Exploring racial inequality

The existence of unjust and avoidable health inequalities in Scotland is well evidenced. However, much of the work on health inequalities has tended to focus on socioeconomic circumstances as a fundamental cause when in fact a wide range of social circumstances impact on health, including visible identities and the impact of prejudice and discrimination.

In April 2019, we held two events to explore this issue. The first was a seminar by Professor Laura Serrant OBE, Professor of Community and Public Health Nursing at Manchester Metropolitan University. In her seminar, From silence to speaking: on silences, health and the importance of being heard, Prof Serrant explored the issue of health inequalities though the lens of race and intersectional identities. She drew on both her personal and professional experience as a Black practitioner to explore why the experiences of some groups and individuals are missing from health research, professional leadership and service development.

She used her considerable experience to explore the importance of breaking silences to develop our understanding, and asked whether we need to reflect more on our own identities as part of our practice, as well as that of our communities. A podcast of the seminar is available to listen to here.

This seminar was followed the next day by a workshop-style event: 'Considering racism as a fundamental cause of health inequalities'. This set-out to consider racism as a fundamental cause of ill health and the implications it has for all aspects of our health services, including research, priority setting, service decision-making and delivery.

The event was co-developed with, and chaired by, Dr Ima Jackson of Glasgow Caledonian University who has spent her career working with and evidencing the experience and perspectives of marginalised groups. Invites focused on bringing individuals with a strategic remit for policy, research priority setting and service decision-making together with individuals with direct experience of racialisation to share their critical thinking about the systemic processes which create and maintain those structures.

Plenary inputs were led by Adebusola Ramsay who focused on Scotland’s role in the historic development of systemic racialisation (the transatlantic slave trade, sugar, tobacco and rum, and colonialism) and the need to acknowledge how Scotland’s past has implications for current experiences and racialised inequalities today.

Further inputs highlighted the production of knowledge and evidence on racism as a ‘fundamental cause’ of health inequality and that the process of racialisation changes over time while the power dynamic that creates adverse consequences is maintained.

Guilaine Kinouani, Senior Psychologist and Adjunct Professor of Cross-Cultural Psychology, and an experienced and renowned equality consultant, researcher and writer, facilitated a ‘long-table’ conversation. This enabled a greater range of perspectives and experiences to be heard and engage in honest dialogue, including a challenge to the policymakers and service deliverers to listen to people’s experience and act on it in the future. 

A particularly prominent learning point was the lack of progress or failure to address how racialised inequality becomes embedded in mainstream actions and agendas and to diversify the composition of decision-making structures and systems. Also particularly prominent was the prevalence of racial trauma, the weight and impact of the past and the urgency of the issue. 

Responding to the challenge

These events, and the challenge they highlighted, created and invigorated a considerable amount of personal and organisational reflection, learning and consideration in how best to respond. The challenges raised indicated that responses were required at a system level, but also within GCPH in terms of our role both as a site of capacity and action internally and through our influencing role with regard to knowledge generation and supporting new approaches to reducing inequality.

Over the past year, many conversations and exchanges have taken place. These have explored how we can support and assist the development of responses and areas of action and make connections elsewhere in addressing the issue of racism as a fundamental cause of health inequality, racialised inequality and under-representation in public health data, strategic priority setting and governance.

We are committed to tackling this through our research and amplifying the issue and the challenge. We are also committed to reflect on and address the diverse representation and inclusivity within our own organisational culture, practices and communications.

Given the systemic nature of the issue, it will require ongoing learning and unlearning, commitment and vigilance over the long-term. We have much to understand and do but some of the resulting initial actions are outlined here:  

• A paper was presented to and discussed with the GCPH Management Board in June 2019 on how to respond to the challenge and progress action on this. Download the paper: Beyond ‘being heard’: How might GCPH usefully address issues of racialised under-representation in the sites of action within public health (PDF).
• A specific programme of work and resource on racialised health inequality included in formal GCPH workplan for 2020-21.
• A new Senior Public Health Research Specialist post has been created to help develop the GCPH response and make recommendations for future activity. This will include addressing our practices, decision-making and priority setting to better represent the experiences of BME communities and People of Colour.
• We are utilising our longstanding role to support creative thinking in public health through collaborative conversations across the wider public health landscape.
• A group has been established to ensure ongoing work on this and exploration with the GCPH team of currents gaps and training needs in relation to research and engagement practice and work with colleagues in academia and public health to promote anti-racist practice in the wider research workforce.
• As part of our 17th Seminar Series, Professor David Williams joined us to deliver a keynote lecture on how racism shapes our health.