GEORGE Floyd is more famous in death than he ever was in life. The African American man died after a Minneapolis police officer knelt on his neck for almost 9 minutes while arresting him, sparking protests around the world.

Floyd is not the first black man to die during an interaction with the forces of the law, and sadly he will not be the last.

What does seem different this time, though, is the scale and reach of the anger and soul searching his death has prompted around the world.

Perhaps this unique moment, in the midst of a pandemic, is somehow allowing all of us to question realities we may have avoided looking at too closely in the past.

Many of us who, because of the colour of our skin, do not have to live with the persistent fear of such violence have been shaken in recent weeks by an outpouring of first-person accounts on social media.

This account by US college professor Steve Locke of being detained by police on his way to work because he “fit the description” of an alleged offender (ie, was also black) is just one of many.

People will have differing views on the advisability of large public gatherings in the current environment. There are valid arguments on both sides, and I’m not going to comment on that here.

I hope, though, that the protests will lead to real measures to address the structural racism embedded in so many of our institutions, and not just in the US.

Almost three decades after Australia’s Royal Commission into Aboriginal Deaths in Custody, Indigenous incarceration rates remain well above those of other Australians. The ABC reports new national targets to address Indigenous justice are expected in the next few weeks.

How might medical institutions respond to the calls for change?

The BMJ last week published a special issue on racism in the UK health system.

Articles in the themed issue discuss treatment shortfalls for patients from minority backgrounds, prejudice in employment and career progression for doctors, and racism in medical education.

“Research has shown differential attainment by ethnicity in the medical workforce across all measures of training and career progression,” wrote the guest editors of the special issue, Victor Adebowale of the NHS and Professor Mala Rao of Imperial College.

Doctors from minority backgrounds are more likely to face complaints, more likely to have those complaints investigated, and may face harsher sanctions after investigation. They are paid less, and are more likely to experience bullying and harassment at work.

For patients, inequalities in care have been shown in areas including genetic counselling maternal health, disparities that are all the more concerning given the higher prevalence of chronic illness in some populations.

Addressing racism in the system will benefit everybody, the editors argue, but it won’t happen by itself.

“Achieving race equality requires leaders with the courage and ability to shift the culture,” they write. “Their greatest need is for knowledge and evidence to identify the gaps, determine what works, and help orient their organisational structures and cultures towards race equality in relation to the ethnic minority population and workforce.”

All humans have unconscious biases that can undermine their ability to deal with others fairly. When somebody tells me they are without prejudice, I tend to think that means they haven’t yet begun the hard work of trying to overcome it.

We often need to have discrimination pointed out to us if we’re not experiencing it ourselves. For both institutions and individuals, the struggle against racism begins with listening, really listening, to those whose experiences differ radically from our own.

Jane McCredie is a Sydney-based health and science writer.

 

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.


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17 thoughts on “Racism in the health system: when will we address it?

  1. Anonymous says:

    https://www.abc.net.au/news/2017-03-10/fake-doctors-former-colleague-says-well-known-poor-medicine/8341976

    It would seem that racism has been well addressed, when Indian fake doctor Shyam Acharya can be noted by colleagues to be incompetent, but not one official complaint was ever made. Despite 11 years of public hospital performance reviews.

    11 years of incompetence, excused by his skin colour.

  2. RobertGeorge Tucker says:

    Yes,Yes,Yes….……ALL Lives Matter………………Rob.the.Physician

  3. Anonymous says:

    I am indigenous. I used to check the “yes” box on job applications. For some reason I wouldn’t get interviews. Then I applied interstate where there was no box to check for indigenous status- I got interview offers on 90% of my applications. I then started checking “no” in Vic and I got interviews. I raised this with the AMA, and I can’t say they were particularly receptive at the time because I was raising concerns about other doctors.

  4. Anonymous says:

    When a man with a sign “Black, white — all lives matter” is booed and physically attacked by an angry mob at a protest rally and no senior politician of any party condemns it, we have reason to be afraid.
    Tasmanian Labor senator Helen Polley has been attacked on social media and forced to apologise for reposting an “all lives matter” image to social media, saying it was “careless and insensitive”. She deleted the post. More silence from those who are meant to reflect Australian values.
    Not only are these but two examples of the warped and selective morality of the protesters, it is a sign of how silence allows the creep of totalitarian attitudes amongst us.
    The mob has gained the upper hand. The mob is fickle. The mob is dangerous. The mob doesn’t have our approval. Our elected representatives should have something to say about such events.
    Andrew L Urban

