NHS: inequality and incorporation

As chief executive Simon Stevens ends his stint at the helm of England’s National Health Service (NHS), a Black health activist takes a critical look at the direction of travel on racial equality under his leadership. He argues that ‘racial democracy’, i.e., ethnic representation or diversity, has displaced the rooting out of racialised injustice and inequality. Using the example of the health service, he reveals just how the struggle against racism in institutions has been reduced under neoliberalism to a mechanical mathematics of inequality. While, simultaneously, long-discarded eugenicist and biological arguments are making an unwelcome comeback, and the ‘hostile environment’, ushered in by New Labour when Stevens was a health adviser, takes its toll on migrants and refugees.

Revitalizing HIV Prevention Programs: Recommendations From Those Most Impacted by the HIV in the Deep South

Purpose: The incidence of new HIV infections is disproportionately high among Black men who have sex with men (BMSM) in Mississippi. Community-based organizations received funding through the ACCELERATE! initiative to implement interventions aimed at increasing BMSM’s access to HIV prevention, treatment and care interventions. Approach: We conducted a mixed methods evaluation of the ACCELERATE! initiative to assess its impact. We also explored factors that act as barriers to and facilitators of BMSM’s engagement in HIV prevention interventions. Setting: Interviews were conducted between July 2018 and February 2020. Participants: Thirty-six BMSM and 13 non-grantee key informants who worked in the field of HIV in Mississippi participated. Method: The qualitative data from the interview transcripts was analyzed using an iterative, inductive coding process. Results: We identified 10 key recommendations that were most common across all participants and that were aligned with UNAIDS Global AIDS Strategy strategic priorities. Several recommendations address the reduction of HIV- and LGBT-stigma. Two of the most common recommendations were to increase representation of the target population in health promotion program leadership and to include HIV with other Black health issues in community-based health education programs rather than singling it out. Another recommendation called for programs aimed at addressing underlying factors associated with HIV-risk behaviors, such as mental illness. Conclusion: Our results indicate that HIV education interventions in the Deep South need to be revitalized to enhance their reach and effectiveness.

Structural Racism and Supporting Black Lives – A Pharmacist’s Vow amid COVID-19

COVID-19 is disproportionately impacting Black communities in the United States due to racial structures that increase exposure (e.g., densely populated areas, substandard housing, overrepresentation in essential work) and promote underlying diseases that exacerbate COVID-19. This manuscript uses Oath of a Pharmacist as a framework to propose a set of best practices for pharmacists to mitigate inequities such as achieve competence in the ideology of structural racism; identify systems of power that jeopardize Black health; value Black voices; name the socio-structural determinants of health; define race as a socio-political construction; name historical and contemporary racism; apply resources equitably based on need; collect robust data to solve complex problems; diminish bias and view patients holistically in the contexts of inequities; and advocate for Black lives. While race is biological fiction, Black individuals are at an increased risk for COVID-19 cases, hospitalizations, and deaths than their white counterparts due to navigating generations of racist practices that often converge with other inequities—such as sexism, classism. To describe these racial health disparities, structured, racial disadvantage is commonly ignored while personal choices and clinical care are highlighted as the culprits. Achieving health equity requires comprehension, acceptance, and assessment of structural racism, and pharmacists are highly trusted, uniquely positioned healthcare professionals who, through their knowledge, skills, and resources, can help attenuate the effects of structural racism to support Black lives.

Picturing sanity, in black and white

This speculative work grapples with a riddle: if white supremacy is noxious, and if it is inescapable, is apparent black health, black sanity, in fact healthy? In order to help the reader appropriately appreciate the feat that is black sanity, I begin with a treatment of Fyodor Dostoevsky’s literary character, Mr Golyadkin. I go on to extend my claim that Golyadkin’s ill health or lack of sanity can be understood in terms of the violation of the norms of sociality, onto Antonin Artaud. Dostoevsky and Artaud therefore provide case studies with which it is possible to begin to develop an outline of the bounds and mechanics of white sanity. I juxtapose this outline to readings from a selection of works by African writers—Bessie Head, Véronique Tadjo and Dambudzo Marechera. This culminates in an interrogation of Franz Fanon’s metaphorisation of disability. I grapple especially with the ethical and existential implications of his understanding of black amputation. The conclusion that I eventually reach is another riddle, which may or may not amount to a restatement of the riddle with which I begin.