\n

Is there really a problem in the health service?<\/strong><\/p>\n

No matter the colour of a person\u2019s skin, the goals of nursing are the same and fair treatment and the absence of discrimination will allow all nurses to work towards those goals.<\/p>\n

If you have a valued, appreciated, motivated workforce, you get better patient care, patient safety and patient satisfaction. <\/em>\u00a0YC July 2020<\/p>\n

However, there is an obvious and persistent inequality. People of colour are more likely to face disciplinary action.\u00a0 The biggest disparity is seen in London where BME staff are 1.77 times more likely to face disciplinary action than their white colleagues 3<\/sup>. \u00a0According to reports they are also slightly more likely to suffer from bullying and harassment from both patients and staff 4<\/sup>.\u00a0 In the 2019 NHS Staff Survey just over 30% of staff from BME backgrounds reported to having experienced bullying and harassment from patients, and 28% from managers and other colleagues 5<\/sup>.<\/p>\n

About 20% of staff in the NHS are from ethic groups other than white but they represent less than 8% of those in senior and very senior management positions 4 6<\/sup>. Interview panels are dominated by white people, and black candidates may seem like more of a risk to them than the person who looks like they do. This is born out in the statistics with white candidates being 1.57 times more likely to get shortlisted for senior grade interviews. Only 8% of those in band 8c, and 6.7% of those in very senior management posts are from BAME backgrounds 4<\/sup>.<\/p>\n

It is more difficult to reach a senior position, and then it is more difficult to operate in that senior position.\u00a0 As the only black person at a senior level you are more visible than your white colleagues.\u00a0 Your mistakes will reinforce any doubts your employer might have, and there is a strong likelihood that your deficiencies will be applied to the whole of your race rather than you as an individual.<\/p>\n

So, what can NHS organisations do?<\/strong><\/p>\n

It is important that organisationally and individually we are allies. At an organisational level both in the NHS and in education we need to make sure that people of colour are not disadvantaged by the recruitment process.\u00a0 The data suggest that people of colour are successful in gaining entry to many universities and at getting entry level jobs, but it is after this point that the inequalities become glaringly apparent. There is an attainment gap in university education in terms of retention, degree classification and graduate employment. Universities must work hard to understand the reasons for these disparities and address them.\u00a0 This requires long-term strategies including increasing the number of people of colour employed as teaching and research staff.\u00a0 The number reaching senior levels needs to be increased. The Race Equality Charter 7<\/sup> aims to improve the representation, progression and success<\/em> of both staff and students of colour in higher education. Institutions start at Bronze level and work to Gold.\u00a0 There are currently 15 universities in the UK that have achieved a Bronze award since the scheme started in 2015. \u00a0To achieve this award the university must<\/p>\n