  5. Anonymous says:

    The biggest issue with racism in health care in Australia is that those affected, and they’re many, cannot even talk about it. They have no avenues to debrief or to be heard without risking job opportunities or other repercussions. The denialism and systemic gas lighting is another big prohibitive factor which comes through some of the posts in this thread. Racist attitudes and behaviours are often dressed as “cultural” issues or this or other “non racial” issue. “We can’t work with this doctor or that nurse because they have a thick accent” i.e the same thick accent that passed the IELTS examinations. The same thick accent that speaks and is understood at international conferences. “How can we be racist when we allowed you into the country?” “How can we be racist when we gave you a job?” “How can we be racist when Australia is a country of immigrants?” We sometimes see its effects on the high failure rates of overseas trained doctors in the exams. We tell ourselves “but that’s because they’re used to different medical systems” as we walk on. Ever notice how the trainee that “does not fit the culture of our institution” is often the brown one or the one from overseas? You cannot really complain that no one conversed with you or asked you to dance at the party when you were infact invited can you? Perhaps the issue is with you and you should have made a better effort to get along, to assimilate. Afterall this is Australia. We’re friendly here, unlike the Americans and the British and whomever else is out there.

  6. Paul Jenkinson says:

    Even individuals within the same family are not born equal so to expect “equality” of outcome across a myriad of different groups ,or even within groups themselves,of whatever type is pure fantasy and defies the nature and reality of humankind (and any other living being).
    I think we confuse equity and equality.It may be possible to enable equality of opportunity but never equity of outcome in how we treat different groups.Presently,for example,in Australia, the Aged Care Commission is trying to find a way to minimise the pandemic of elder abuse.Asiatic students do much better than caucasians and blacks given the same opportunities.Conversely,mandating strict gender quotas on various entities without equality of opportunity based on merit will only likely result in poorer representative outcomes in most situations.
    Our task,in a fair society,is to not concern ourselves so much with an unequal outcome if there is equal opportunity.Racism is in medicine as it is everywhere but
    there are many other “isms“ we must acknowledge. However,we are human and never will be very close to perfect.We are always capable of forgiving ourselves and others though.

  7. Greg the Physician says:

    Hi Pauline. Just to clarify – I am not judging individuals in my comment. My use of the words “correct” and “wrong” refer to opinions and are not intended to pass judgement on those who hold them. All persons have flaws and I do not claim to be a better person than anyone else, even those with whom I strongly disagree on key moral issues. I have read some philosophy. I accept that there are those, probably many, who disagree with me and I will defend their right to do so while we still have free speech. However I also remember a quote from a text along the lines of “I have a right to my opinion. No you don’t, unless you can rationally argue your opinion from facts and not just repeat claims which are demonstrably false”.

  8. KChat says:

    Can I ask ALL the people who are flogging the ALL lives matter rhetoric – are you THAT afraid of having equality that you have to draw the attention back to yourselves? Your Hippocratic oath is to do no harm so consider reflecting on the fact that racism is undoubtedly a public health issue. One incorrect stat about white incarceration which does not adjust for the population (only 3% are aboriginal & Torres Strait islander) is the same as saying smoking isn’t an issue because I know someone who didn’t die of lung cancer. The rule is it leads to multiple chronic conditions and therefore has government regulations. Being coloured has the same disadvantage. If you cannot hear the voices of hundreds of thousands of protesters and the history of millions before them then you are a lost cause that needs to pass on like all the other dinosaurs did. Or alternatively just open your eyes and mind. Neuroplasticity will help you grow better brain cells

  9. Pauline says:

    Dear Greg the Physician, it’s best to avoid words such as “right” and “wrong” as well as “good” and “bad” if we are aiming at being non-judgemental. Jon Kabat-Zinn clearly articulates this point in this clip:
    https://www.youtube.com/watch?v=OwVkxcw1eZE&t=6s

    I don’t want the point I was attempting to make about the need for non-judgement to get lost in the emotional aspects of the hashtag comments.

  10. Greg the Physician says:

    Pauline is correct and Anonymous is wrong. The death rate in custody in Australia for whites is higher than for blacks. All Lives Matter means that the importance and morality of protection and preservation of life does not depend on ethnicity or skin colour – all lived are of equal importance. Black Lives Matter implies the opposite – that the lives of dark-skinned people are more important than the lives of others, such as white police, nurses, paramedics and medical practitioners who risk their own lives to protect the community, and whose lives and health are put at risk by the anarchists and ANTIFA activists participating in these marches and demonstrations.

