Anoosh Chakelian and Nicu Calcea, The New Statesman, July 24, 2020
Five days after giving birth to her first child, Candice Brathwaite was rushed back to hospital with acute sepsis. For nearly a week, her symptoms — sweating through to her mattress each night, a lump gathering beneath her C-section wound, an inability to breastfeed — had been written off by healthcare professionals. She was advised to “stay off those mummy websites” and stop worrying. This oversight meant she spent weeks in intensive care away from her newborn daughter, Esmé-Olivia, and took nearly a month to recover.
Brathwaite, then a receptionist and marketing assistant, had felt something was wrong throughout her pregnancy. Hospital staff seemed to her to be noticeably more attentive and empathetic to white expectant mothers. When her baby was induced, her pain was dismissed as down to hormones, and her waters were broken when her husband wasn’t there, having nipped home for a shower. During her emergency C-section, the surgeon muttered: “Let’s hurry this one along as I was supposed to be home hours ago.”
“It made me feel as though black mothers aren’t listened to, that my voice didn’t matter,” she tells the New Statesman. Brathwaite has documented that experience, which took place in 2013, in a new book about black British motherhood called I Am Not Your Baby Mother. “From conception, black bodies have a multitude of hurdles to jump and that’s before a baby is even born.” Her story, while shocking, is far from unique: data shows that from cradle to grave, black people in Britain still face major obstacles to equality.
Let’s start at the beginning.
According to New Statesman analysis of a lifetime of inequality, black babies are less likely to even make a start in life at all. There were 6.7 infant deaths recorded for every 1,000 live births of black children in England and Wales in 2017. This is more than twice the rate of 3.1 deaths per 1,000 live births among white children.
For mothers, the outlook is even more unequal. Black women in the UK have a higher chance of dying in pregnancy with 38 deaths for 100,000 women, more than five times the rate for white women, according to a report by MBRRACE-UK in 2019.
This means black women account for just 4 per cent of births, but 18 per cent of maternal deaths.
The next point at which data becomes available is when children start school. In early education, the race gap starts small and grows rapidly as children enter adolescence. At 4-5 years old, black children meet expected development goals at similar rates to their white classmates. Even at ages 7-11, the same share (64 per cent) of both black and white children meet the expected standard in reading, writing and maths.
By the time they reach their GCSE exams, however, fewer than two out of five black children (39 per cent) receive a strong pass — grade 5 or above — in English and maths, compared with 43 per cent of white children and half of Asian children.
The racial “grade gap” gets progressively wider from here. Only 5.5 per cent of black students achieved three As or better at A level in 2019, compared with 11 per cent of white students and 25.7 per cent of Asian students.
For those that progress to university, 57 per cent of black students graduate with first and upper second class honours compared to 77 per cent of white students.
In the broadest sense, it normally comes down to what’s termed as a ‘lack of sense of belonging’ at the institution,” says Amatey Doku, a consultant and former vice-president of the National Union of Students, who worked on a report last May with Universities UK into closing the higher education attainment gap.
This feeling of exclusion, says Doku, “comes out of the sense that decisions being made in the culture of the institution – processes, procedures, instances — reinforce this idea that black or BAME individuals don’t quite fit in, or belong. That then leads to a whole range of disparities in outcomes.”
This can manifest itself in a feeling of alienation from, or reluctance to approach, majority white and middle-class tutors, lack of diversity and cultural awareness in student support services, timetabling that disadvantages commuter students (a significant proportion of whom are from ethnic minority backgrounds), overt racism, microaggressions, and the need for students from less well-off backgrounds to work through their degrees.
“We know that black students are more likely to come from disadvantaged backgrounds, so they will be more likely to have caring responsibilities, be financing their way through university, and supplementing their income through other ways,” says Doku.
Even when a black student arrives at university with exactly the same school grades as a white student, “they are still less likely to do well regardless of their prior qualifications”, Doku explains.
Worse educational outcomes is one obvious reason why Black adults are less likely to end up in well-paid, influential jobs. Just 5.5 per cent of black employees work as directors, managers or senior officials, less than half the rate of white people (12.2 per cent).
This has direct implications for salaries: In 2018, black Brits earned an average of £10.80 per hour compared with £11.90 for their white colleagues.
The Resolution Foundation estimated the pay gap between white and BAME employees to amount to around £3.2bn per year.
As with the gender pay gap, this is then reflected in retirement. Black pensioners have an average gross income of £425 per week, compared with white pensioners’ weekly £554.
But before you can have a salary, you need to have a job. The good news is that unemployment among black Britons has fallen significantly since the great recession, from 18 per cent in 2009 to nine per cent in 2018.
However, it remains more than twice as high as unemployment among white Britons, which stood at four per cent in 2018.
The Covid-19 pandemic is likely to widen the employment gap still further. Studies from the University of Essex as well as the University of Sheffield have confirmed that black Britons – who are disproportionately likely to be in lower-paid, blue-collar jobs – will be hit hardest by coronavirus job losses.
