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Institutional, structural, and systemic racism are real and have a role in HIV

01/04/2021

By Deborah Gold, Chief Executive of National AIDS Trust

I am deeply troubled by the Commission on Race and Ethnic Disparities rejection of the existence and impacts of institutional and structural racism in the UK. The commission’s conclusions ignore evidence, real experiences, and defy logic in the context of those things that the commission does accept and recommend.

The response to the report has been one of horror and anger from many of those with expertise in this area and experience of living with racism. Runnymede published a powerful statement, well worth reading, in which it says:

“The very suggestion that government evidence confirms that institutional racism does not exist is frankly disturbing. A young Black mother is four times more likely to die in childbirth than her white friend. A young Black man is 19 times more likely to be stopped and searched by the Metropolitan Police than his young white neighbour and those with Black or Asian ‘sounding surnames’ have to send in twice as many CVs as their white counterparts, with the same qualifications, to receive the same jobs.”

When National AIDS Trust submitted evidence to this review in 2020, we said we were concerned the commission was asking the wrong questions. We concluded that rather than being a neutral collection of evidence, the review was designed to get answers negating the impact of systemic racism in the UK. This was further underscored by its overall insistence on referring to disparity rather than inequality. Given this, the conclusions of the report should perhaps not be surprising.  

The commission’s report seems utterly confused. On the one hand it insists that there is no evidence of institutional or structural racism, yet it also acknowledges socio-economic disparities. But it is structural racism that feeds these disparities, acting as key factors contributing to inequalities in education outcomes, health outcomes, recorded rates of crime and employment. It is not distinct from inequalities, but inextricably linked because these inequalities further feed this type of racism.

Over this past year, the increased visibility of the Black Lives Matter movement has created an opportunity for all of us - individuals, organisations, government, and society - to increase our reflection and understanding of racism and to challenge ourselves and the very real racial inequalities that exist. This isn’t ‘accusatory’ rhetoric (as the report calls it) or a threat, it’s a necessary and positive challenge. National AIDS Trust is not where it should be, and the Black Lives Matter movement has enabled me to better understand and to take action on this.

This commission appeared from the start to be established with the aim of undermining this positive movement and excusing us all from taking necessary action to genuinely confront and combat racism in the UK. This is more than a missed opportunity, it signals an utter disregard for people’s lived experiences, silences their voices, and signals a disturbing perspective on inequality and race from this Government.

A closer look at health and HIV

There are some aspects of the report’s section on health that could be helpful.  We welcome its proposal to move away from ‘BAME’ data categories to a more detailed understanding of health outcomes among different ethnicities. However, the report does damage by its framing in terms of an emphasis on where people of different ethnicities are doing better than white people, and its lack of acknowledgement of the causes of health inequalities it identifies.

While there is some useful consideration of multiple factors in driving health inequality in the report, there is a refusal to accept evidence that these inequalities may be the result of racism in anything other than a historic context. This is despite evidence from many, including that submitted by the National AIDS Trust that included several examples of very current Government policies and practices in the health and immigration systems that fuel mistrust and support systemic racism today, affecting the way people engage with health and HIV services. 

It is also despite the HIV Commission report, welcomed and endorsed by the Government when it was published last December, which highlighted in detail the multiple structural inequalities, including racism, that contribute to overall poorer outcomes in HIV among Black people in Britain and in other minority ethnic groups often hidden by looking at the data on a macro level.

The Commission on Race and Ethnic Disparities' report recommends a new Office of Health Disparities (OHD) should be established. Arguably some of the activities of the OHD suggested could fall within the remit of the new Office for Health Promotion (OHP), which should have inequalities brought front and centre in its responsibilities. But there is much to do and the commission’s recommendation that a new OHD should work beyond health and across government, to cut across a variety of issues that contribute to health outcomes, is sensible. Surely if the commission believes there is a need for this then it must accept there are systemic issues that increase racial inequalities that need addressing? The HIV Commission recommended a cross-government approach to achieving goals in HIV and this is in response to evidence of systemic, structural, and institutional factors that uphold HIV stigma and inequalities linked to risk of HIV.

Among the more welcome recommendations in the report is that the Government should be, “increasing programmes aimed at levelling up health care and health outcomes”. We fundamentally agree with this. An important place to start would be to properly fund the public health system, which has been starved of resources, alongside programmes that work in the NHS and beyond.

Overall, the framing of the commission and the report undermines the many recommendations contained within it. It’s hugely ironic that while the report speaks of rebuilding trust, it is simultaneously destroying it.


Deborah Gold is Chief Executive of National AIDS Trust. You can follow her on Twitter here: @deborahagold

We have signed Runnymede Trust's joint letter to the Prime Minister rejecting the Sewell Report and calling for the implementation of the recommendations of the long-standing Macpherson, Lammy, Marmot and Williams reviews.

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