Context This work was carried out alongside the Association of Directors of Public Health (ADPHL) Steering Group on Supporting Black, Asian and minority ethnic communities during and beyond Covid – working with public health leaders in London, particularly local authority directors of public health and their teams.

Issue/Challenge During the first wave of the Covid pandemic, in 2020, there was renewed public and professional interest in ethnic inequalities in health, following the release of the Public Health England (PHE) reports, which highlighted the disproportionate impacts of COVID-19, particularly amongst Black, Asian and minority ethnic communities.

At the same time, there was an increased social awareness of the impacts of racism and the Black Lives Matter movement, following the murder of George Floyd.

There was a moment in time to speak out on the situation and that emboldened us to be heard in a way we haven’t been heard before. Reflecting on our experience as black female public health leaders in the London public health landscape, the challenge was how we capture this and respond to this matter in a way that brings real change and maintains momentum.

A particular piece of work was supporting the development of the ADPHL policy statement ‘Racism is a public health issue’ and its related action plans.

Traditionally, the medical/healthcare professions have been challenged in understanding and taking into account the impact of racism in health. There is an identified need for a different kind of health leadership during these uncertain times.

-Although there is increased interest and discussion of racism and its impacts currently, we anticipate challenges with maintaining momentum, particularly at senior level, to embed lasting change

There is limited research on the experiences of black leaders working in this context and how they are heard, involved or valued

Assessment of issue and analysis of its causes

We looked at examples of leadership on this subject matter at local, regional and national level, including an understanding, lived experiences and perception of discrimination, support at work and in health outcomes, health literacy and access, behaviour and attitudes, black and ethnic minority workforce experiences and morale.

Impact Our work has been recognised across London local authorities, wider health and care partners and national public health forums.

We were awarded the Faculty of Public Health Sam Ramaiah Award.

Our work has influenced partner organisations to develop actions plans or strategies around tackling structural racism (e.g. Greater London Authority).

Our work has motivated fellow Directors and Consultants to have conversations on this uncomfortable subject matter, in a way they’ve never done before and consider how we maintain this momentum.

It has also led to creating a safe space through a network of ‘Black’ leaders, where we can reflect on our professional development in uncertain times.

Intervention As above, we wanted our voices to be heard in response to the challenges that were faced. During the process of developing the position statement and action plan, we considered our own positions as effective leaders in this space, how we continue to maintain momentum of this agenda, and influence other system leaders in tackling racism in public health.

We invited speakers from other organisations to our working group to challenge us on these concepts as system leaders, and considered how we could bring the service users’ voice to hold us to account, as well as provide their perspectives.

We also organised and facilitated workshops with London local authority public health Directors and Consultants on this subject matter.

Involvement of stakeholders, such as patients, carers or family members:

There was no direct patient involvement, however we shared our lived experiences.

Key Messages Reflecting on our experience as senior black healthcare leaders leading effective multicultural teams and addressing health inequalities we found that:

• There is change and changing language around racism and health

• Cultural competency and cultural humility in leadership plays a crucial role and there are different views so we need to look at the different perspectives and actually understand what it means

• Although leading whilst holding discomfort is universal there appears to be disproportionate burden

• The impact on perception, behaviour and morale from a workforce and patient/community perspective

• Support and peer engagement does not always happen

The narrative can be deemed to be repetitive and nuances get missed

Lessons learnt There is interest in leading this way

• Holding the ambiguity and discomfort is universal to leadership in this context and so as leaders of this agenda we need to ensure we do not respond to the pressure to react with immediacy

• We learnt that we still need allies and we need time

Measurement of improvement This is ongoing and will be measured using qualitative approaches such as through the various dialogues across the public system, training and organisational development.

Strategy for improvement We will look at this as part of the workforce development, share at conferences and through the work with ADPH.