Understanding race, ethnicity and health inequalities – with Heidi Safia Mirza and Shabna Begum

Jennifer Dixon:

We know that inequalities are faced by people of different race and ethnicity in the UK, but what is the evidence actually showing us, and what are the implications for policy? Well a significant analysis was recently published as part of the Deaton Review of inequality in the UK. This finds that there is no single story of advantage or disadvantage in ethnic groups. In short, the story is highly complex and nuanced. One of the two authors, Professor Heidi Safia Mirza, is with us today to discuss all this. Heidi is Emeritus Professor at the Institute for Education, which is part of University College London. And she is joined by Shabna Begum, who is the Chief Executive of the Runnymede Trust, a charitable think tank working to reduce racial inequality in the UK. Welcome both.

Can you just tell us briefly, Heidi, about the scope of the Deaton Review into inequalities more widely?

Heidi Safia Mirza:

Well, it's under the auspices of the IFS, the Institute of Fiscal Studies, and Angus Deaton is the Nobel laureate in economics and economics of inequality. So the Nuffield Foundation funded a 5-year programme looking at inequalities, not only in Britain, but in America and across Europe, and I was absolutely bowled over that they asked me to lead on the race and ethnic inequalities. All the results have just been released through the Oxford University Press, as journal articles, I think there's over 80 at the moment, and growing. Everything from looking at disability and immigration and gender, work, pensions, wages... Oh my gosh. It's just huge and it's a massive resource for policymakers.

Jennifer Dixon:

And highly valuable it is too, and I really recommend all listeners to have a look at it. And the paper that, Heidi, you and Ross authored really was a very deeply comprehensive paper analysing inequalities by race and ethnicity. I wondered whether, first off, that both you and Shabna might just help listeners just define those concepts of race and ethnicity a bit more for us, because some people use them interchangeably, but they're obviously quite different.

Heidi Safia Mirza:

Well, race and ethnicity are two very different concepts, and they're often conflated with each other, and particularly if we look at how we collect statistics in the Census, sometimes we use terms like Black, which is a racialised term, and then we might use Pakistanis and Bangladeshis. So we're always conflating it, but the roots are massively different, and rooted in quite a disturbing history of race and the idea of race, which evolved in the late 16th century and into the 17th, 18th, and 19th century, as a way of seeing difference through biological and inherently different ways of being. We know now, with the Human Genome Project and others, that there's actually very little genetic difference between groups. There's more difference within groups than between groups. So we know that it's a pseudoscience.

So the idea of race constructs difference as inherent, essential, unchangeable, with particular qualities: 'Blacks are not so clever, whites are superior, Asians are sneaky...' All of these kind of racial stereotypes that are embedded in our everyday thinking when we judge people when they walk into the room. It's a bit like saying, ‘Well, women aren't as clever as men.’ Ethnicity on the other hand is far more about the kind of cultural and linguistic and religious differences between groups. So ethnicity is more of a self-defined concept, where people would say, ‘Well, I'm Pakistani Muslim,’ so it has nationality, blood ties. It's far more about this idea of belonging. And then on the other hand, we have the idea of nationality and citizenship. Can you belong to a country? Who owns that country? Who owns the right to live in those countries? So nationality is a kind of intermediate way in which we can look at race and ethnicity together.

So it's a troublesome area, and I know a lot of people are very afraid of talking about race because they might be shut down, they might use the wrong words. There's a lot of policing about terminology, which I think is unfortunate. I don't think we should be afraid. All we need to know is to know our history, to know where those terms come from, and then to respect people from different cultures, religions and ethnicities.

Shabna Begum:

That idea of superiority and inferiority, both related to ideas about race, are also assigned to culture and ethnicity, as you then distinguished. But again, we still see that different ethnic groups are assigned superiority or inferiority based on values assigned to their ethnicity. So I think that you're absolutely right to say that they are distinctive, that we can also see how they have been conflated, and how that has served a political purpose. It's really important that we challenge the way that politics and political discussion has happened over the last 10, 14 years, has really undermined our ability to have open, honest, frank conversations around this, both in a way that's undermined our ability to really understand the issues, but also made us, as you say, fearful of talking about these issues as well.

