It is Black History Month therefore the focus is on the black experience and contribution through history. There are pros and cons to having a designated Black History Month as black history is part of British history and the history of nursing, but this is not up for debate here.
In the past 5 years or so there has been a shift in society and nursing due to the work of the Black Lives Matter movement and the COVID-19 pandemic, highlighting the precarious position that black lives have due to racism and its symbiotic relationship with the increased death toll of black members of society, particularly healthcare workers (Brathwaite, 2020; Kapilashrami, 2022). The social determinants of health also have a relationship with racism and poorer health outcomes (Marmot, 2021). Racism and its connection to some of these issues were being theorised, discussed, analysed and debated long before 5 years ago but terminology related to racism and what this means has become more used in mainstream society. For example, white supremacy, white fragility, bias, microaggressions, individual racism and institutional or structural racism.
The Government response to these changes has been to do what has been done repeatedly throughout the history of the British Government: to have independent reports written. Two reports have been published, the first of which tried to understand the higher death rate of black people due to COVID-19 (Public Health England (PHE), 2020). The second was written by the Commission on Race and Ethnic Disparities (2021) set up by the Government, but has come to be known as the Sewell report after the chair, Dr Tony Sewell. These reports are relevant to nursing and health care in general because they look at the reasons why the experiences and outcomes for black people are different in various ways than the white British population. Different in an unequal way across multiple markers of inequality in society such as work, housing, crime, education, and health. In nurse education there is an awarding gap difference between non-white students and white students, with white students doing better (Godbold and Brathwaite, 2020). In nursing there are fewer black nurses in senior positions, although they make a larger proportion of the nursing workforce than their numbers in the population, particularly in London (Workforce Race Equality Standard Implementation Team, 2022). Black registered nurses are more likely to be subject to a Nursing and Midwifery Council hearing for disciplinary matters (Allan, 2022). There are documented accounts by black nurses of experiencing racism from both the public and fellow team members (Gordon, 2021). Being anti-racist as an individual and as an organisation is paramount for true equity for black nurses.
‘If report after report states that … it is only racial discrimination on an individual level and not institutional … then this only supports the argument that institutional racism survives’
The problem with both reports is that they do not clearly identify or do not acknowledge the existence of institutional racism as a structure of power that plays a role in the harsher nursing and health outcomes for the black population and black nurses.
To be anti-racist, racism must be understood and it must be acknowledged that racism actually exists. This may seem ridiculous to state as the existence of racism is clearly out there in society. However, a real understanding of what it is, is altogether something different. Racism is a complex term and incorporates prejudice, discrimination, stereotypes, and bigotry. ‘Race’ linked to skin colour is only one part of what makes racism. ‘Race’ is socially constructed and what is attributed to certain ‘races’ is based on cultural differences. Difference is also important as it is aligned with being weak, less powerful and inferior to whiteness, which is not considered as a ‘race’ at all leading to the centrality of whiteness and power being the default position and the norm in society (Elgenius and Garner, 2021).
Whiteness and the power that it has is rarely considered as an important part of formulating and perpetuating racism. From clinical decisions, access to health care, to what is deemed acceptable and relevant to be considered important such as the history of black people. Making clear recommendations on how to combat racism and be anti-racist that will be truly followed through. Ultimately these reports maintain racism and uphold white privilege in the NHS and social care. If report after report states that racisms is present, or it is only racial discrimination on an individual level and not institutional – such as in the Sewell report (Commission on Race and Ethnic Disparities, 2021) – then this only supports the argument that institutional racism survives.
Real change to equity for all and to be anti-racist is messy, complex, and paved with mistakes from everyone trying to achieve this goal. Making racist assumptions, asking racist questions, centralising whiteness as the norm, not dealing with the uncomfortableness with talking about racism for white people and using white fragility to deal with that uncomfortableness (DiAngelo, 2021) and asking black people to explain what is or is not racist instead of doing the work of learning about what racism is constitutes racist practice. The burden of learning how to be anti-racist is not on black people but for white people to learn about. There are a plethora of articles, books and podcasts on racism that can be used to get educated. The goal in nursing as in society is to be actively anti-racist. ‘Not being racist’ is not enough to make systemic change to society, our profession or the NHS.