With lower salaries and employment, black people in the UK are also less likely to be able to take other steps towards financial security. Most visibly, just under a third (32.4 per cent) of black people in England owned their own home in 2018-2019, compared with two thirds (66 per cent) of white people.
This isn’t entirely a matter of money; the 2011 census put the average age of Britain’s black population at 30, compared to 41 for the white population, and found that 98.1 per cent of the black population lived in cities, especially London (where home ownership is lower). These factors increase the likelihood of renting after we have adjusted for income.
But it isn’t just that black Britons are more likely to be privately renting – they are also nearly three times more likely to be in socially-rented accommodation, with their flat or house owned by a council or housing association. Overall, 44.4 per cent of black people are social renters, in comparison to just 15.8 per cent of white people.
Government figures show that black people are also more likely to live in overcrowded houses and properties with damp problems — which leads us on to health inequality.
There is a surprising lack of up-to-date, reliable data on ethnic differences in health outcomes. However, there is some evidence that BAME groups experience generally poorer health. One study that analysed survey results collected between 2009 and 2011 found that one in four (24 per cent) Brits of African descent aged 60 or over reported poor health, compared to 13 per cent of people of white British background.
A 2018/19 survey revealed that nearly three quarters of black adults in the UK are overweight or obese (73.6 per cent), compared with less than two thirds of white Brits (63.3 per cent).
We also have data on nutrition, which shows that only 44.2 per cent of black people in England eat five or more portions of fruits and vegetables a day, compared with 55.9 per cent of white people. This, again, is likely to be a product of lower incomes.
In terms of general mental health, the differences between black and white Brits aren’t huge. Both groups reported similar anxiety, happiness and life satisfaction scores.
When it comes to more acute mental health issues, however, black people are affected far more. Some 3.5 per cent of black people in England screened positive for bipolar disorder in 2014, compared to 2 per cent of white people. One in six black people (17 per cent) also screened positive for a personality disorder, and 1.4 per cent had been diagnosed with a psychotic disorder. The respective figures for white people were 13.9 per cent and 0.5 per cent.
Black people are significantly more likely to be detained due to their mental health. One in 326 black people in England were detained under the Mental Health Act during 2018-19 – or more than 0.3 per cent of the total black population. White people were more than four times less likely to be detained under the same Act.
Those detentions do not just reflect a difference in the mental health of different groups; a higher level of detention suggests that, as in crime statistics, the system is racially discriminating between people in the same situation.
Indeed, police have the power to section people, and the New Statesman has recently analysed the latest data on the disproportionate use of policing against black people.
“The current Mental Health Act is a criminal justice approach to black people, based on cultural and racial misdiagnosis, as opposed to cultural mental health needs,” says Colin King, who advises the NHS on advancing race equality in mental health, particularly on restraint and therapeutic practice.
Founder of the Whiteness and Race Equality network, which aims to “produce an Afro-centric race equality approach to mental health”, King himself felt discriminated against when he was sectioned under the Mental Health Act at 16, diagnosed with schizophrenia. He has since been detained three further times after two suicide attempts. He is currently working on a book, They Diagnosed Me A Schizophrenic When I Was Just A Gemini: The outside of madness in whiteness, about his experience.
“White psychiatry fails to adjust its cultural lenses,” he tells the New Statesman. “It perpetuates stereotypes of black men, based on danger, being ‘challenging’ and ‘aggressive’… The current case management approach to services is inappropriate to diverse cultural needs of the black community, so the Mental Health Act is used as a service-based control system.”
King also saw this bias in the system against black men play out firsthand, when he himself became a mental health practitioner. He was involved in 200 sections of black men, and describes “the backstage racism of practitioners” manifested in “fear, stereotypes of black men as big, dependent on drugs, from dysfunctional families, unable to respond to medication”.
This could result in longer-term damage: inappropriate discharge plans, labelling people unresponsive to counselling, in need of higher medication levels, and unable to respond to work or a structured timetable.
“As an approved social worker, manager, teacher and commissioner, I have witnessed the emergence of an institutional racist diagnostic framework that reduces black men to slaves, primitive and in need of control,” he says.
A Mind report notes that the criteria for detention involve “subjective assessments of whether someone poses a risk to themselves or others” and that “these criteria in themselves might open the door to biases”. Both Mind and other organisations have called for the Mental Health Act to be reviewed to better support black people with mental health conditions.
Achieving some degree of cradle-to-grave equality isn’t just a matter of fairness. Even if we have no interest in achieving social justice, an unequal society is unlikely to be a harmonious one. When people become aware they face systemic inequalities in a society, they cease to identify with that society. Statistics show black people increasingly feel like they don’t belong to this country. In 2018-19, three quarters (75 per cent) of black people felt they belonged in Britain compared with 85 per cent of white people.
While that isn’t a huge gap, the more salient fact is that it has been getting wider. The previous year, 82 per cent of black people in Britain felt that they belonged here. That might be a sign of changing attitudes or circumstances, or it might be a sign of decreasing tolerance of racial inequality.
We’ve known for some time that outcomes for different racial groups aren’t equal in modern Britain, and talked a lot about the need for change. It’s hardly surprising that more and more people are beginning to lose faith.