Episode 1
Ruby Zelzer, Reimagine Redefine

Transcript

Awino Okech: 

Welcome to the FCRJ podcast, where we discuss topical issues at the intersection of feminism and racial justice, as well as engage partners and comrades on projects we are carrying out together. This is the first in the series of podcasts developed by the Feminist Centre for Racial Justice, which is hosted at SOAS University of London. For more information about the Feminist Centre, please go to our website, www. feministcentre.org.

My name is Awino Okech the founding director of FCRJ, and I'm excited to welcome our first guest, Ruby Zelzer. Ruby, welcome. 

Ruby Zelzer: Thank you. 

Awino: Let's start off by you telling us a little bit about yourself. 

Ruby: Okay, so I am a knowledge and research consultant at Re Imagine, Re Define. Our grand goal at the consultancy is to see the end of systemic racism in the UK. We work with academia and NHS. And how we do this is, one, through data science. We perform analysis to show the presence of systemic racism in academia and NHS, we also do a lot of community organizing, creating safe spaces for people to discuss racism and racial justice in UK, and we are now developing flagship courses to discuss how knowledge is created and disseminated, who gets to be funded, and how to support staff who are racialized for organizations who are interested in that.

Awino: That's exciting, large scale work. How did you come to start working with the NHS? 

Ruby: It was actually directly through... in 2020 after the murder of George Floyd. And I have, because of my community organizing work, I began to realize there's a lot of racism happening within the NHS. So it started with 95% of doctors who died from COVID, in the early phase, were Black and minoritized. And this figure was very shocking to me because the staff are only 44% at the time who were Black and minoritized, but 95% died. And it spoke to the fact that there were people who were exposed basically to environments, which are toxic in a sense, when we don't know how COVID was spreading at the time, it seems like Black and minoritized doctors were sent into these areas.

And that led me basically to interactions with people online who were actually organizing to tell GMC, which is the General Medical Council and BMA, which is the British Medical Association... one is a regulator, one is a union... to basically tell them that this needs to be addressed. And that's how I got into the work. We found out that, you know, Black doctors are not being recruited. We have one hospital in London which had zero black doctors recruited in 2020- 2021, and white doctors were six times more likely to get an offer. So these were the sort of things that we started community organizing around and actually highlighting to say, it's actually not okay to do this level of discrimination.

And right now we have a report now from GMC, which acknowledges some of these things, which acknowledges this differential attainment, meaning that doctors are who are Black are less likely to pass their speciality exams. Which doesn't really make sense at all as to why that happens. And they want to examine why this is happening. We also have Black and minoritized doctors being referred to GMC at a higher level compared to , white doctors. And they have actually recognized it and to set a target to say that they actually want to address it in a way. So some of the community organizing has actually led towards the efforts of GMC acknowledging this as a problem and something that they need to address.

Awino: This provides a very good segue to how we, we come into conversation with each other at the Feminist Centre for Racial Justice because FCRJ is a very new centre and part of the work that we thought we would do initially was to commission a series of scoping studies around particular thematic areas that we were interested in investigating to determine really what is the lay of the land, to understand where we could add potential value, both from a research perspective, but also from a collaboration perspective with social movements.

And the area of health inequalities was something that I think for all colleagues who are part of the Feminist Centre was something that they flagged. Obviously, the immediate memory, it was around COVID 19 and, you know, the sort of vaccine inequities that we were seeing, for those of us who live in the UK, the racialized experiences in terms of outcomes, health outcomes in connection to COVID- 19.

I also distinctly remember being in a taxi on my way to get my second vaccine jab and I was talking to the cab driver who spoke to me about his reluctance to go and get a vaccine and went into a longer conversation around questions of colonialism and, and the lack of trust that many Black communities have in relation to health systems generally. And I think this really provides a good foundation because we can easily speak about some of these ideas being too far-fetched. But there's an immediate history in relation to why certain communities are reluctant to trust institutions and are reluctant to trust doctors. So let's, let's talk a little bit about the study that you did for us. 

You already began to hint at some of the systems issues in terms of the hospitals themselves and, you know, Black doctors training figures in terms of this continuum of health. Health experiences and health outcomes. But if you turn to the study, what would you say are some of the major things that you picked out that sit at the axis of racialized experiences and subsequent health outcomes for those in the health system. 

Ruby: What came out to us were four key things. The most major one of them was belonging and othering in society and in healthcare. The second one is surveillance and the involvement of state police. The third one is border violence. And the fourth one was how anti blackness extends into international policy.

Just talking a little bit about each one of them, I would say for belonging and othering, it was this environment for Black people where they do develop that mistrust, a breakdown of trust with the healthcare provider because their concerns get dismissed. Because of when they actually get to the hospital, they're not actually treated the same way as a white person or somebody else of a different colour would be treated. And this forms a situation where patients don't trust the information which doctors give to them. So there is a 'them and us' structure that is actually created as a result of this and people are perpetually framed from their migrant origin as opposed to being part of that country which they've been living in even for multiple decades 

Now the second one was surveillance, and as a feature a lot of people, for example, in the mental health system in which the NHS RHO study, which we highlight, says there's a higher likelihood of police or criminal justice involvement before admission to hospital for Black people. This again creates that environment of mistrust because the police are bringing them into hospital, they get unfair treatment in hospital, it perpetuates the cycle of inequality. 

