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

This blog was authored by the Race Equity & Ethnic Diversity (REED) Group at DoP: Jane Han, Lauren Harding-Brown, Borbala Vagh, Nafiso Ahmed, and Rachel Royston.

There is a lack of Black representation in mental health careers. According to the Higher Education Statistics Agency, around 1% of professors came from Black backgrounds in the UK. In terms of clinical practice, only 9.6% of qualified clinical psychologists were from Black, Asian and Minority Ethnic backgrounds according to the NHS Workforce Statistics. Black voices in mental health careers matters because it contributes to culturally competent research and clinical practice.

In order to reduce this inequity, it is important that young Black students interested in mental health are able to start their career in academia and clinical practice. Therefore, the Black History Month committee based in the UCL Division of Psychiatry hosted a mental health career workshop for Black undergraduate students on November 29th. The aims of the workshop were to equip students with the proper tools to navigate the early stages of their career after their undergraduate qualification.

The workshop had a plethora of speakers from academic and clinical backgrounds, who shared wonderful, inspiring stories about their career trajectories. Many have presented the multiple challenges that came along with establishing a career in mental health and the practical guidance on how to overcome these challenges. Committee members delivered insight and resources into applying for careers in mental health. The workshop ended with a 1:1 mentoring session from staff from the Division of Psychiatry.

Students overall reported that they found the workshop incredibly helpful. One student said that the most important thing gained in the workshop was “that there is space in academia for someone like [them].” Another student reported that they found the workshop “really helpful and encouraging”, and they “definitely left feeling confident and hopeful.” Another student commented that they were “considering UCL for their MSc next year.”

We would like to thank everyone who attended and supported the workshop. We hope that the workshop contributes to the series of concerted efforts to promote equity within mental health careers.

This blog written by Race Equity Lead, Bilal Malik.

Black History Month was first celebrated in the UK in 1987 to honour and commemorate black history and the lives and experiences of the black diaspora living in the UK. It is, however, important to recognise the power and potential of diversity and remember to challenge inequalities all year round.

Race is a social construct, and racism is a learned behaviour. As a child of South Asian heritage growing up in Britain, I wasn’t aware I was any different to my white peers until I was explicitly told so. The concept of colour was alien to an eight-year-old child. This behaviour is learned and can be changed, as can the situation where people who would rather stand than sit on the only empty seat on the bus, next to my brother and me going to school. Some may be applied, but this is nothing to what most black and other ethnic minorities endure. However, learned behaviour can be unlearnt, challenging situations, and education is key.

One way to honour Black History Month is by becoming a better ally. Therefore, questioning assumptions, attitudes, and beliefs and being aware of unconscious bias. It’s not enough to be “not being racist”; you must be anti-racist. So, not being a bystander when racism occurs and confronting discrimination makes us anti-racist. Race is a social construct distinguishable from ethnicity. Social constructs can be deconstructed and reconstructed. Consequently, we can transform race inequality.

The real challenge is structural and institutional racism embedded in the system. We need to understand the lack of opportunity that those from diverse ethnic heritage backgrounds still experience and an appreciation of intersectionality concepts and race as a social construct. There is evidence that racism is embedded in AI and algorithms and AI systems that can produce racist outcomes. We know to dismantle institutional racism, bias, and inequity, we need reforms across policing, criminal justice, healthcare, housing, education, employment, and economic systems. These reforms cannot work unless we all work together without perfunctory tokenistic gestures from those in power. I will leave you with a few words by Kendrick Lamar (the song became an anthem and rallying call for the Black Lives Matter movement and protests).

“Alright”

Song by Kendrick Lamar

“Alls my life I has to fight……..

Wouldn’t you know
We been hurt, been down before,
When our pride was low
Lookin’ at the world like, “Where do we go,?”
And we hate po-po
Wanna kill us dead in the street for sure,
I’m at the preacher’s door
My knees gettin’ weak and my gun might blow
But we gon’ be alright

We gon’ be alright
We gon’ be alright
We gon’ be alright
Do you hear me, do you feel me? We gon’ be alright.

