Probably the words ‘unprecedented times’ have been overused but it's hard to find another phrase that quite captures the singularity, and tragedy, of the times we are living in. The lens was already focusing on race and ethnicity with regard to the disproportionate number of people of colour catching the virus. Even more troubling was the number dying as a result of Covid-19. Amidst the general chaos of the situation, at home and abroad, the Black Lives Matter (BLM) movement spun into action following the murder of George Floyd, a black man living in Minneapolis who died after a police officer knelt on his neck for 8 minutes and 46 seconds; I know the numbers off by heart; I’ve never concentrated so hard to stay on one knee for exactly that length of time on a protest march myself – despite two dodgy knees, I was determined not to sit out a single second of this time.
What has this got to do with education? Well, quite a lot – calls for a decolonised curriculum are coming from many quarters, and not least from the BLM movement. Everyone I know in the UK with roots in former colonies wants this too. Our (I say this as an Indian Sikh having had most of my education here in Britain) personal experiences of schooling made us more than a little aware of the hidden history; and in recent years, I’ve often been told by black and brown pupils in schools that their classmates and friends need to know ‘how we come to be here’. There have been articles, column inches, twitter feeds and insightful comments on other social media on what a decolonised curriculum might look like; what it might include. However, it appears to me that little is being said about what more we can do, indeed much more, to improve teaching about racial disparities in health – a topic that unequivocally connects the Covid-19 pandemic with the BLM protests.
The first thing we need to understand is that the differential outcomes from contracting Covid-19 for people of colour compared to their white counterparts are nothing new in terms of health inequalities based on race or ethnicity. Just as the BLM movement has firmly brought into our purview the hidden histories and hidden stories of Empire, colonialism and slavery, so the pandemic should bring firmly to the forefront of our consciousness the long ignored, but very well documented within decades of research, disparities in health outcomes based on race and ethnicity. For example, South Asian, African and Caribbean people are overrepresented in the data for Type 2 diabetes - six times more likely to be diabetic for South Asians and three times more for African and Caribbean - and of course being diabetic is an identified risk factor in Covid-19 related deaths; if you are of South Asian origin, you are very likely to suffer from high cholesterol – our bodies are simply not able to manage the bad cholesterol and get rid of it as easily as our White British fellow citizens. The impact is pre-mature death from heart or cardio vascular disease.
Black people, especially men, are significantly overrepresented in the numbers suffering from mental health conditions – often these are not diagnosed until contact with the criminal justice system. This raises a huge question about what schools are doing to support black pupils’ mental health and well-being, and why they aren’t intervening early enough to make more of a difference. Examination of exclusions' statistics, which show the disproportional rates at which black pupils are excluded, raises further questions about how well schools are interpreting behaviour needs i.e. not as a need for well-being or mental health support, but rather as ‘bad’ behaviour requiring punishment.
My own forays into schools and personal, social and health education suggest that very little is taught about health inequalities. And even more importantly, what children in our schools can do as a result of being better informed, the life-long messages they can take away with them. And I mean all children! Because this is not a problem for those of us of colour alone to resolve, not least because the reasons for these inequalities are complex. Many of the health inequalities that people of colour suffer from are not replicated in their countries of origin or heritage. For example, Black women in the UK are five times more likely to die during childbirth than their white counterparts. That is a statistic that should shock you. I listened recently to a talk given by a senior health professional who happened to be black. The first thing she said was that she was so grateful she had had her children in the African country of origin before she came to the UK. What does that say about healthcare in the UK for prospective black mothers? To what extent do racist tropes such as ‘angry black woman’ and ‘black people can bear more pain’ contribute to this astonishing statistic?