With border violence, I mean, it should be really obvious to people as to why this is a problem, um, but it really speaks towards the inequity in terms of actually accessing health care in the first place because many migrants who are coming as refugees and needing care are not actually able to access that level of care at all in the first place. This impacts their mental health as well. 

And with extension into international policy, we see things like these... visa apartheid... we see things like people who are trying to have connections -european institutions with African institutions- just unable to do that because people are denied visas or cannot actually come in to get visas. There's the other part of COVID if we can remember about how, basically, Europe was hoarding vaccines and sending them out to African countries at a time point when they could not be used because the deadline was too short to actually be able to get the vaccine to people.

So these are things that have emerged to say that, you know, health inequalities have got really big impacts on death, physical health, mental health, maternal care and healthcare access.

Awino: Indeed, and your paper also picks up on a larger global dynamic, particularly in relation to epidemics that we have seen before. For instance, the ways in which the globe responded to supporting and helping Africans and African doctors in relation to Ebola. I come from a generation of people who experienced that a period of the HIV AIDS epidemic and the length of time that it took for us to get lifesaving medication. And even when it did arrive, you know, the sort of inequities that arise around that, particularly in terms of cost, etc, still remain palpable. So this for us, there's a long jury here in relation to think about how global and public health issues have very specific manifestations that are linked to racialized communities in the continental Europe and in the UK.

I wanted to speak a little bit around the question of border violence, particularly as it connects to Prevent, which we know is really sort of a huge thing in the UK context, but also because migration is an area of interest for the Feminist Centre. If you could tease that out a little bit, what are some of the ways that you see the connections between, you know, racialized and unequal health outcomes and border violence? How do the two meet within the health system in particular? 

Ruby: I think within the health system, it has to be the case where, there's a separateness that's embedded within society. So people are othered because of their immigration status, and that has a significant role because people who are othered will not feel the ability to access healthcare. At the same time, that access to health care is limited to them. Um, there's a big question of mental health, because we have to actually also address the fact that with border violence, we're also talking a lot about immigrants who are refugees, who have experienced violence, and then now are not able to access any health care to actually address it. So, or when they do access healthcare, because the mental health, um, specific area has shown that Black people are more likely to be treated worse in hospital, more likely to be given more aggressive treatment, more likely to be isolated, compared to other people. So, there's a big interplay between being Black and actually accessing healthcare when you are an immigrant, especially so. And especially when you're coming from a precarious immigration background.

Awino: Let's turn a little bit to the question... you mentioned maternal health, and I wanted to pick up that thread, even though that was sort of not a central core of the brief around the scoping studies, but I know it was picked up in the paper. So one of the traditional ways, I use the word 'traditional' loosely in terms of thinking about gender and health, the most prominent -perhaps, let me put it that way- prominent ways in which people think about an equal health outcomes has often been through the maternal experiences of people who are giving birth and experiences of maternal health care, but maybe you could start off there and just talk to us a little bit about the connections between gender and racial inequalities as they lead to declining health outcomes.

Ruby: I would agree with you. I think with maternal health care, it has to be really emphasised about the levels that we're talking about. For example, in the UK, you're four times more likely to die in pregnancy if you're a Black woman compared to if you're a white woman. The background to this is not covered in the scoping study, but it's sort of important to know like recently, in June 2023, the UK government had the opportunity to create a target to end the racial disparities related to this, and they've chosen not to do so. So The fact is that from a policy making angle, this isn't actually going to be addressed, despite the fact that the figure itself, four times more likely to die in pregnancy, is so severe for Black women. And of course, if they've got previous children, this also impacts their previous children as well.

So, yes, gender has a big role in this. I would say maternal health came out itself as one of the, areas which have very much impacted. I actually think there's another bit about border violence, where we have the evacuation of... In Ukraine and Black women and Black children were not classified in that category as 'women and children'. So trains are prioritized for women and children, but that did not include Black women and children. I can just graphically remember seeing this video of this Black woman with a baby breastfeeding in the snow and the train is moving away from her and she's just in a group with other Black people around her.

And I think to myself, this is the situation which will create healthcare inequalities because why are you leaving a Black woman in a dangerous situation with her baby? And so you can see all the factors in there, in terms of her health, is not a priority. And so these factors have to be addressed. It's something that we actually have to say: "Here is the data. You can actually see that this actually exists". 

Awino: Let's talk about data a little bit because this is something that you surface in the scoping study, which is if you think about continental Europe... in the UK, you're likely to be able to find data sets to work with whilst in other contexts across Europe, the lack of data around questions of race means that groups are therefore developing independent ways of thinking about data collection.

