This blog, co-authored by Joy Warmington (brap CEO) and Simon Newitt (Senior Consultant, Kings Fund), originally appeared on the King Fund website.
We – all of us working in health and care – still have a problem with racism. There, we’ve said it.
As the historian Nell Painter (2010) has said, race is an idea not a fact. But though it has no biological validity – there is no gene or cluster of genes common to any so-called ‘racial group’ – race remains one of the most powerful organising ideas in our society, profoundly influencing people's chances in life, their experience of public services, and their health.
In Between the world and me, Ta-Nehisi Coates notes that ‘Race is the child of racism, not the father.’ This reminds us that the idea of race is a political one, emerging at a particular historical moment to morally justify European colonialism and slavery, and create a distribution of power, resources and opportunity that is inequitable. The idea of race continues to be remade because the inequities created in that moment endure today and require an active belief system to maintain them. If we want to rid ourselves of these inequities, we must rid ourselves of the root cause of them – the idea of race and the racialised thinking that activates it. It's not comfortable work.
Achieving sustained and sustainable change on racism depends on our ability to recognise and respond to these root causes. We won’t do that if we, and White people in particular, can’t tolerate some discomfort, because the roots are in us, embedded in the racialised thinking and belief system that all of us carry to some extent. The hard truth is that because our tolerance for discomfort is low, the overwhelming majority of race equity work in health care emerges from racialised thinking. In other words, it is too often part of the problem it is trying to solve.
We all play a part in manufacturing the idea of race and maintaining the racialised belief system that shapes our responses to ‘difference’. For example, we spend an awful lot of energy articulating our differences, justifying who is (and isn’t) included in our definitions of racism, describing its impact and collecting data. We spend very little time thinking about how an underlying belief in different races remains present in our worldview, expressing itself in subtle and often well-intentioned ways. It’s this unacknowledged belief in race, and the social norms, systemic patterns and social structures it creates, that is what we mean by root causes.
If we can’t speak to this belief then we won’t see it, and then it becomes impossible to interrogate the causes of inequality beyond what we are superficially willing to ‘see’. Typically, this means that ‘race’ somehow causes poor interview skills, a lack of leadership capability and worse health outcomes. And it means efforts to tackle racism end up targeting those on the receiving end of it – locating the problem with those who are racialised, and taking a symptomatic approach preoccupied with celebrating cultural differences, symbolic solidarity, reverse mentoring and initiatives to improve representation. To be clear, most of what we do in health and care is not anti-racism. Reducing the impact of racism is not anti-racism. Doing more of the same, no matter how sincere our intentions, is not anti-racist.
Anti-racism is very different to what often passes for race equity work and stands in complete opposition to the inherent cultural conservatism of health and care organisations. But what does that mean in practice? The following principles can help us bring anti-racism to life more clearly.
Racialised thinking leads to racialised outcomes. Race is an idea to be dismantled. So long as the idea is present in our worldview, it remakes itself. And we are all of us – to a greater or lesser extent – socialised into a structurally racist world. So all of us have work to do.
Examine the un-examined norm. Racism hides in plain sight because what should have our attention and focus in race equity work (but rarely does) are the everyday unexamined norms that maintain a system of Whiteness and racial hierarchy. Anti-racism makes these unexamined norms visible.
Mobilise White people. Anti-racism actively invites White people into the work with an acknowledgment of the particular role they have to play dismantling race and racism. Indeed, anti-racism values coalition building as a way of overcoming the divisions created by processes of racialisation and oppression, including the competition (for resources and visibility) sown between different marginalised groups.
Challenge systemic patterns of oppression. One of the reasons racism endures in health care is because organisations expend a lot of effort reducing it to inter-personal behaviour and adopting crude technical fixes that don’t draw on evidence. Anti-racism is committed to addressing systemic racism and exposing the wider context and patterns of racism that play out in organisational life. It is focused on root causes and recognises that initiatives aimed at symptomatic issues (such as representation) will not in themselves solve the problem of systemic racism.
Adopt a complexity mindset. Racism in health and care is a 'wicked’ issue; intractable, complex and dynamic. Like any complex problem facing the system, making progress on it requires an ability and willingness to avoid binary and reductive thinking, simplistic toolkits and tick-box projects. Anti-racism requires a more radical spirit of collaboration, experimentation, and learning.
Make power explicit and visible. Ultimately anti-racism is interested in power; the way it is constituted in organisational life and administered systemically through cultural norms, technical processes and human relationships. Re-distributing and using power well is at the heart of anti-racism, and it's grounded in the fundamental belief that power is not an object or finite resource to possess and hoard. For anti-racists, power multiplies the better and more it is distributed – no one loses if everyone wins.
To paraphrase the writer, Ijeoma Oluo, anti-racism is the commitment to fight racism wherever you find it, including in yourself. You don’t have to pretend to be free of it to participate. That should go for organisations as much as individuals, but it doesn’t mean anti-racism is easy. The aims and difference anti-racism represents should, however, be unambiguous. It is an insistence on radical systemic reform, and a reimagining of the ways we think, identify, and organise ourselves. It isn’t comfortable work, but it is urgent work. And we all have a part to play.