A groundbreaking new report from the UCL Institute of Health Equity (IHE) has unveiled the deep-rooted effects of structural racism on the health and wellbeing of ethnic minority communities in the UK’s city of London.
The report entitled, Structural Racism, Ethnicity and Health Inequalities in London, highlights how racism contributes to avoidable and unjust inequalities between ethnic groups across the capital. Funded by the Greater London Authority, the review draws on both published and unpublished research, health data, and social determinants. It was informed by consultations with community groups and overseen by an advisory board of experts. The findings paint a grim picture of how structural racism persists, affecting everything from poverty levels to health outcomes.
The study reveals that people exposed to racism regularly, either in their daily lives or while accessing essential services, experience severe consequences for their physical and mental health. While the study acknowledges efforts to combat institutional racism, it makes clear that the consequences of racism remain significant, leading to stark ethnic inequalities in areas such as poverty, housing, employment, and career progression.
SIGNIFICANT INEQUALITIES ACROSS ETHNIC GROUPS
IHE researchers pointed to critical disparities, particularly in maternal and child health, mental illness, and interactions with the criminal justice system. Professor Sir Michael Marmot, Director of the UCL Institute of Health Equity and co-chair of the advisory board, emphasised the moral imperative to address these disparities: “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.”
One of the most striking findings shows the overwhelming proportion of children from minority groups growing up in poverty. Nearly 70% of Bangladeshi and Pakistani children, and 52% of Black children in London live in relative poverty, compared to just 26% of White children. This gap highlights how income and living conditions – key drivers of health and wellbeing – are unevenly distributed based on ethnicity. The report warns that children growing up in poverty face reduced life chances, from housing conditions to educational attainment and future employment prospects.
WORKPLACE RACISM & INEQUALITY
Although many young people from ethnic minority groups achieve high levels of education, these accomplishments do not translate into good employment opportunities. Poverty rates for minority groups remain disturbingly high, with 59% of Bangladeshi, 53% of Pakistani, and 42% of Black households in London living in poverty, compared to just 20% of White households.
Ethnic inequality is particularly stark in employment. Black youth (aged 16-24) face unemployment rates that are double those of their White peers, and White Gypsy and Traveller communities have the highest rates of unemployment among all minority groups. A concerning 40% of ethnic minority workers reported experiencing racism in the workplace over the past five years, while a third of UK employers lack equality, diversity, and inclusion (EDI) strategies.
“Racism is a challenge that transcends boundaries and borders, and whilst this report is for London, we hope it will have a wider impact across the UK,” noted Professor Habib Naqvi, co-chair of the advisory board and Chief Executive of the NHS Race and Health Observatory. “Racism has deep historical roots; it is pervasive, and it is embedded in the structure of our society.”
CALL FOR ACTION & ACCOUNTABILITY
Sir Michael Marmot further explained that addressing healthcare alone is not enough to tackle the health impacts of racism. He outlined three major ways racism harms health: “First, how racism directly damages health and wellbeing. Second, the reasons why some ethnic groups are more likely to be in poverty, experience poor housing, suffer in the educational and criminal justice system, and experience low pay, racism and poor employment prospects – all of which harm health. Third, it does not deal with racism that leads to worse experiences of healthcare and other services and worse outcomes as a result.”
The IHE is now calling for stronger leadership and greater accountability from institutions, employers, and policymakers. To ensure meaningful change, the review recommends several key actions, including:
- Mandating all employers in London to pay the London Living Wage and eliminate pay disparities based on ethnicity.
- Developing a city-wide anti-racism strategy led by the Greater London Authority.
- Strengthening the enforcement of legal non-discriminatory recruitment practices and creating co-designed programmes to support people from affected groups into work and training.
- Ensuring that reports of racism are investigated by independent bodies, not employers.
BETTER DATA COLLECTION TO ADDRESS INEQUALITIES
The review also highlighted a major gap in data collection, which limits the ability to fully understand and address ethnic inequalities in health. Researchers emphasised the need for better data to inform future policy decisions and to place communities with lived experience at the heart of decision-making processes.
