how reviewing Evaristo’s novel should prompt a critical analysis of racism in healthcare -- part 2
Uncomfortable conversations about privilege—'it’s about context and circumstance’—allying oneself with the ‘establishment’—'you’ve dropped your principles for ambition’—and gender—'one of the biggest lies of our civilisation’—are made accessible, though not diminished, by Evaristo’s prose. That is not to say that all of Evaristo’s characters are solely emblematic of contemporary debates; they are complex women, often flawed and inextricably ‘othered’ by society. Carole, a bright girl from an inner city comprehensive school, is one of the only black students accepted by the University of Oxford. Constantly made to feel grateful for the opportunities afforded to her, Carole must reconcile the unchallenged, unremitting racism she encounters in her high-flying job in order to achieve ‘success’. Winsome, a Barbadian embroiled in an unhappy marriage, has an affair with her son-in-law and is emotionally ostracised by her own self-loathing . These women must learn how to exist in a society seemingly intent on marginalising them and their lived experiences.
Although Girl, Woman, Other is fiction, the very real barriers that face BAME women in British society, and black women in particular, are no more apparent than in healthcare. If the WHO definition of health is accepted as ‘a state of complete physical, mental and social well-being and not merely the absence of disease’, then access to appropriate healthcare is a major contributing factor to the quality of life of black women across the UK. There is increasing research about the barriers facing BAME women in accessing healthcare, but this remains a shamefully deficient field. Mental healthcare and maternity care are two of the poorest performing healthcare sectors for equitable access in the UK. In 2018 and 2019 the findings of the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries Across the UK (MBRRACE) report found that black women were 5 times more likely to die during childbirth than their white counterparts (see here and here). Additional research published in the British Journal of General Practice found that black women of Caribbean origin are less likely than women of other ethnic minority groups to seek healthcare for symptoms of perinatal depression. The inequitable access to healthcare suffered by people from BAME backgrounds is often compounded for females, who are dually disadvantaged by a system institutionally entrenched in both racial and gender bias.
The book culminates in an exuberant after-party that brings many of the characters’ journeys together; a celebratory recognition of the myriad contributions of black women to the UK’s cultural landscape. In stark contrast, the UK healthcare system remains part of a diseased social body that must cure its institutionalised racism before it can celebrate being truly equitable for all. As Evaristo suggests through her fiction, cerebral critical analysis must be balanced by corporeal action in order to effect meaningful change.
Jasmine Virk, Junior Doctor, 2020
Sister Outsider: Essays and Speeches, Audre Lorde
The Bluest Eye, Toni Morrison
Racism in Healthcare, BMJ Special Edition, February 2020