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We need to talk about race

Dr Rebecca Steinfeld

Now could not be a more pressing time to discuss the issue of health inequity, the focus of our conference How Can We Dismantle Health Together - National Voices' conference to realise the power of the voluntary sector (Mar 2, 9, 16, 23). COVID-19 has made pre-existing health inequities starker, and generated fresh injustice. The stakes could not be higher, yet the barriers to change are also significant and complex - nowhere more so than in the area of racial inequality.

  • How Can We Dismantle Health Inequity Together?
  • Be The Change
  • Health inequalities
  • Lived experience

In two weeks’ time, National Voices will be convening an online conference about health inequity. Now could not be a more pressing time to discuss the issue. Health inequity was a major, intractable problem even before the pandemic hit. But COVID-19 has made pre-existing health inequities starker, widened the gaps, and generated fresh injustice. The stakes could not be higher, yet the barriers to change are also significant and complex.

As the UK’s leading coalition of health and care charities, our focus is on the role of the voluntary and community sector in health and care in tackling health inequity. We believe we have a responsibility to lead in this space, and to intervene at this pivotal moment in history, where there is all to play for – a moment that holds the potential for transformational change to narrow the health gaps between rich and poor, and black and white, but also a moment that risks leading to the entrenchment of existing gaps, if not further widening. There could not be a better time for VCSE organisations to take stock, to clarify our role and our purpose, and to identify opportunities for us to work together for fairness in health.

And yet… despite all this inspiring rhetoric, the truth is it’s all a bit awkward. Because despite our good intentions, we’re keenly aware that we are in fact a mostly middle-class, digitally literate, and perhaps most problematically, all-white staff team operating in a sector that is also largely white. We are a ‘Charity So White.’ That begs the question of how we can be true to our core value of “nothing about us without us.” So while, as you can imagine, we’re now abuzz with activity to make sure we can pull off our first ever online conference – confirming speakers, liaising with members, finessing the tech – there is another thing at the forefront of our minds: race.

So what are we doing about it?

Last year, we started an organisational conversation about racial justice. In response to the resurgence of the #BlackLivesMatter movement, and in light of the disproportionate impact of COVID-19 on BAME people and communities we started to think harder and to act more decisively.

We talked about what we could and should do to address racial inequality in our internal practices, especially in staff recruitment and Board appointments, as well as in our external work – primarily our insight projects and influencing activities. We reached out to BAME colleagues to discuss the euphemistically termed “demographic disparities” around COVID-19. We advocated in our networks for the publication of PHE’s report about the views of hundreds of BAME community organisations in response to those findings. We organised a webinar on the disproportionate of COVID-19 on BAME people. We have extended our membership offer to diversify our coalition. In January, when it became clear that ethnicity data on vaccine uptake was not being routinely collected or published, we publicly called for both. We then pressed for further research into why this latest disparity was emerging, keen to avoid a kneejerk victim-blaming exercise if the issue was in fact one of equitable distribution and access. In our digital exclusion project, we made sure BAME people were front and centre, working with partner organisations that have credibility and reach. We committed to not have events with all-white panels, and to ensure all our engagement is inclusive, but more than that – focused on people and communities that carry the biggest burden of ill health, and also often struggle with disadvantage and exclusion.

Recently, the staff team undertook anti-racism training, challenging ourselves to think about the ways we as individuals and an organisation might perpetuate, however unintentionally and unconsciously, any of the four Is of oppression: ideological, interpersonal, internalised and institutional. We learned about the importance of tackling racism with bravery, creativity and joy. We reflected on the plethora of microaggressions that can quickly and easily create a toxic culture of bullying and exclusion.

Ahead of our conference, we’ve invited speakers from diverse backgrounds to ensure we are truly amplifying everyone’s voices – not easy in a context in which many people are flat-out working on the COVID-19 response. We’re including experts by experience across all of our conference activities – panel discussions, member sessions, follow-up reflections. We’re designing a highly interactive conference to enable as many people as possible to engage and share their perspectives. All of this is intentional – to make sure it isn’t the same crowd of pale and stale sages on a stage talking at and about people, rather than hearing from people who can speak from more direct places of insight and experience.

More broadly, we are now drafting a plan, identifying priority actions to take forward. We’re already making changes in how we advertise our jobs and how we interview candidates. We will do the same when we next recruit to our Board of Trustees. We will be speaking to our black/BAME/racialised colleagues to sense check our plans to tackle racism within our organisation and within our sectors. Not because we want to push the work of challenging structural inequality back onto the people most affected by it, but because we know that we need help and want to learn.

We know none of this is perfect, but we don’t want imperfection to hold us back from confronting these uncomfortable truths. We would welcome your views about what we can and should do better – about what charities and other voluntary sector organisations can and should do better, about what organisations in health and care need to do. And about what you are doing too.

Clearly we need to do more – much more. We are not writing this now as a humblebrag, as a pat on the back, or to virtue signal. We are by no means experts or the finished article. Far from it. We have a mountain to climb – and we know that. But we do think it is important not to stay silent or to shy away from an open and honest conversation about these blind spots. We do think that as leaders in the voluntary and health sector spaces we need to challenge ourselves, and only then can we challenge others to do better.