So, what do we need to do in schools? A key starting point has to be to identify the health issues that have a disproportionate impact based on race/ethnicity. More than this, we need to understand why we need to teach our pupils about these – clearly to help them to identify where changes in lifestyle will help prevent some, possibly many, of these conditions. For example, for many people of colour, currently, becoming a Type-2 diabetic isn’t a question of ‘if’ but ‘when’. For many of us, our eating habits from our countries of origin and the foods we like to eat are fine in a hot climate where the heat enables us to burn up the calories. But that’s not what happens here – instead we pile on the pounds. I’m trying hard to get my Congolese husband to reduce down the amount of ‘fufu’ (pounded yam) he cooks – yep, back in the Congo, he’d walk it off in 20 minutes, but here, the heavy carbs just send him to sleep in front of the telly! But it isn’t just the eating habits; it’s also the ready availability of the wrong food, fast food outlets, advertising…..and we haven’t yet touched on poverty, which often affects BAME communities disproportionally.
Knowledge is power. I have to admit, and I am red faced about this, that I wasn’t aware how easy, as a person of colour, it is to become vitamin D deficient if you live in a cold climate. I even used to follow the school’s advice on hot days and put sunscreen on my children when they were little – note here about checking on the advice in the letters we are sending out to parents when the weather gets hot. It’s worth noting that Vitamin D is important for healthy immune systems, bones and mental health. And there’s the link to Covid-19 again…strengthening immunity to colds and flu viruses…a number of groups are researching into the role Vitamin D may play in helping against the coronavirus.
Making our children more aware means that as they get older, armed with the right knowledge, they are more likely to make good choices around food and exercise. They are also more likely to ask for screening tests to check on things like vitamin D, cholesterol levels etc; black girls will grow up to be more demanding of health services as pregnant women in later life.
It's not only the PSHE curriculum that needs to be inclusive of differential health needs. The curricula in subjects such as food technology and science could be more proactive in raising the issues around the health inequalities that our BAME pupils are likely to face, and be helping them to identify solutions. Many conditions such as Type 2 diabetes and heart disease, strokes etc can, at worst, be delayed but, at best, even avoided through better self-care. Not all of the health inequalities will, of course, disappear because of better self-care and changes in life styles. There are other social and economic factors at play, not to mention unconscious bias, maybe even conscious bias. Within the mix, how the health and other health related services, including the food industry, are inclusive of race are important factors. This is why the education about health inequalities should be taught in all schools (yes, I can hear the cries, but we have no/very few BAME children in our school) to all pupils; it is exactly because we need everyone to make the wider social, economic and cultural changes to improve health outcomes for all of us; many of the children we are teaching now will be working in the health service, the food industry and the world of leisure and fitness in the not too distant future. They need to be armed with the knowledge and understanding to do a better job.
Finally, it's worth talking about what schools, and pupils in our schools, can do to take a more proactive, civic stance. So, what does this mean in relation to health? For starters, check what your local annual public health report says about local health needs, and the extent to which it is inclusive of race and ethnicity. I was somewhat shocked to check the Public Health report in my local authority area. On the one hand, it seemed to be quite focused on children and young people – it looked at health through the eyes of children and young people living in my county. What about race and ethnicity? Well, this has failed completely. While acknowledging that 15.6% of children in my local area were from a BAME background, and that, proportionally, they were more likely to be obese than their white counterparts, the report completed no additional analyses or gave further consideration to the issue of health inequalities for BAME residents. It did not even state the obvious: that being obese was more likely to lead to Type 2 diabetes, heart conditions…. etc. – in fact, not another single word. Covid-19 played its role though – it put the health needs of people of colour on the map, metaphorically speaking; late in the day but at least those leading health services are talking about the inequalities and what they can do. But coming back to schools, wouldn’t it be great for pupils to feedback on the Public Health report in your area? They would be contributing to the local strategy for health. What a great way to be involved in local democratic processes!
Schools have a real role to play in improving health and especially health inequalities. As with any other subject, those in schools leading on PSHE or the health curriculum must make sure that they have the in-depth subject knowledge to guide other staff and make sure pupils are well informed.
Associate Director for Incyte
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