Dr Cordelle Ofori, advisory board member and Director of Public Health for Manchester City Council, emphasised the urgency of this work: “The time is now, to build trust with communities, to ensure services are antiracist and culturally competent, and to dismantle policies and processes that ensure that a significant group of Britain’s population continue to be underserved.”
RECOMMENDATIONS TO BUILD A FAIRER SOCIETY FOR ALL
As the report’s findings show, addressing the deep-rooted causes of health inequalities in London – and across the UK – requires a broader focus than just healthcare services. Tackling structural racism in employment, education, and living conditions is essential for building a fairer and healthier society for all.
The recommendations to build a fairer and healthier society for all include:
Give every child the best start in life
1. Increase the spending on early years provision at a minimum meeting the OECD average and ensure allocation of funding is proportionately higher for more deprived areas and excluded ethnic groups.
2. Reduce levels of relative child poverty in all ethnic groups to 10 percent – level with the lowest rates in Europe.
3. Ensure programmes that tackle child poverty and mitigate its impacts are designed appropriately to meet the needs of different ethnic groups.
Enable all children, young people & adults to maximise their capabilities and have control over their lives
1. Reverse the cuts that have happened since 2010 in per pupil funding in schools and youth services.
2. Schools to strengthen antiracism approaches through capacity building and enforcement of legal obligations and additional duty to report and to act on racism in school settings.
3. Strengthen enforcement of legal requirements for non-discriminatory recruitment.
4. Increase the number of programmes to support young people’s mental health and fund youth services and safe spaces that are culturally appropriate.
Create fair employment and good work for all
1. Ensure all employers pay the London Living Wage and eliminate inequalities in pay by ethnicity.
2. GLA to develop and lead an antiracism approach for all employers in London.
3. Ensure that programmes to support people into work and skills-building programmes are appropriate for different ethnic groups and are developed with them including in-work training.
4. Reports on racism to be investigated by independent bodies not by employers.
Ensure a healthy standard of living for all
1. Tax and benefit system reoriented to reduce ethnic as well as socioeconomic inequalities. 2. Universal Credit should meet the cost of daily life essentials.
3. Develop advice and support services in collaboration with the ethnic groups who are most affected by poverty to ensure they access the financial support they are entitled to including uptake of benefits.
4. Increase the coverage of programmes to insulate cold, poor-quality homes, working with ethnic minority groups who are particularly affected.
Create and develop healthy and sustainable places and communities
1. While increasing supply of affordable housing enforce the Decent Homes Standards across all housing sectors and inform tenants about their housing rights by offering culturally appropriate free advice, support and advocacy services.
2. Assess housing providers, including the private rental sector, for racism and regulate the sector appropriately, enforcing sanctions.
3. Ensure that the views and concerns of ethnic minority residents are incorporated into planning including regeneration, access to green spaces and safety.
4. Implement the recommendations of the Casey and Lammy Reviews to end systemic racism in the criminal justice system.
Strengthen the role and impact of ill health prevention
1. Ensure that the focus of the public health system incorporates the fundamental role of social determinants, ethnicity and experiences of discrimination and racism in shaping health.
2. Redesign public health approaches to smoking, alcohol, drugs and obesity to ensure they are culturally appropriate for ethnic minority groups in London.
3. The health system to take a longer-term, prevention focussed approach to tackling health inequalities.
End racism in health and social care
1. Eliminate racism and ethnic inequalities in access to NHS services and in quality of experiences and outcomes through coproduction, increased investment, education and training, provision of appropriate support and culturally informed practices.
2. Address racism and systemic bias in diagnoses, treatments, medical devices, AI and resource allocation.
3. Eliminate racism in NHS and social care employment with greater equity in recruitment, pay, progression and seniority.
4. Ensure awareness of racism in the NHS and social care among both providers and users and apply appropriate sanctions.
Recommendations towards a more racial equitable system: Role and impact of institutions and organisations
1. Strengthen legislation, regulation and enforcement.
2. Aim for all London organisations to develop and apply antiracism approaches.
3. Ensure communities are central to the development of approaches to tackle racism.
4. Ensure there are sufficient resources for all organisations to tackle racism and evaluate and monitor antiracism approaches.
5. Develop data, research and evaluation to better identify and tackle racism.
6. Strengthen national advocacy and development of social movements to support antiracism
Click here to read the full report.
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