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Here are a few links to interesting talks and facts to celebrate the month:

https://www.ted.com/playlists/230/talks_to_celebrate_black_history_month

https://www.blackhistorymonth.org.uk/

https://www.raceequalitymatters.com/black-history-month-2023/

https://www.raceequalitymatters.com/5-black-women-currently-making-history-that-we-are-saluting-this-black-history-month/

The ERB Centre, also known as the Centre for Equality Research in Brain Sciences, offers funding and opportunities for research that promote equality, diversity, and inclusion.

Authors, Christina Smith and Rachel Reeves conducted a research project on exploring students’ experiences from Black, Asian and minority ethnic (BAME) backgrounds on a pre-registration speech and language therapy training programme.

They discovered, previous research with students from BAME backgrounds on physiotherapy training programmes identified themes that included: feeling like an outsider, lack of understanding of cultural and ethnic differences and lack of power and influence. The speech and language therapy profession has even fewer members from BAME backgrounds.  Therefore, this study will aim to discover whether similar or different themes arise with speech and language therapy students.

All students on the MSc Speech and Language Sciences programme (approximately 120 students) were invited to participate in an online focus group if they identify themselves as being from a BAME background. Christina and Rachel recruited a research assistant not associated with the programme, to run the focus group with ten students, using a topic guide developed from the literature.

The Zoom platform was used to record the group conversation during the focus group. This will enable the generated high quality transcript automatically. The research assistant (supervised by the applicants) conducted an analysis on the transcript and took the lead in writing the report.

Ethical guidelines were followed. The student volunteers were asked for consent after being provided with the relevant information. Only the research assistant knew the names of the participants and, during the focus group, they instructed the participants not to use each other’s names. The recording was deleted once the anonymised transcription was completed.

Themes arising from the analysis indicate issues to be addressed on the programme and other programmes for health professionals at UCL and other higher education institutes.

To keep up with the latest news from The Centre for Equality Research in Brain Sciences (the ERB Centre), kindly visit their website. In case of any inquiries, feel free to reach out to fbs.edi@ucl.ac.uk via email.

The Race Equity Lead, Bilal Malik answered a Q&A to mark International Day for the Elimination of Racial Discrimination on 21 March- find out what Bilal had to say below:

What does International Day for the Elimination of Racial Discrimination mean to you?

What are your ambitions as Race Equity Lead within the Faculty and what attracted you to take on this role?

Can you tell us about any race equity initiatives that you are involved in currently or any that are in the pipeline?

What can we do as a university to create a more equitable academic environment?

Are there particular lessons that universities could learn from other organizations or sectors?

The Faculty of Brain Sciences is delighted to announce the appointment of our new Race Equity Lead, Bilal Malik.

Bilal says upon appointment:

It is a real pleasure to take on the role of Faculty Race Equity Lead. I am delighted to be given this opportunity and hopefully, I can carry on the good work performed by the previous leads.

I work in the Department of Neuromuscular Diseases at the Queen Square Institute of Neurology (IoN). At the Institute I am involved with the Equity Diversity and Inclusion action groups. Through this role, I wish to support students and staff from ethnic minorities in order for them to achieve success in their studies and careers whilst at UCL. I hope I can provide help in closing the BAME attainment gap, remove racial inequalities and promote UCL as an inclusive diverse place of learning.

If you are interested in joining the Faculty’s Race Equity Team to progress meaningful change with Bilal, please contact the Brain Sciences EDI Team at: FBS.EDI@ucl.ac.uk.

In the summer of 2021, the Faculty of Brain Sciences EDI team conducted a number of focus groups with ethnic minority staff to better understand their experiences working in the Faculty. This project was facilitated and analysed by Clinical Fellow Dr Roopal Desai, from the Division of Psychology and Language Sciences.

Literature on ethnic minority employees within UK universities paints a stark picture of the additional barriers and difficulties ethnic minority employees face in relation to recruitment, career progression, and retention. Through running focus groups with our own staff, we hoped to better understand these experiences of our colleagues, and effectively address and dismantle the barriers they face.

