“Of all the forms of inequality, injustice in health is the most shocking and inhuman.”– Dr. Martin Luther King, 1966.
I want to name what’s going on in terms of racism and the turmoil and distress experienced by us all, by people of colour especially and black people in particular. I am deeply saddened by what’s going on. I also feel galvanised by the protests and activism that’s gathering momentum.
Today’s blog comes at a time when the whole world we are all talking about race. The unforgivable death of George Floyd, and the subsequent protests it has triggered, highlight that racism is still an issue despite significant ground having been gained in terms of rights both in law and behaviour. We still have a problem.
I want to take a more detailed look at #BlackLivesMatter and draw your attention to why Black Health Matters. You may not be in the habit of thinking of health in terms of equality and race but given how COVID-19 is disproportionately affecting Black and minority ethnic (BME) communities, it would be remiss of me not to join the conversation and speak of race equality from a Helpful perspective.
That’s why I wanted to write a post that looks at the issue of equality in terms of race and health. The fundamental principle of the Helpful approach to health, feelings and wellbeing is the BioPsychoSocial model. It is my belief that in order to have robust and resilient health you need to look after your health in all of the three dimensions: Biology – that is the physical, Psychology – that is the mental, and Social – that is emotions, relationships, society and indeed socio-economic factors like race.
We all need to recognise the privileges and disadvantages that we experience in terms of e.g. the colour of our skin and how this directly affects our ability to seek helpful health outcomes.
Now, I want to start by saying that I am not black, nor am I an ethnic minority. Furthermore, I’m acutely aware of my white privilege and how much of it is not even visible to me in ways that I can actually comprehend. I do, however, have my own reference in terms of the lived experience of being in a minority. I am transgender and non-binary, so I do share some aspects of what it is like to belong to a minority group. I know first hand how invisible the binary privileges are to binary people (men and women). I have personally experienced both micro-aggressions and overt aggressions. But this does not make me an authority on what it feels like to be a person of colour. I know that there will be aspects and perspectives that I miss in this blog. Some of my writing may be ill-informed and for that I apologise. I invite all feedback so that I can develop my own thinking and understanding.
One of the complex aspects of increasing awareness about a minority experience is when there is an expectation of that minority to ‘educate’ the majority. I am mindful of that and how my understanding is my responsibility. A day at a time, I’m learning. A day at a time, I am realising how much I do not know yet. A day at a time, I practice showing up. This is what is within my sphere of influence.
This blog is specifically and deliberately written from a health perspective and not a political one.
The disproportionate impact of COVID-19 on BME communities
Office for National Statistics (ONS) data published on May 7 shows that BME communities are at significantly higher risk of dying from COVID-19 than the rest of the population. Indeed, after adjusting the results to consider age, men and women of black ethnicity were more than four times as likely to die from COVID-19 compared to people of white ethnicity.
Furthermore, a report by the Intensive Care National Audit and Research Centre found that ethnic minority people accounted for 34% of COVID-19-related admissions to intensive care, despite only representing 13% of the population of England and Wales.
The NHS Confederation also says that evidence suggests the impact of COVID-19 is greater on BME communities. As well as more fatalities among BME patients, BME health workers are also overrepresented among coronavirus fatalities.
While it is crucial to point out that correlation does not necessarily equal causation, factors such as comorbidities and socio-economic status are being put forward as possible explanations for the disproportionately high number of BME deaths from COVID-19.
Finally, a new polling analysis has revealed the pressure on BAME women during the coronavirus lockdown, who often feel bewildered about where they can turn for help in times of crisis.
The BioPsychoSocial model of health
The BioPsychoSocial model of health and illness was developed by George L. Engel. It states that interactions between biological, psychological, and social factors influence the cause, manifestation, and outcome of wellness and disease. I personally benefitted from using this model as the fundamental principle for my own recovery from ME/CFS and Fibromyalgia and it underpins all health support here at The Helpful Clinic. This is the 3D Approach to Health.
Now, while the biological and psychological aspects of health are often discussed, the social factors frequently get neglected in the conversation. That’s why this is the specific focus today. To help us understand perhaps why BME communities have been so adversely hit by COVID-19, it is necessary to understand both sociocultural and socioeconomic factors and how your race can affect how empowered you feel to advocate for your health needs.
The factors that influence health and relate to society (socio) and culture (cultural), including:
The factors that influence health and relate to society related economic factors, including:
These factors relate to and influence one another. For example, your education usually impacts your level of employment, which in turn impacts your income.
