Decolonising healthcare: Why we should do it and how we can

This summer we read a book. It’s not a very revolutionary thing to do; to read a book, but the book inspired us to help tackle the systemic healthcare problem we’re facing - that of racism and unchecked biases, especially in healthcare engineering. So, in some ways, this was a revolutionary act?

You might be asking: What’s the book? It’s Annabel Sowemimo’s ‘Divided: Racism, medicine and why we need to decolonise healthcare’. We were so enlightened by the book in the IHE team that we invited her to speak on a cold winter’s morning last month in the Cruciform building – one of Annabel’s old haunts from when she was a medical student.

Lois Haruna-Cooper started things off as our chair. Lois is a Clinical Lecturer and the Equality, Diversity and Inclusion and Widening Participation Lead so perfect to chair the event.  

Annabel started the conversation off with what decolonisation means. She broke it down as a way to look at the past to make the future better for all. But is decolonisation even the right word? Are we being feminist instead? Or maybe it’s a class issue? Are we talking about something else and is there a better way to critically analyse each other? Language and the words we use are important so it’s fitting Annabel started her lecture in this way.

UCL knows language is important which is why their tagline is ‘The world’s Global University’ and was the first universities to accept women into their cohort, which is amazing. What might tar this image a little is that UCL is also the birthplace of eugenics, and for those interested – we still have a eugenics collection under the Portico which Annabel talks about in her book.

Francis Galton is often touted as the father of eugenics. He coined the term in 1883 whilst he was a professor at UCL and went on to become the first professorial Chair of Eugenics. Whilst Galton was undeniably talented (he also coined the phrase “nature vs nurture” and developed the statistical model of regression towards the mean) he was also a deeply flawed human. He was obsessed with measuring, especially humans, and believed that certain measurements gave way to superiority. He also thought natural selection was no longer working as people were starting to interfere with the process and wanted to improve the “stock” to the better race and class. We all know what that meant in 19^th century England – and it didn’t mean good things if you were poor or weren’t English.

Ok, so that’s a short summary of Galton and eugenics. But what does this have to do with us now? Although Galton might have been a product of his times, some of his racist thinking has followed through to the present. Let’s take a look at pregnancies and birth. Black women are more likely to face complications or die whilst giving birth than their white counterparts. Or eGFR machines adjusting readings if you’re Black. If you’re underestimating kidney function, you’re underestimating how effectively kidneys are working which leads to less monitoring and fewer dialysis referrals. And then there’s Covid. Black and Asians were disproportionately affected not because of a biological fault but because of the systematic racism they’d been facing. The kind where Blacks and Asians are disproportionately healthcare and service workers so more likely to get Covid or the kind where oximeters couldn’t detect the blood oxygen levels of those with darker skin tones because it had only been trailed on White people.

But how this system racism feed into our education at UCL? During her talk, Annabel mentioned that her lecture theatre was very segregated with people grouping together with those they recognised from other specialities and institutions which puts those without these connections at a disadvantage. So, there's a lot of work to just be done on our own doorstep and by addressing subgroups within faculties.

Let’s end this by talking about blind spots. Most of us can drive and we have blind spots, right? And racism in healthcare is a blind spot for a lot of us – in that because we’re not Black, we don’t always see the issues and that’s human nature – we don’t often see things that don’t affect us. Annabel gave us the example of accessibility as an able-bodied person in that you’re not always looking out for step free access or lifts when you’re able bodied and that’s not because you’re ableist but because we don’t always see things that don’t affect you directly. It’s not a good thing, granted, but once we can see our blind spots then we can do something about it.