  11. Max says:

    The article starts with the premise that we are all equal in our humanity – hopefully not contested by anyone – and then assumes that we must therefore be equal in every other way too, which is clearly preposterous (achieved only in socialist utopias only by dragging everyone down to the same level, by a combination of property theft, intellectual denigration and intimidation).
    Within medicine there are variations in skills, ability, training, culture and attitude which cannot be subject to levelling and which can never be expected to be ‘equal’, but it remains the case – as with most discussion around race – that the variations within a racial group are vastly wider than the variations between such groups.
    “Achieving race equality” is only achieved by ignoring race.
    That’s the opposite of what we are presently doing.
    Martin Luther King still said it best.

  12. David Henderson says:

    I agree with the above comment. Accusations of racism are fashionable at the moment, and are made in the context of statements that Australians are very racist, which in my experience is not the case. Australians are certainly less racist than the people of many other countries. If the author wishes to make the claims, there is a need to say wether these are systemic across the whole health service and medical profession or occur in pockets.
    I think that most health professionals are mature enough to judge people by their professional and social performance, rather than by their ethnicity.
    I have had signifiant experience with overseas medical graduates and one statement that has been made to me is that Australia has a less racist attitude to IMGs than say the UK. Of course IMGs come from different educational and cultural backgrounds, which does colour their performance, but again in my experience they work to the best of their ability, are keen to learn and be involved and adapt to what is for many a very different medical system from the one where they have been educated and trained. Many more experienced IMGs bring valuable skills and abilities to the medical system and are recognised for that.
    My other comment would be that in hospitals staffed by a mixture of Australian and overseas doctors, there is mutual respect and acceptance.

  13. Peter Bradley says:

    Excellent point Philip. I would go even further and challenge the whole concept of trying to force change, which is what the word ‘address’ conjures up. As you say – “change what, and where..?
    I would take issue with this statement even…

    “Addressing racism in the system will benefit everybody, the editors argue, but it won’t happen by itself.”

    And the reason I say that, is found in this statement shortly after it…

    “All humans have unconscious biases that can undermine their ability to deal with others fairly.”

    That is true, and therefore being unconscious it is not really possible to address it directly to try and force a change in that unconscious bias, so it has to be one that is changed in the individual by themselves – again, almost subconsciously – by processes of illustration, example, education, etc.

    Which is why, in my view, these recent protests if anything would have had the opposite effect to the above. Seeing folk, (a majority being black in the US case), seizing the marches to act out violence, property damage, looting and arson, just tends to reinforce negative stereotypes, and was not the way to go at all. (Over and above the pandemic risks). That violence completely negated in most eyes anything positive that might have come out of it all. The few seconds of the original graphic video with sound, (“I can’t breath”) we all saw on TV was enough of itself to achieve the outrage and horror the occasion demanded.

    Appropriate action by the authorities involved, along with official denunciation by eminent people, and by letters to papers and politicians, etc, by others, should have sufficed. The hypocrisy of the whole protest thing was exposed in a Sydney march, when the sole placard which had Black and White crossed out, replaced by ‘All’, so it read ‘All lives matter’, was torn down, trashed, and the bearer attacked and needed police escort to safety. That about summed up how much good those marches achieved. It was a very expensive and dangerous way to just release pent up frustration. The effect on the pandemic still to emerge…

  14. Anonymous says:

    To “Pauline” … #AllLivesMatter misses the point entirely. If your house was on fire and the fire department turned up and poured water on all the houses on the street because All Houses Matter perhaps you’d see how ridiculous it is. Of course all lives matter, nobody is saying otherwise. What people are saying is that right now black lives are on fire and in need of some help.

  15. Pauline says:

    The struggle against racism also requires that we increase our skills for non-judgement of others. What that really means is learning the ability to reduce our judgments that label people as “good” and “bad”, whilst simultaneously preserving our capacity to utilise the facts.

    We are all equally human. A hashtag #ALLlivesmatter would go well.

  16. Anonymous says:

    Racism has existed since mankind existed. But to use that to dis honor colleges, discriminate those of another culture needs to be addressed here in our health system. There are many instances where careers have been ruined and reputations torn as a result of so called cultural supremacy. Sad but fact

  17. Philip Morris says:

    Jane McCredie makes the following statement “We often need to have discrimination pointed out to us if we’re not experiencing it ourselves. For both institutions and individuals, the struggle against racism begins with listening, really listening, to those whose experiences differ radically from our own.” Fair enough. But this could be interpreted as insinuating that the Australian medical system is discriminatory or racist. If this is the case, then Jane McCredie should point out the problem areas rather than making generalised accusations. On specific issues, we can then have a meaningful debate that might lead to action.

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