Tackling racial inequality in healthcare
DPYD testing and dosing A systematic review commissioned by the Observatory identified limitations in routine DPYD testing and an additional variant, c.557A>G, associated with African ancestry. 85 The North West Genomic Laboratory Hub subsequently introduced the variant into routine testing based on the research findings, enabling clinicians to adjust chemotherapy starting doses for patients at increased risk of severe adverse reactions. 88,89 Pulse oximetry The Observatory’s work on racial bias in pulse oximetry also contributed to updated national guidance, an independent government review and further research into equitable medical devices. 90,91,92 Maternal health Over the past five years, MBRRACE-UK has reported a reduction in the disparity in maternal mortality, with the relative risk for Black women compared with White women falling from around fivefold to around threefold. 93,94 While many organisations contributed to this improvement, Professor Habib Naqvi, chief executive of the NHS Race and Health Observatory, says it demonstrates that evidence based action can begin to reverse longstanding inequalities.
In February 2020, The BMJ published a special issue dedicated to racism in medicine, examining racial discrimination and health inequalities experienced by patients and doctors. 78
The special issue helped bring about the establishment of the NHS Race and Health Observatory, which, six years later, continues to provide national leadership and develop global partnerships to reduce ethnic health inequalities through evidence, policy and implementation. 79
Partnerships and progress 2021–24: Observatory research on racial bias in pulse oximetry leads to updated NHS guidance and contributes to an independent government review of bias in medical devices. 80,81 A 2024 systematic review also identifies gaps in routine DPYD testing for patients of non-European ancestry. 82 2025: The Observatory partners with NICE to address ethnic bias in clinical guidance. In September, an additional DPYD variant associated with African ancestry is introduced into routine testing by the North West Genomic Laboratory Hub following the Observatory’s research. 83,84,85 2026: NHS England commissions the Observatory to help deliver a national programme tackling racism and discrimination in maternity and neonatal care. 86 Chief executive Habib Naqvi also chairs the health equity group of the government’s National Maternity and Neonatal Taskforce. 87
I keep The BMJ Racism in Medicine edition on my desk. It still reminds me how powerful evidence can be in
driving change. We are beginning to see credible outcomes because organisations are adopting evidence based interventions that shift the inequity dial.”
Professor Habib Naqvi, Chief executive, NHS Race and Health Observatory, UK
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