For members of the BME community, there’s a disproportionately greater chance of living in poverty. They are also likely to be less educated, both factors that can lead to less healthy lifestyle choices. An example of this is having unhealthier diets because of less access to and less capacity to buy healthier foods.
Moreover, whilst we don’t truly understand correlations and causal factors at play now, when it comes to COVID-19, members of the BME community seem to be more likely to live in densely populated urban areas and overcrowded accommodation, which may increase their risk of being exposed to SARS-CoV-2. Furthermore these individuals seem to also be more likely to be key workers — especially in London — which again, would increase their likelihood of exposure to the virus.
The power of knowing you have a voice
It can be challenging for all of us to seek help with our health issues and to advocate on our own behalf for the treatment and support we need. It is my understanding that it can be even more so for people of colour.
This isn’t something that only impacts the BME community though, the point I’m making is the additional obstacle the colour of your skin can be. When I was ill, I was surprised at how many times I felt as though I was being dismissed by my doctor and my symptoms as well as my experience disregarded. The prejudice there wasn’t the colour of my skin but the diagnosis and range of my symptoms.
I had to advocate on my own behalf for medical support and although I struggled with it I didn’t think twice about my right to speak up and be heard. I never doubted that right or felt ‘what’s the point’ as I did not have the experience of systemic disadvantage and prejudice. I have no doubt that part of this mindset is the fact that I am white and have grown up with the right to speak up and be heard.
I am also university educated and so I had training in putting my argument across in an ‘educated’ way. My white skin and privileged educational background meant I stood by the courage of my convictions and sought second opinions because I knew that I was being let down and had other options. The thing with privileges is that we often do not see or consciously appreciate that we have them.
It is my perception that this is often much more difficult for members of the BME community. Whereas I was confident to seek help from elsewhere and inevitably had a say in my own health, people of colour often report that they don’t feel that they have a voice and don’t feel the confidence that I take for granted. Feeling that you have a voice and the right to speak up and be heard is a key component to feeling empowered and that sense of being in the driving seat of your own life. I have no doubt that this sense of whether or not you feel you have a voice impacts the health outcomes you experience.
The importance of health literacy
Health literacy is defined in the Institute of Medicine report, Health Literacy: A Prescription to End Confusion, as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”. In other words, how good a position someone is in and how much knowledge they have to make appropriate health decisions for themselves.
We take being able to read and write as a basic human right. I argue that we need to apply that same thinking to learning health literacy (and indeed emotional literacy) to be able to ‘read and write’ our own health. We all need to become agents in our own lives and learn to talk more about our health and feelings to get the support we need when we need it. This includes recognising our privileges and support others, less privileged, to share what we see as our basic human rights. This will help ensure that everyone (regardless of skin colour) gets the education they need to become fluent and literate when it comes to their health and feelings.
This belief is the fundamental premise and reason for The Helpful Clinic and why it is a social enterprise. See more here about our ethos and the Helpful Mission
Think of it a bit like learning a language. We start with basic words and increase our knowledge steadily until we become more fluent and then begin to look at the subtle nuances and advanced elements. We won’t always get it right. But if we teach ourselves and each other, everyone will benefit. By standing together and making Black Health the focus of the conversation, we will share the responsibility for our individual and collective health, improving outcomes for all of us in the process.
Still unaware of your privilege? This short video gives a sobering demonstration:
Many, although not all, of our clients here at The Helpful Clinic are white. This isn’t down to some conscious marketing plan, or desire to only help white people. It’s an observation of the current reality. I would dearly love to discover why this is the case and understand what I and we can do to make sure that what we do is accessible to all regardless of race.
Please consider being a good ally. Even if you’re not part of the BME community, you still have a valuable role to play. We all need to recognise that we are co-contributors to this experience and reflect whether what we are doing (or not doing) is ultimately helpful, right and just.
We all use our voices differently: some people protest, some sign petitions, some contribute more in direct conversations and some by writing or creating. Whatever your way is, stay true to that and don’t shame yourself or others for not speaking up in the same way as someone else. At the end of the day, it should never be viewed as a guilt trip. Diversity helps all of us and that also applies to diversity in communication and activism.
Please consider sharing this post with your friends and acquaintances, especially if they are members of the BME community.
We all show up in different ways and the Helpful premise is that it’s always more Helpful to be curious than critical and not shame those who speak with a different voice to our own. Look to develop your voice in a way that aligns with your values and respect the experience that black people are having at this time. Let’s all join the conversation and become part of the solution.
Go gently, hold steady, stay the course.
All the best, Thor