The NHS Takes on Racism: How Should the U.S. and Others Follow Its Lead?

By Reginald D. Williams II

Earlier this year, the U.K. National Health Service’s Race and Health Observatory published a major report documenting instances of racism in British health care. Even in a national health system providing free health care to all and highly rated by those it serves, people of color still experience inequities in their care. The report, Ethnic Inequalities in Healthcare: A Rapid Evidence Review, attributes treatment disparities to structural and interpersonal racism. 

Here are two particularly striking findings among the many highlighted: 

• Black children are 10 times more likely than white British children to be referred to counseling and mental health care through the social services system, not their general practitioner or family doctor. This means that when white children need mental health care, their doctors help them get it through the health care system. But when Black children need such care, it’s often up to social services to intervene — a system many Black parents distrust, the report notes, out of concerns over racism. 
• Asian babies are overrepresented in admissions to neonatal intensive care units for jaundice. Jaundice in babies with darker skin tones is often missed, as visual estimation is unreliable, especially for nonwhite babies. 

Many people may not know (or remember) that back in 2003, the U.S. released its own version of the NHS report. The bombshell, 764-page Unequal Treatment found not only that Black, Latinx, Asian American, and Indigenous people were less likely than white Americans to receive medical care, but that their poor health outcomes were directly affected by unconscious bias and stereotyping from health care providers. 

Unequal Treatment outlined several steps the U.S. health system could take to improve health disparities. These included systemic strategies such as reducing administrative and linguistic barriers to care and training in cross-cultural medicine and education. But little came of these recommendations. Twenty years later, U.S. health care still has a long way to go. 

And while some health organizations in the U.S. have committed to taking steps to combat racism in their own systems, disparities overall may be getting worse. Consider maternal mortality rates: Black women are three times more likely to die of pregnancy-related causes than white women, and the COVID-19 pandemic widened the gap, just as it exposed and exacerbated other disparities in U.S. health care. 

How the NHS Report Goes Further 

Two decades separate the NHS report from its U.S. counterpart, and today there is much greater awareness about racism and its impact on health. Moreover, many efforts are underway in the U.S. to make health care more equitable. But there is another critical difference: while Unequal Treatment focused primarily on recommendations for research and data collection, the NHS paper went a step further and offered guidance on practice and policy change. Moreover, the authors took care to note the specific actors within the NHS that could support improvement. In essence, the NHS wants its research recommendations — covering inequities in mental health, maternal health, and neonatal care as well as digital inclusion — to work in tandem with its practice and policy recommendations. 

The U.S. report, while thorough in its recommendations, did not emphasize areas of policy improvement. To be sure, the fragmented nature of the U.S. health system has hindered progress as well. 

An Opportunity for Policy Action 

There’s a learning opportunity here for health systems around the world: words must be followed by actions. The NHS report is a step in the right direction, but now its recommendations must be carried through. If progress can be made, the NHS plan could pave the way for other health systems looking to address the inequities created by decades of inaction, especially in countries with histories of racial inequity, white supremacy, patriarchy, and colonization. 

Let’s move from reports to new policies and practices.