Jennifer Dixon:

I know there's a lot of discussion about ‘systemic racism’. Should we be better talking about systemic ethnicism, then?

Shabna Begum:

That is an interesting question. I think because the two are so interconnected, structural racism, systemic racism, institutional racism is really important, because again, even though they are distinctive ways of categorising groups, they are often conflated. And in the ways in which racism operates, it conflates the two. So I think that, when we're talking about systemic racism, structural racism, institutional racism, those are deep-seated ways of treating people differently, often based on an understanding of what their culture is, but usually first and foremost in that is the physical appearance, the physical attributes that identify and mark people out as different inferior or different superior.

Jennifer Dixon:

So obviously in the paper, you described the 18, I think it is, ethnic group categorisations that are used by ONS or statisticians, on which you look at some of the outcomes that we're going to talk about. So that's obviously an ethnic categorisation, which is quite mushy in a sense, or multifaceted I think is probably a more forgiving term, as you describe. Is this sort of broadly acceptable, given it's so complicated, or are there better ways that we can categorise in order to see what's happening?

Heidi Safia Mirza:

I think the categorisation in the Census really speaks to what Shabna was just saying, and what you were just saying is a mushy kind of conflation of ethnicity and race. So you have white other, white British, Black Caribbean, but at the same time you will have Pakistani and Bangladeshi, which are countries. So you have regions, countries, notional ideas of race, all packed into one. And the trouble is, we have systems of collecting data which rely very heavily on these preconceived concepts that have just evolved in this mushy way. I love that word. And how do we pull back and say, we need a new way of collecting data for policy?

And what has happened to people like Bangladeshis and Pakistanis, who are some of the most disadvantaged in the study, is they become racialised, as Shabna was saying. Their bodies become loaded with meaning. So when they walk into a room or they go into a classroom or a doctor's surgery, a whole pile of expectations follows them into the room. So for example, they're seen as women are oppressed, and that would be some of the reasoning for different health outcomes, or Black people from the Caribbean, very, very different from Black people from Africa, in terms of their health and wellbeing and educational outcomes, are seen as one and the same. People don't even know how to distinguish them sometimes in a policy arena or in a school, they don't understand the nuances and the differences of culture. So we have become racialised, even though we are ethnicised. Religion matters to us, language matters to us, what we eat matters to us. There are so many complications about how ethnic groups become racialised and then turned into policy objects.

Shabna Begum:

We are often lumped into the Black group or the Asian group, and as we know, as your report very well highlights, the colonial histories, the migration journeys, the generational impact, the life course journey of different groups, all of those things shape the experience and the health outcomes of those groups.

I heard Gary Younge talk recently, and he talked about racism being a language, but having many different dialects, and that there is no one universal experience of racism. It is very much shaped by each of those factors that you highlight in your report, which sometimes offer advantage, other times offer huge disadvantage to the different groups. And I think that is one of the real problems around the policy conversation, particularly when it comes to health experiences and health outcomes, is that we are not allowed to see those differences and to therefore speak to those differences. And that is something that does need to change.

Jennifer Dixon:

So that's a really good point, and that links to my next question really. One of the big things I thought about the paper that was so fascinating was the sheer dynamism, the waves, the cohorts, the history, and the population changes were so profound. And I wonder if you could just chart that out for people. What is happening to the population here?

Heidi Safia Mirza:

The huge energy of our communities in Britain are just so exciting, while there's so many issues around poverty and inequality, but there is a dynamism there. The population of Britain has just been changing continuously, and one of the themes in the report is that there is no single story for ethnic groups. We have very crude concepts in our data analysis, but there's no single story. Indians are doing very well, but they came at a different time. So what we have to look at is, when did different groups come to Britain? And how that has related to where they are now. So we see things like a lot of Indians came from India, but also from Uganda and Kenya in the 1970s [inaudible 00:11:11] middle class of Asians came to Britain when they were expelled from Uganda and Kenya, and therefore we have Priti Patel and we have Rishi Sunak from that generation. But we also see that Indians are very much in the higher professions. They're doing very well economically, but other so-called Asians are not doing so well.