The key themes that emerged from the focus group data are summarised below:

• All participants reported experiencing subtle forms of racism, discrimination or disadvantage whilst employed at UCL.
• The participants reported a sense of being held to a higher standard in terms of amount and quality of work they produce.
• Participants felt isolated, and as though they do not belong to the UCL community.
• Participants felt less able to progress at UCL as they do not see themselves reflected in senior roles.
• There was a sense that the burden of solving issues such as discrimination falls to ethnic minority staff, whilst White employees could choose to look away.

Overall, it has become clear that issues raised in the research literature on this topic are mirrored in the concerns of ethnic minority staff in the Faculty of Brain Sciences. This demonstrates the serious and urgent need to better address racial inequalities in the Faculty, and wider UCL.

Recommendations from the report are going to inform the Faculty’s EDI strategy, including forming networking groups, and supporting staff into schemes such as BMEntor and Inclusive Advocacy schemes.

It is important to highlight that in talking about some of these experiences considerable distress was elicited in some of the participants. There was also a strong cynical feeling of resignation that there was little will or appetite for change at UCL. This should be a call to action to all staff across UCL; that without appropriate responses to these results we risk further marginalising ethnic minority staff.

The concluding quote below from one of the focus group participants captures a common experience of distress and sense of frustrated resignation that several of the participants voiced.

“It is quite emotionally exhausting talking about experiences and[…] then after this it’s kind of like…then what? We’re being extrapolated for data and then what?”

Jake Cable, newly appointed Acting Race Equity Lead

The Faculty of Brain Sciences is delighted to announce the appointment of our new Acting Race Equity Lead, Jake Cable. 

Jake is a technician within the Ear Institute, and has been at UCL since studying at undergraduate level. Jake will be Acting Race Equity Lead for 12 months, whilst Lasana Harris is on sabbatical.

Jake said of the appointment:

“I am delighted to be Acting Race Equity Lead for the 2021/22 academic year. Since 2020, I believe the tide has turned on our collective understanding of institutional and interpersonal racism and discrimination on the lines of Equality Act 2010 protected characteristics.

It is my intention to take an intersectional, data-driven approach in directing Faculty resources directly to staff and students that would otherwise be discouraged or intimidated by an inequitable academic environment.

It is my hope that the Faculty of Brain Sciences can become a leading example of how universities can help transform society by empowering and supporting Black and ethnic minority staff and students, including closing the achievement gap and opening avenues for Black and ethnic minorities to enter academic work and study.”

If you are interested in joining the Faculty’s Race Equity Team to progress meaningful change with Jake, please contact the Brain Sciences EDI Team at: FBS.EDI@ucl.ac.uk.

To mark the United Nation’s International Day for the Elimination of Racial Discrimination (21 March) we spoke to Dr Lasana Harris the Faculty of Brian Sciences’ lead for Race Equity about his research in this area and how the Faculty is working towards promoting equality.

Photo of Dr Lasana Harris, Faculty Race Equity Lead

Can you tell us about your research and why it’s important to society?

My work on dehumanisation elucidates the psychological mechanisms underlying such behaviour. Dehumanisation is behaviour, which we can’t ethically study. What we explore instead is dehumanised perception, defined as failing to consider another person’s mind; their thoughts, feelings, emotional states, goals, motives, and so on. Indeed, we have discovered that dehumanised perception is an everyday phenomenon, something we are all capable of, and probably engage each day. There are a variety of reasons why we would dehumanise another; if the situation encourages it, to avoid empathic exhaustion or emotional burnout, to spare ourselves unwanted feeling like guilt, and to rationalise past bad behaviour. This is important for society because it recasts the focus for human atrocities to the situations that led to such behaviour, rather than the individuals who committed the atrocities. So in the case of genocide, we have to examine the historical and political circumstances that make genocide possible, rather than the ‘bad apples’ who committed the genocide. This makes avoiding such occurrences less likely in the future.

What specific race equity initiatives are you involved in as part of your role?

