Dr Syed Mujtaba Hasnain Nadir has a good eye for picking up the bullying and harassment that BAME healthcare professionals face daily and creating viable solutions. It is why the Gastroenterology Registrar and Clinical Informatics Trainee won Workforce Innovator at the National BAME Health & Care Awards 2019.
What problems do the BAME community face in health and care?
The problems are manifold, and the absolute tragedy is that they are entirely predictable. The Workforce Race Equality Standard (WRES) report, which was based on workforce data from NHS Trusts and the NHS staff survey questions, showed that black Asian and minority ethnic (BAME) staff consistently found themselves disadvantaged in their career progression. This results in underrepresentation at senior management level relative to their population in the NHS, and gross underrepresentation at the Clinical Commissioning Group (CCG) level.
BAME healthcare professionals also faced more bullying, harassment and abuse than their white colleagues and found themselves more likely to be referred for formal disciplinary processes. Worryingly, almost all of these trends were more prevalent in and around London.
Why did COVID-19 the disproportionately affect the BAME community?
We are not entirely sure why the pandemic disproportionately affected the BAME community. However, substantial work has been done in the UK looking at healthcare inequality, socioeconomic and demographic factors that have seemed to disadvantage our black, Asian and minority ethnic groups. This would include a higher than average prevalence of chronic diseases such as diabetes and hypertension, which provide a negative survival benefit in hospitalised COVID patients as per the Office of National Statistics and ICNARC data.
Studies show that access to healthcare remains an issue for the BAME community, and urgently needs to be addressed. Dietary factors are being looked into, particularly Asian and Middle Eastern diets that predispose to higher than average BMIs; and a study looking at eight North West London boroughs showed that overcrowding in residential accommodations also played a role.
Occupation may also be a factor, with members of the BAME community finding themselves in careers with increased exposure and therefore a greater risk of contracting the disease. The Lancet published a paper in the summer that also suggested that the relatively low levels of Vitamin D in BAME groups also had an impact.
How do we prevent the BAME community from being disproportionately impacted by future pandemics?
This question is a tricky one without a simple answer. One cannot assume that all pandemics, of varied aetiologies, would disproportionately adversely affect the BAME community. As an example, we did not see this trend in the Spanish Flu pandemic of 1918, which predominantly affected the young and otherwise healthy without an apparent preference for race.
In the case of a pandemic that is proven to affect the BAME community disproportionately, we will have to take a multi-prong approach on a governmental/institutional and individual level.
On an institutional level, within healthcare, risk stratification of staff is a very reasonable first step. This will need to be coupled with an approach to shield vulnerable members of staff – extending ‘vulnerable’ to include age and ethnicity.
NHS England and the NHS Confederation recently created the NHS Race and Health Observatory – a new research centre to investigate the impact of race and ethnicity on health outcomes, which may inform our planning for future pandemics. The provision of appropriate PPE would also be central to an institutional approach to safeguarding the BAME community. The need of the hour, however, is an independent inquiry into the deaths of BAME Healthcare workers is, and be made available for public scrutiny.
Healthcare literacy and public health measures are essential for the wider public. We must use all available platforms, including social media platforms, to engage with the BAME community to provide them with reliable information about their health. We must also develop robust, focused public health measures to address these health-related inequalities in the BAME community.
How can we change the way that the BAME community receives healthcare?
I think a good start would be to call a spade a spade and to show unapologetic courage where it is needed. The healthcare situation the BAME community is in will not change if we continue to brush it under the carpet.
We must critically analyse all the data and statistics on the BAME community and be willing to question and challenge them. For example, our Trusts must provide us with detailed information on the different parameters of the WRES report so that as individuals and leaders, we can improve them. Individually we should aspire towards positions of authority within our institutions so that we can directly influence policy matters that affect our community.
A lot of people from the BAME community have reconciled with being second rate citizens in a first-rate country. This is unfortunate and only true if we look at it through the lens of the few. I think part of the problem lies in our segregation. It is easy to find comfort in the familiar, and what I have often noticed is that individuals of the BAME community are hesitant to interact socially with non-BAME groups. This is detrimental and undermines the plural nature of the NHS.
The NHS is, in some respects, a microcosm of some of the problems that underpin global communities. If we are more inclusive and understanding of one another, if we cultivate an environment of kindness and understanding, this will have a positive effect not only the health and wellbeing of the BAME and white community but also on the NHS as an institution.
How will you continue to help the BAME community in your work?
I firmly believe in equality. If our aim is a free, just and equal world for all, then our work should not suffer a selection bias.
This belief influenced the work that led me to win the inaugural BAME Healthcare award involved challenging bullying and harassment suffered by members of staff of all races and colours. Indeed, the WRES report that I eluded to earlier shows that all members of staff suffer bullying and harassment in the workplace regardless of race or ethnicity.
I’m a Clinical Informatics Trainee and hope to have a role in shaping the Digital Future of the NHS and better outcomes from BAME healthcare professionals and communities.
If I can become a strong advocate for health equality for all and stand against workplace-based harassment, then I feel I will have done my part for the BAME community. I aim to work passionately towards a position that allows me to influence health care policy so I can lead meaningful and lasting change.
Dr Syed Mujtaba Hasnain Nadir is a Gastroenterology and Clinical Informatics Trainee working across Health Education England, North West, and Gastroenterology Registrar at The Royal Bolton Hospital. He has a keen interest in Hepatology, has presented two first prize-winning posters, authored six original research publications and is co-authoring a book on Inflammatory Bowel Disease. He was recently appointed Honorary Clinical Teaching Fellow in Medical Education at the School of Medicine, University of Manchester.
Don’t miss the opportunity to celebrate the work this underrepresented group of individuals do. You can nominate your candidate, or yourself by visiting The National BAME Health & Care Awards site or clicking here. Support the cause by using the #BAMEHCA21 and #celebratingexcellence.