Health inequalities experienced by communities of colour have been acknowledged by Walcott and Nightingale (2025), concluding that the government aims of better health for all cannot be realised without a diagnosis that understands how racism determines health. Their report cites examples of harrowing media stories such as the death of two children linked to air pollution and mould exposure. Although as a society we have had moments of recognition, mostly stubborn ignorance prevails to racialised patterns, with a reliance on seeing the matter solely as a social-class issue, or distraction by wanting to debate the genetic predispositions that some people may have to poor health, with neither being helpful.
The impacts on physical and mental health of racism in the NHS, as well as wider society, needs to be acted upon.
Kline and Warmington's report (2024) also questioned why concerns about racism are not heard or acted on. They focused specifically on the experiences of Black and minority ethnic staff within the NHS regarding racism and the challenges faced in raising concerns. It used survey data, analysis of employment tribunal cases, and qualitative testimonies to illustrate the pervasive nature of the problem and the institutional barriers that prevent effective action. Key survey findings from over 1300 NHS staff found:
- Colleagues denied promotion opportunities
- Over a third of Black and minority ethnic managers' report their authority being questioned in ways those of white managers are not
- Experiences of rude or different treatment compared to white colleagues are common
- Lack of development opportunities is a major issue, affecting 57.7% of staff in bands 6-7 and 56.0% in band 8 or over.
The report acknowledged barriers to raising concerns, a lack of confidence in complaints and investigations, and argued that a narrow definition of racism as solely deliberate acts of prejudice is ‘misguided’ Racism operates through formal and informal structures and processes. The ‘emperor's new clothes’ analogy was used to illustrate how individuals may go along with discriminatory practices for fear of being seen as unwise or disruptive, allowing the status quo to continue. The report distinguishes between ‘transactional’ and ‘transformational’ approaches to addressing racism. Transactional activities (such as Black History Month celebrations and mentoring programmes without addressing systemic issues) often fail to create meaningful change because the underlying beliefs and assumptions remain untouched. The report concluded with recommendations for employers:
- Develop a nuanced understanding of racism beyond deliberate prejudice
- Ensure HR staff handling race cases have appropriate competence and support
- Critically evaluate decision-making in potential litigation cases, ensuring the correct understanding of racism is applied and considering whose interests are being served
- Move beyond transactional approaches to address the root causes of racism
- Routinely monitor relevant data by ethnicity.
The Walcott and Nightingale (2025) report highlights the importance of broader socioeconomic factors that influence health inequalities in the UK, with a specific focus on the role of structural racism, arguing that addressing racism is fundamental to achieving better health for all. They define institutional racism as:
‘The collective failure of an organisation to provide an appropriate and professional service to people because of their skin colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviour that amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racial stereotyping.’
Furthermore, it cites that people of colour face systemic barriers in accessing the fundamental elements necessary for good health, such as good housing, quality employment with fair wages, and high-quality education, detailing significant health disparities across ethnic groups. It recognises that people of colour experience discrimination throughout the employment lifecycle with the following examples:
- Unreasonable qualification and language requirements
- Evidence that people with Asian or African-sounding names need to submit twice as many CVs to get an interview
- White applicants for NHS roles being 1.5 times more likely to be appointed from shortlisting compared to those of colour since 2016 (Walcott and Nightingale, 2025).
Both reports demonstrate the pervasive and damaging effects of racism within the NHS and wider society.
Ignoring racism not only harms individuals but also undermines the principles of equity and fairness that should underpin the NHS and a healthy society. The evidence presented in both reports provides a compelling case for urgent and comprehensive action for us as nurse leaders.