“Representation is everything”

It occurred to me during my evening home commute, New York Times’ “Modern Love” podcast in tow – which by the way I highly recommend – the now too familiar autumn rain blurring headlights, a sign of the steady row of traffic ahead, that today was indeed the eve of the conclusion of the ‘Black History Month UK’ calendar.  A time, where I would typically consume the avalanche of Black cultural activities and events available in our metropolis that is London, suddenly seemed to have passed me by, a seeming consequence of the current once-in-a-century pandemic with which we find ourselves. 

Black History month or BHM, to the woke youth was a concept first started in London in 1987, borrowed from our neighbours across the pond who began this tradition in 1970 as a means of remembering important people and events in the history of the African diaspora.  These days, whether it’s liberialism, globalization or dare I say political correctness; Black History Month seems to be taking centre stage, more so than ever before. By which I mean, almost every major global brand or label has claimed its stake, boldly declaring its support to ensure it does not overlook this demographic and resultant market share. I admit at times, this can appear as corporations simply riding the trend, being de rigueur, with marketing that can vacillate between forced, opportunistic and frankly off the mark. I need not remind you of the 2017 Pepsi x Kendall Jenner debacle where it was intimated that a can of Pepsi could end racism and/or police brutality while wrapped in the cloak of a “Black Lives matter” protest. Yes, that idea was greenlit.

This is not to say that the support shown isn’t in earnest. In fact, many companies have made a concerted effort not only to celebrate the achievements and contributions of African and Caribbean heritage peoples but ensure visibility and give a platform to Black voices with hope to effect real change. For instance large-scale retailers like Sainsbury’s announced they would review their ethnic pay gap and ensure that its Black colleagues “have a fair and enjoyable experience working at Sainsbury’s”, while John Lewis Partnership have sought to establish an advisory group to ensure inclusivity in under-represented groups. Similarly, GAP and dating app, Bumble have launched campaigns teaming up with major Black voices and creatives, the former to provide a unique design representing what Black history means to them from their life experiences  and the latter to reflect on the breadth of Black Love .

This got me thinking about my own experience, my Black experience in the UK, in medicine. How does it compare perhaps, to other Western countries or other ethnicities? A recent BMJ Open article, unsurprising to some, found that white doctors were over-represented in top NHS jobs. The study reported that 46% of white doctors were consultants – the most prestigious group of doctors – compared with 42.2% of Asians 33.4% of Chinese doctors and 30.6% of black doctors. For context, the same study found that Black people as a whole are largely under-represented both among doctors and as consultants. 

To many, this is not news, however it should remain a constant thorn in the minds of all Black healthcare professionals.  We know Black people have worse health outcomes than any racial group, Black men have the shortest life expectancies, Black women have the highest maternal mortality rates and Black babies have the highest infant mortality rates. Statistics of which have been linked to inequities in health care workforce not reflecting patient populations. Studies in the US by Michigan University and UCLA have termed this ‘patient-provider racial and ethnic concordance’ and shown lack thereof is a contributing factor to higher rates of preventable heart disease and stroke. However, diversification of its workforce is not just about the employment of minorities en masse but ensuring that representation permeates to top ranks. The BMJ study showed even amongst nurses and health visitors (grades 6 to 9) in the NHS, white people occupy the higher paid positions in a similar pattern to that found in doctors.

A close friend of mine always harks “Representation is everything!”,  like a newsie hawking the day’s headlines: ‘Extra Extra Read all about it!’. My response: Of course, representation is important, one need not be a genius to accept that to be true. The need for inclusivity has led to affirmative action in human resources, positive discrimination for University applications and implementation of the Rooney Rule in US Sports recruitment. Heck, even the British Academy of Film and Television Arts or BAFTA and Screen Actors Guild have delineated a quota system for minority actors. Most recently, the Academy of Motion Picture Arts and Sciences colloquially known as the Oscars, sought to make amends following the 2015 #OscarsSoWhite trending hashtag by announcing in early September that new inclusion requirements for best picture contenders would be enforced from 2024. Progress right?

However in medicine, can we say the same? Has there been progress? I came across a rather thought-provoking article the other day, one in the slew of ‘BAME-focussed’ longreads from notable publications intended to celebrate Black History Month. The title: “Is Britain the best place in the world to be Black?”. The argument was put forward by Conservative MP, James Cleverley. The conclusion:  Yes, but it still has a long road ahead.  In many ways, I agreed with this optimistic deduction, I had to concede, my career to date has been extremely positive, enlightening even. However, I still look around and see few to nil senior mentors with even the slightest mahogany complexion. I still carry a slight unease knowing that there is mass under-representation in the rooms and corridors where decisions are made. 

So I use this opportunity to call us to rank! Black specialists & physicians must seek to rise to higher roles within our diverse NHS.  To be visible and authentic is important not only because this translates into better health outcomes for minorities in the short term but in the long-term propagates a system that allows more Black physicians to ultimately care for more Black patients, teach and mentor more Black trainees, and perform more critical research to eradicate health inequities.

So where do we start? Start now! Join that committee, talk to your department heads, take that responsibility, and aim for that position. Indeed with spirits high, now a full week on from the from the end of Black History Month UK, as I complete this piece with the new knowledge that the Vice President-elect of the United States of America is the first biracial woman to ever hold office, maybe  now more than ever our potential seems boundless and then the musings of my friend resonates more than ever: “Representation is everything”.  

Dr Nkem Okonkwo

Cardiology SpR

(linkedin: Nkem Okonkwo)

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