Review

White coat, white club

RACISM IN MEDICINE: an agenda for change
Naaz Coker (ed)
King’s Fund, 2001, £15.99

One problem with racism is that no one will admit to it – so it is hard to get improvement. Thanks to the Macpherson report, institutional racism is now a widely understood concept and has the advantage (some would say disadvantage) of allowing individuals to admit that their organisation is racist, while continuing to deny that they personally are racist. Progress then begins to be possible and it becomes more and more difficult to see personal racism as acceptable. This book, with its highly readable mix of hard facts and personal testimony, makes it depressingly clear that the NHS is institutionally racist and that individual racism is rife among staff and patients as well.

The main focus is on doctors, and the racism they suffer at all stages in their careers, from application to medical school onwards. Coker takes a broad view and in two outstanding chapters she outlines first ‘Understanding race and racism’ and finally ‘Leading for inclusion, valuing diversity: challenge for leadership’. Refreshingly she takes an organisational focus and does not assume that individual professionals can eradicate racism on their own. ‘Against a background of efficiency cuts, demanding expectations from the public and the politicians, growing interdependence of different agencies…combined with low professional morale, leaders have to develop new skills and practices.’ This is basic stuff and what is good for the NHS as a whole is good for antiracism. The new focus on antiracism comes from the Race Relations Act (Amendment) 2000 which places on the NHS and other public authorities a duty to promote race equality. There are new accountabilities involved, with new training and advocacy needs.

As this book makes clear, it is a tragedy that the contribution of ethnic minority workers at all levels of the NHS is never acknowledged with gratitude, but rather seen as a sign of falling standards or a low status specialty. Even minorities born and educated in the UK are subject to prejudice about their language skills and, as Coker says, a profession where a high proportion of the workforce (ethnic minority doctors, for example) do not trust their leadership and their institutional processes ‘does not bode well for the future of that profession’. The book is a worthwhile read for everyone – not just doctors.