The first medical textbook on anti-racist healthcare, launching in Parliament on Monday, warns that ethnic inequalities still run deep throughout UK medicine. Its authors argue that proactively fighting racism is fundamental to fulfilling a founding promise of the NHS: fairness.
Being 'race‑blind' in medicine is not enough. The NHS must actively become anti‑racist if it is serious about equity.
Zeshan Qureshi
The first medical textbook dedicated to tackling racism in medicine and delivering anti-racist healthcare in the UK is launched today in Parliament with MPs, professors, clinicians, students and patient advocates.
The project is co-led by Dr Zeshan Qureshi, an NHS doctor and philosopher, who is currently conducting a PhD at the University of Cambridge on how race and ethnicity are vital to understanding and improving healthcare outcomes in the UK.
Despite the NHS being founded on universal access, Qureshi argues that equal access to healthcare remains "an ideal rather than a reality," with ethnic health inequalities persisting and even worsening since Sir Michael Marmot's landmark 2010 review on health inequality in the UK.
The new book, Anti-Racist Medicine, offers a "blueprint" for medical students as well as existing frontline healthcare staff who serve ethnically diverse populations, says Qureshi, who argues that 'race-blindness' alone is not enough, and medical practice needs to be actively anti-racist to achieve equity in healthcare.
"The NHS England constitution, in its first principle, says that it has a duty 'to pay particular attention to groups where improvements in health and life expectancy are not keeping pace with the rest of the population'," said Qureshi. "Sadly, the NHS is still failing ethnic minorities, 75 years after it promised care for all."
"Racism affects how diseases are understood, how patients are treated, who progresses in medical careers, and whose data counts. Racism infiltrates every aspect of medicine."
"At a time when equality and diversity programmes are being rolled back, we risk treating racism as a side-issue or optional extra in the NHS," said Qureshi, from Cambridge's History and Philosophy of Science Department.
"Being 'race‑blind' in medicine is not enough. The NHS must actively become anti‑racist if it is serious about equity."
The book brings together a wide range of case studies and data to show how ethnicity affects the type of health issues people suffer, the ways patients get treated, and the medical professionals who treat them. These divisions are particularly stark in the areas of maternity and mental health.
Qureshi and colleagues cite research showing that Black women in England are more than twice as likely to die in childbirth as White women, while infant mortality for Black children is reported as double that of White children, showing that ethnic health gaps are still present from the very start of life in the UK.
Black patients are between six and nine times more likely to be diagnosed with schizophrenia than White patients, and Black individuals are four times more likely to be detained under the Mental Health Act.
Type 2 diabetes is between two and six times more common among South Asian and Black populations compared with White populations in the UK. Gypsy, Roma and Traveller communities arguably face some of the worst health outcomes of any group in the UK.
"From sickle cell disease and maternal mortality to mental health and psychosis diagnoses, many areas of medicine cannot be understood or fixed without confronting racism head-on," said Qureshi. "This includes disparities in medical career progression."
He points out that, while the UK's medical workforce has become increasingly diverse, persistent inequalities remain, particularly affecting Black doctors, women from ethnic minority backgrounds, and international medical graduates.
"For example, across London, on average, Black doctors are six times less likely to be appointed as a consultant, rising to 15 times in some trusts," said Qureshi.
Inequalities in data collection are a major issue for ethnicity in healthcare, argues Qureshi, and new technologies reliant on these datasets, such as artificial intelligence, risk reinforcing racial biases in medicine on both the treatment and career fronts.
"Ethnicity should only be used in treatment algorithms when there is clear, robust evidence for its use, and no better alternatives, which in practice is rare," he cautioned.
Improved data is just one of the key recommendations put forward in the book, along with reforms around professional regulation, greater support for international medical graduates, safeguards against bias in digital health, and medical courses that teach "cultural humility": a recognition of the individual values and lived experiences of patients from all backgrounds.
Qureshi and colleagues say they wanted to create a "vision for anti‑racist medicine, across the domains of leadership, education, workforce, clinical care, research, and technology."
"Anti‑racist medicine is not about lowering standards or favouring one group over another," added Qureshi. "It is about removing barriers that worsen outcomes for patients and professionals alike."
"The NHS was founded on fairness, a principle that the British public holds dear. Anti-racist medicine is at the heart of ensuring this promise is honoured."
