The Government has recently presented to Parliament its response to the Sewell report.
The Government’s response, titled Inclusive Britain, is an Action Plan with a set of measures linked to the findings from the Sewell report. When released in March 2021, the Sewell report came under heavy criticism, primarily due to the outright denial of institutional racism and its central role in patterning poor health and low socioeconomic position of ethnic minority people.
Crucially, the report largely ignored the longstanding body of evidence documenting the existence of structural and institutional racism in the UK, and its associated negative impacts on physical and mental health. Consequently, the recommendations in Inclusive Britain are not centred on the root cause of ethnic inequalities, racism; instead they focus on ‘agency, resilience, and mutual support’ (p.9) with the report claiming that these are what ‘ultimately drive success and achievement’. Omitting racism as the key driver of ethnic inequalities will not lead to meaningful solutions to improve the lives of ethnic minority people.
With regards to health, Inclusive Britain includes recommendations addressing racial bias in medical equipment, life expectancy, maternal health, and the NHS workforce. Worryingly, Inclusive Britain disregards a large body of evidence documenting stark ethnic inequalities in health, and instead highlights health outcomes where some ethnic minority groups have better health than the White British majority – for example, life expectancy. But, as we have previously cautioned, life expectancy estimates recently reported by the ONS, and cited in the Sewell and Inclusive Britain reports, are experimental, and should be treated as such.
Importantly, focusing solely on life expectancy disregards the evidence on ethnic inequalities across a myriad of health outcomes over the life course, including in later life, and ethnic inequalities in healthy life expectancy. In addition to disregarding the undeniable evidence around ethnic inequalities in health, and the role of racism in leading to them, Inclusive Britain ignores the evidence around ethnic inequalities in healthcare. We have recently reported clear evidence of ethnic inequalities in access to, experiences of, and outcomes of healthcare, and have documented the pervasive and insidious role of racism in perpetuating them.
Health-related actions in Inclusive Britain reflect the false dichotomy presented in the Sewell report that separates deprivation and ethnicity. Undoubtedly, area-level deprivation is a key determinant of poor health, and place-based interventions are an important approach to addressing inequalities, but for ethnic minority people, a focus solely on deprivation is not sufficient. Most ethnic minority groups are more likely than White British people to live in the most deprived areas, and studies on ethnic inequalities in health show that even after taking into account the role of individual and area-level deprivation in leading to poor health, ethnic inequalities still remain.
Historical and current racism at the structural, institutional, and individual levels is a root cause of ethnic inequalities in individual and area-level socioeconomic inequalities. Ignoring racism as the main explanatory – and changeable – factor leading to ethnic inequalities in health and area-level deprivation will only partially address ethnic inequalities.
In an effort to build trust in health interventions, Inclusive Britain has proposed an action to increase participation of ethnic minority people in clinical trials and research. Increased involvement of ethnic minority communities in research is a positive move forward as long as participation is promoted within a health equity lens.
We are concerned, however, that increased equity and diversity in data and research are not maintained in bodies such as the Race Disparity Unit. Recommendation 24, Action 8, proposes to reform the “Ethnicity facts and figures” website, and provide a smaller range of datasets. Data are crucial to monitor ethnic inequalities, and a reduction in the availability of data has direct implications for accountability and transparency. Data and monitoring alone will not lead to the disappearance of ethnic inequalities, which have persisted despite indisputable evidence.
The Inclusive Britain report maintains that “we’re already one of the fairest countries in the world” (p.9) but this is in direct contrast to the indisputable evidence on widespread ethnic health inequalities, and to the lived experience of ethnic minority groups. The Government must use evidence to develop and implement national policies, framed around racism, that tackle ethnic health inequalities now, and going into the future.