Racism takes place in many forms, including interpersonal, institutional and structural racism. Interpersonal racism includes overt or violent acts of hostility and discrimination, as well as more subtle microaggressions. Institutional racism operates through the policies, practices and cultures of organisations, which can lead to unequal outcomes for different groups. Structural racism refers to the wider system in which inequalities are produced and reinforced across multiple institutions and areas of society, shaping life chances and outcomes.
UCL Institute of Health Equity Review on Structural Racism, Ethnicity and Health in London, October 2024
The review’s findings highlight that repeated exposure to racism in everyday life and within essential services is associated with worse physical and mental health outcomes. Although it acknowledges ongoing efforts to address structural and institutional racism in London, it finds that ethnic inequalities remain stark, particularly in relation to poverty, housing, employment, pay and career progression. Structural racism continues to shape the health and wellbeing of ethnic minority communities and contributes to avoidable and unfair inequalities between ethnic groups.
The review draws on published and unpublished reports, materials, and health and social determinants data, and is informed by an advisory board and consultation with community groups. It was funded by the Greater London Authority. IHE researchers also highlight persistent inequalities in maternal and child health, mental illness, and experiences of the criminal justice system and healthcare services more broadly.
The IHE calls for greater accountability from leaders, institutions and employers to prevent racism from continuing unchecked and to improve outcomes for those affected. The review’s findings and recommendations are relevant both across the UK and internationally.
Professor Sir Michael Marmot, UCL Institute of Health Equity Director and co-chair of the
review’s advisory board said:
“Racism is a scar on society. Social justice requires that we take the action necessary to deal with it. It is a profound injustice if the conditions for good health are unequally distributed, depending on ethnicity. Especially so, where that unequal distribution results from the evils of racism. Inequalities in the social determinants of health are storing up health problems for the future.”
Key findings from the review showed that:
Nearly 70% of Bangladeshi and Pakistani and 52% of Black children are growing up in relative poverty (after housing costs) in London, compared to 26 percent of children in White households. One of the most important drivers of health and wellbeing is income – children who grow up in poverty are less likely to live in decent housing, be able to eat nutritious food, or have places to play or sleep. As a result, their educational attainment and prospects throughout life (such as income and employment) are negatively affected (Department of Work and Pensions, 2019).
Progress in education does not translate into good employment or income due to
workplace racism: while many young Londoners from ethnic minority groups are reaching high levels of educational attainment (a result of their own efforts and progress by London schools and staff) this does not translate into good employment or income, manifesting in disturbingly high rates of poverty among many minority ethic groups – 59% of Bangladeshi, 53% of Pakistani and 42% of Black households in London are living in poverty after housing costs (compared to 20% of White households) (GLA, 2020; DWP, 2019).Ethnic inequalities are most apparent in employment opportunities and levels of pay:
unemployment among young people who identified as Black (aged 16-24) are more than double the rate of those who identified as White. Meanwhile, White Gypsy and Travellers have the highest rate of unemployment of any ethnic minority group. Additionally, in London 40% of ethnic minority group workers had reported racism at work in the last five years, and nationwide one third of employers were found to lack Equality, Diversity and Inclusion (EDI) strategies.
7 recommendations toward a more racially equitable system: The role and impact of institutions and organisations:
Strengthen legislation, regulation and enforcement
Aim for all London organisations to develop and apply antiracism approaches
Ensure communities are central to the development of approaches to tackle racism.
Ensure there are sufficient resources for all organisations to tackle racism and evaluate and monitor antiracism approaches.
Develop data, research and evaluation to better identify and tackle racism.
Strengthen national advocacy and development of social movements to support antiracism.
End racism in health and social care.