The Inclusive Curriculum Health check (ICHC) is a tool to help degree programme teams diversify their curriculum. It helps them identify areas around content and assessment that could be improved, and strategies for change and improvement. This measure was adopted by UCL and is now part of our Annual Student Experience Review (ASER) process of programme review. The idea is that any curriculum could benefit from undergoing this Health Check. We have introduced a new Science of Bias module to bias train our undergraduate students. On a study trip to Utrecht University in the Netherlands, I saw that they had created a mandatory module for their undergraduates where they talked about the science behind bias. We have learnt so much in the last couple of decades about how bias operates, it is obvious we should share this with our students. We conducted focus groups in the faculty and at the wider UCL level and discovered that Black, Asian and minority ethnic (BAME) students did not feel a sense of belonging, not just with their departments or the university, but amongst their cohort as well. Therefore, we thought that creating such a module would be a way of educating our students about the latest cutting edge scientific research related to bias, facilitating bias training. I have a very dim view about traditional approaches to bias training because of the focus on implicit bias, and the research backs up such pessimism, so I wanted to do something that was novel and potentially more effective. It covers not just social psychology, but neuroscience, genetics, and evolutionary anthropology dispelling societal myths, tackling issues in these disciplines regarding how we conduct our science and addresses UCL’s involvement in the eugenics movement.

Can you tell us about the BAME awarding gap in Higher Education?

There exists both an awarding and a pay gap, where people of BAME backgrounds earn less money and receive less exemplary grades. BAME is a poor umbrella term, but it does capture the fact that these discrepancies are more likely if you are not of traditional Western European descent. In both cases, the gaps are attributable to differences at the top; there is less ethnically and racially diverse staff at the highest pay grades, and less ethnically and racially diverse students receive a first. Addressing both gaps is complex, but in each case, we have started with qualitative research, led by experts in the field. This then informs our strategy, which is multi-pronged. For the awarding gap, initiatives such as the introduction of a Science of Bias module for our undergraduate students and the ICHC are initial attempts, but more is in the pipeline. For the pay gaps, we are reviewing hiring and promotion practices and policies, and designing training specifically to address the unique situation here at UCL and in our Faculty.

COVID-19 has heavily impacted young people, including those from minority backgrounds, exacerbating existing structural inequalities – what role do universities have in tackling this?

Universities can help broaden their pipeline so we get more BAME young people interested in Higher Education, and in STEM specifically. We can also support all students, including minority students, by making their student experience better and providing more resources and services. We need to listen to our students to inform the best course of action, rather than assuming that we know what is best. We have created fellowships for doctoral training for Black students in the Faculty of Brain Sciences.

How can institutions ensure BME student success in Higher Education?

We can partner with the plethora of grass-roots organisations and government organisations already engaged in such work. We also need to review the barriers we have created historically to access these hallowed halls, including financial barriers, and come up with creative solutions to circumvent or remove them. For instance, we have created fellowships for doctoral training in the Faculty for Black students. This will increase the number of highly trained scientists that we can draw from when hiring academic staff. Such initiatives are vital for creating a more fair society and restoring equity. Remember, centuries of discriminatory policies and practices have created an uneven playing field while benefitting others for generations, and we have to move beyond equality if we really want to redress this.

You completed all of your Higher Education in the US (Howard University, Washington, and Princeton University). How successful do you think other countries’ approaches to creating a more inclusive student body have been?

The US is not the UK. It is difficult to import their approaches here because culturally and historically, they are different. Howard was set up out of the end of the American Civil War during Restoration as a teaching college for formerly enslaved people. Affirmative action policies in the US seek to redress the continued structural discrimination there. Whether such policies would work in the UK is open to debate, but any approach has to take the British approach to racism into account. This society is socially stratified, thus race can often seem like it is not an issue. But the ‘head in the sand’ approach is not going to work. Younger generations are demanding change, and the arc of history is moving in that direction whether people like it or not. We have to embrace the role the UK has placed in creating the society that now exists, including the problems and deficits in health, income, education, and the like that continue to plague people of colour. Only then will we be able to develop approaches that truly work for this society.

Links:

• Dr Lasana Harris
• PALS Research Opportunity Scholarship
• Unilever Unstereotype Experiment 
• United Nation’s International Day for the Elimination of Racial Discrimination