Covid-19, racism and the equitable future of health and social care
By Dr Trudy Foster
FMLM Lead for Scotland
It was always going to take an event of seismic significance to supplant coronavirus in the media’s attention. The appalling death of George Floyd in the USA and the subsequent protests resounding around the world, has sadly been that event.
The coronavirus pandemic and the injustice of George Floyd’s death are completely different, but the severity of their impact is not and there are lessons for us all to learn from them. We have seen males from BAME backgrounds disproportionately represented in the coronavirus mortality figures. Issues of equality and equity have been discussed long and hard in health and social care, often used interchangeably, but they have subtle yet important differences in their meanings.
Equality; noun The state of being equal, especially in status, rights, or opportunities.1
Equity; noun The quality of being fair and impartial.1
Unfortunately, all men and women are not created equal. To achieve equality, some need more support, care, understanding and assistance than others. Ignoring this fact risks further widening of divisions within our communities. The equitable way to approach the situation is to tailor support to the needs of individuals.
In his topical poem on lockdown, writer Damian Barr, wrote:
I heard that we are all in the same boat.
But it’s not that.
We are in the same storm, but not in the same boat.2
Our response to the coronavirus pandemic, as well as the pervading epidemics of prejudice and discrimination, needs to begin by acknowledging the different starting points and applying resources and interventions appropriately so we can reach a point of equality. Treating people differently in such a context is not discrimination but equitable.
So, how do we learn and move forward in health and social care? I have heard people talking about life in general returning to normal, or the new normal. But what was normal in health and social care, and is that what we want to aspire to?
In UK healthcare we had a GP service in crisis and several medical specialties with significant vacancy rates. In psychiatry, 19% of consultant posts were unfilled in 2016 and in paediatrics it was 7%.3 We are at risk of looking back with rose tinted glasses and being too fearful of taking the necessary steps of change. Change is scary, whereas normality is synonymous with familiarity and the comfort of routine.
There is a grave need for doctors, healthcare professionals, politicians and policy makers, indeed society in general, to be brave. The way forward is uncertain, not everything will go to plan, life rarely does. We are in some ways like the author trying to write the elusive second novel. The page is blank, the story is just an idea and the pressure is high in light of previous success (the 71 year-old National Health Service). But even if we do not know how the story will end, we need to make a start on some essential edits. We need to overcome the fear of writers’ block. Not all plot lines will be followed (service planning), some pages may be deleted (service redesign) but if we do not begin the redraft (and soon) we risk becoming a tragic legacy to the visionary ideas of Aneurin Bevan.
Where (and who) are the modern-day equivalent visionaries to lead health and care systems towards equality and equity and deliver NHS2.0 for the benefit of all?
- Oxford English Dictionary
- Damian Barr via twitter
- The medic portal blog 2016