Professor Mala Rao OBE is a professor and senior clinical fellow of public health at the Department of Primary Care and Public Health, as well as director of the Ethnicity and Health Unit at Imperial College London. In addition, Professor Mala serves an adviser to the NHS England Workforce Race Equality Standards group and is also Vice Chair of WaterAid UK. In a distinguished career she has gained international recognition for her pioneering work on race equality, workforce development, environmental health and was also a co-founder of the NHS Race and Health Observatory.  Her work on the intersection of race, health, climate, sanitation, and gender equity has earned her global appreciation and respect and campaigned for raising awareness about the impact of climate change and eco-anxiety on patient wellbeing and mental health. Professor Mala has been an advocate for race equity and pioneered several significant and influential initiatives to address health inequalities and diversity in healthcare. It is a real honour and pleasure to have a discussion on race equity with Professor Mala for our Race Equity Blog at UCL Faculty of Brain Sciences.

 

1. How has your cultural background influenced your perspective on life and your values?

I am Indian by origin and lived in India until my graduation in medicine. My family was largely made up of academics, engineers and civil servants with a deep commitment to contribute through their own spheres of influence to achieving socio-economic equality in India. I feel certain that this background explains my determination to work towards health equality, a theme which has underpinned my career and indeed my final years of undergraduate medical studies when I had decided that I would specialise in public health.

2. Can you share a significant experience from your childhood that shaped who you are today?

I was very aware from a young age that my maternal grandmother who I absolutely adored, was unusual in having been university educated and the headmistress of a girls’ school. She was widowed at a very young age and at a time when early twentieth century cultural norms in India would have compelled her to be marginalised and voiceless. Determined that this should not be her fate, her father, my great grandfather, encouraged her to return to her education, regain her self-esteem and confidence and pursue life as she wanted to. She became a deeply loved and admired head teacher, often spending her own modest income to purchase books for students growing up in poverty. My passion for gender equality and for speaking up on behalf of marginalised individuals or communities were probably shaped by such instances in my family history.

3. What do you believe to be the potential barriers or challenges to the concept of race equity in higher education?

 There are many barriers to race equity, and I lead the writing of a paper published in 2022 the BMJ which summarised these obstacles. A key issue is that every aspect of research – its commissioning and funding, implementation and publication – has structural barriers embedded in its processes and systems. All these barriers could be removed but the leadership of research funding organisations and academia remain largely indifferent. Added to this is the new challenge of ethnic minority people appointed to leadership positions denying the existence of racism and discrimination. 

4. Similarly, what are the potential barriers or challenges race equity in health care and medicine?

 In health care and medicine too, there are barriers in every aspect of health delivery. Evidence on access to health care, the experience of the workforce in terms of careers and opportunities, and how medicines and technology are developed demonstrate race inequalities.

5. What specific strategies or initiatives do you think are useful for promoting race equity in higher education and/or healthcare?

A systematic approach lead by people who have a deep understanding of the root causes of these inequalities is needed, if the NHS leaders are serious about achieving race equity.

6. Are there any personal stories or case studies that you can that illustrate the importance of race equity?

I would refer anyone interested in this to read the reports (Why Diversity Matters, Delivering through Diversity and Diversity Wins) of a series of investigations across hundreds of companies carried out by Mckinsey in 2015, 2018 and 2020 to examine the business case for racial and gender diversity. Their findings showed that for companies with  diversity in executive teams, the likelihood of outperforming industry peers on profitability had increased over time, while the penalties were getting steeper for those lacking diversity. There also continued to be a higher likelihood of outperformance difference with ethnicity than with gender although both were linked with better performance. The positive impacts are likely to be replicated in health research and delivery, if actions were to be taken to achieve race and gender equity. 

7. Are there any resources you can recommend for individuals or organizations interested in advancing race equity?

There are many reports and resources being published and I would urge anyone interested to search for these as they are relatively easy to find on the internet. One publication which brings together the evidence on the health workforce as well as from health care is the 15 February 2020 special issue of the BMJ entitled Racism in Medicine which I had the privilege of co-guest-editing. This publication is a good place to start, for those who are unfamiliar with the literature on this topic. Colleagues may also wish to read the report of a review I lead in 2014, to assess the likely drivers of lower levels of wellbeing in ethnic minority communities in England. Launched at the House of Lords, this report was first to sensitise NHS leaders to the effects of racism and discrimination in the NHS and in our communities, and influenced the establishment of the Workforce Race Equality Strategy Advisory Group at NHS England.

8. What is your feeling on the role of privilege and allyship in advancing race equity education and healthcare?

I believe that allyship is crucial to secure enduring change. I emphasise at every talk I give, that the allyship of white colleagues is much needed, if systemic barriers to race equity are to be dismantled.

9. Do you envision a more equitable future in terms of race equity and social justice?

  I am an optimist, so yes, I do believe we will achieve greater equity and social justice not just in terms of race but also gender, given the significant intersection between the two dimensions.

10. Who has been the most influential person (or persons) in your life, and why?

The most influential people in my life have been my family – my husband for being the best sort of critical friend and ally, my parents, grandmother and other ancestors for the values they taught me, and my lovely daughters and grandchildren who constantly remind me as to why I want to keep working towards a just and equitable society.

11. What are some hobbies or interests you have that might surprise people?

My interests, such as reading and walks in British countryside are in general not surprising. I guess one interest which is generally not associated with Asian women of my generation is that I have attended the keep fit class in my village for many decades. I am just another villager in that context, throwing myself into a routine of jumping jacks and the rest!

12. Can you share a memorable travel experience and how it impacted you?

I have been a regular visitor to India because of my family connections with the country. I was also fortunate to return to live and work there between 2008 and 2014, having served as the inaugural director of Public Health Foundation of India’s Institute of Public Health in Hyderabad until 2011. Throughout my adulthood I have been very aware of the impact of socio-economic status, gender and other determinants on the health and wellbeing of people in India. But the immersive experience of living and working there more recently, vastly enhanced my knowledge and understanding not only of the systemic and societal challenges, but more importantly the innovation, resourcefulness, humanity and hope, often with women in the lead, which help drive positive change in the harshest circumstances. As a result, I am convinced that there is much that the UK can learn from low and middle income countries on how to continue to strive for health equity in these resource-constrained times.

Written by Dr Bilal Malik UCL Faculty of Brain Sciences Race Equity Team