If you were to think about access to data, lack of access to data, reliable, what would be your major... sort of, points around this question and how it leads to effective advocacy or effective change making around this issue? 

Ruby: Yeah, I would say we have to frame it to know that the hegemonic powers of Europe do not collect data on race, and they do so on a said egalitarian basis to say: "We are all human, race doesn't really matter, we treat people equally, it does not need to be collected". Or in the case of Germany where they say: "Well, race data has been abused before, so we don't want to collect it because there's that risk". Unfortunately, that doesn't help the situation because it still exists. It's very clear that there are racialized effects which create health inequalities. It's very clear because... from the data, all this does is that it creates a situation where people have to be referred by their migrant background.

So, so we have things like in the paper where it's like, "I'm Swedish Sudanese" or a "migrant from a majority group in Kenya"; we have 'global south migrants'. These are the terms of reference which are used for Black people. But interestingly, like groups need to realize that these people are the ones who are still getting discrimination within the health system. And it is really because they're Black. It's not acknowledged as such, but I feel like the, the push for advocacy has to be: This is the data. This does exist. These people who you do not call Black who are Black, are therefore getting discriminated against. And this is the proof of it. 

So yes, data collection and reliability of that data collection is definitely a key part in terms of actually producing the research, but we have to also underlie this maybe with the background, which we've had before... which is, for example, here in UK, the government is aware of the maternal health -and four times- people who are Black are more likely to to die in pregnancy- and then chooses not to make a target to end this racial disparity. So there is the part where, yes, European governments do not really acknowledge the presence of race and racism, although it does happen in those countries. But a uniting factor with UK and Europe is that there is no real impetus from the policymaking angle of governments to change these racial disparities. So it is something again for groups to actually be aware that this needs to change as well. 

Awino: Now, one of the things that you did with the scoping study was also to map the sort of organizations and the work that is being done. But also you started off this discussion by telling us about the work that you were doing. So as an organisation, as a Research Centre that is quite invested in action research -research that has impact and meaning making in the world- where would you argue we should put our resources, and resources means our intellectual resources, modest financial resources around this particular issue, particularly as a Centre that's interested in working at the intersection of questions of feminism, racial justice, migration, and, and bordering.

Ruby: I definitely think like for myself, my work... I work myself with another Black immigrant woman, so the kind of work that we do at Reimagine Redefine is in that nature. The other people who I have worked with in community organizing whose work I really value include people like Miss Evelyn Mensah; she's an ophthalmologist, a surgeon, and does a lot of anti racism work with GMC and BMA, and NHS trusts, trying to make sure that the Black doctors are actually treated equally and fairly. A second person I would really recommend and really think is doing a lot of work is Dr. Annabel Sowemimo, and she has recently written a book called Divided about decolonization of healthcare and racism within healthcare. She's a doctor, she's an academic, she's an author. A third person is Dr. Rochelle Burgess, and she does a lot of work with mental health, and relating to the Windrush, as well as in global health as well. So on a intellectual basis, I feel like... in terms of academics and writing, this would actually be someone who the community should be aware of. 

Looking ahead to sorts of charity and funding, I think the... they call themselves, I think the Baobab Foundation, and they give a lot of money to community organizers. They recently had a three million pound fund, which was actually for continuous, run-through funding for five years for organisations, which were specifically Black led organizations. And these are the type of activities I feel are necessary for communities to actually know about. They're actually probably due in for a large chunk of money because Lankelly Chase is going to give them an amount of an endowment as they tie over. So these are the things that I think... yeah, those are the ones I would recommend.

Outside of this, I'll say... towards you, when I think about Europe, I think I would highlight the work of Dr. Tiffany Florvil and in Mobilizing Black Germany, that's her book title. And she talks a lot about how... because Germany does not acknowledge Black Germany, and how this can actually change as well as the movement in Germany called Afrozensus, which is collecting data, challenging the fact that data is not being collected about Black people and that it does need to be collected. 

Awino: How might you think the transnational as we close out? Because I'm quite keen for us to draw the links and the connections between what is happening in continental Europe and some of these other regions that we're keenly interested in, such as Africa, Latin America and India as a subcontinent.

Ruby: So, in terms of people who work in those areas, I feel like I would like to highlight the work of Catherine Kyobutungi, in terms of her, I think her advocacy around visa nationalism and apartheid of COVID vaccines as well as visas is something that is really important. And a little bit... trying to think about Beth Maina Ahlberg, and she studies in Sweden, and she's talking about racism in healthcare, and looking forward towards actually what we can do in a country where racism is not actually acknowledged, but understanding that many of these racialized populations come from Africa, and what can be done to support these populations.

Awino: Well, thank you so much, Ruby, for undertaking this piece of work for the Feminist Centre for Racial Justice. We really look forward to continuing our collaboration on the outcomes, particularly, and recommendations that came out of this scoping study. 

Folks, this brings to the end the first of the FCRJ podcast. Please look out for more in the series.