So you have Bangladeshis and Pakistanis who came much more impoverished to begin with, and live in the northern parts of the UK, or parts of the inner city like in London in Tower Hamlets and so on. We do see that those groups haven't been flourishing in terms of employment and health, and wellbeing. But what we do see, this goes back to there's no single story, that they are doing brilliantly in education, the young people, and these are the biggest population groups for the future. So at the moment they've got the youngest families and the most children, and they are really the future of Britain, because they're young, they're going to school, they're getting into work. But there are a lot of barriers that we're finding in terms of work for those groups. So even though they get degrees, they often don't get into the job market or the wages that they should, commensurate with their qualifications. So there are barriers, there are growth, there is really exciting things about the future.

Jennifer Dixon:

And I'll talk to Shabna in a second, but the kind of waves, the post-colonial waves from the Caribbean and from parts of Africa, the post-War wave you described very well, then there's a sort of Middle Eastern, African, South Asia and China wave, and then more latterly a sort of white Eastern European wave in the early 2000s, as well as the growth in the population as you just say. And I was particularly interested in one of the graphs which showed the projections, showing the proportion of the white British population in 2011 was about 83%, but by 2061 it's projected to be 62% across the country. So that shows you a massive, massive change that is likely, and is something for us all to address and face and embrace.

Shabna, what were your thoughts about some of the contours of change that you found useful in the report?

Shabna Begum:

Heidi, where you talked about social mobility through education, and really looking at some of the success stories that we've seen, the story of the Bangladeshi education attainment gap, that not just being closed but actually being exceeded, but then the labour market outcomes haven't necessarily reflected those educational gains.

One of the things I wanted to pick up on from what Heidi was talking about is that often we have a conversation around, for example, the Indian community, which is economically doing well, and therefore doesn't face the structural racism in the way that other communities, Bangladeshi and Pakistani, might. And we often fall into this model minority authoritarianism, where we assume that if one group can do it, then there is something deficient about the other groups who aren't. And I think, again, Heidi's paper does the work of really outlining what it is about the migration trajectories as well as the socioeconomic factors that really support and inoculate in some ways some groups from experiencing the structural racism that many other groups are overly exposed to. And I think that's really important for us to be able to make that differentiation, and to see that these aren't reflections of cultural deficiencies. They are reflections of much wider, longer, historical but also contemporary experiences.

The other thing I wanted to point out is that one of the reports that I first did at Runnymede Trust was a report called Broken ladders, which is looking at the myth of meritocracy for women of colour in the workplace. We often talk about health experiences and outcomes in terms of physical health in a quite direct way. One of the things that our report highlighted was the emotional and mental health and wellbeing impacts of racism, where you have the professional qualifications, those have been proved, we are seeing much better attainment [inaudible 00:15:21] some of these groups, but that's not reflected in your workplace progression and your career ladder. And often we talk about the physical health impacts, and we talk about the NHS and health care, and what we forget about is the impacts of racism on our mental and emotional health and wellbeing.

What came out from that report was so many women of colour who we talked to, in senior roles across different sectors, they talked much more about what it meant to have the stress levels they operated with in the workplace, where they're navigating often hostile workplaces where they are in a minority, and the hypervigilance that they described of trying to fit in, of trying to conform, of trying to play the not too aggressive but assertive but not passive Black or Brown woman in that workplace.

I also wanted to bring it back to this summer's riots as well. So this summer, we saw some of the worst racist riots that we've seen in generations in the UK. The political and the media conversation has moved on very swiftly from that and has shut down, and we've had the law and order response. But from our perspective, the Runnymede Trust are really thinking about, what are the stress impacts, what happened to all Black and Brown communities who witnessed that? Not just the people who were directly impacted by the violence, but really thinking about the levels of stress that all of us experienced as a result of watching that racism in that very direct and violent way play out, and the impact that has on our health and wellbeing in the long term as well. That's something that is a really important part of the health conversation when we talk about race and racism.

Jennifer Dixon:

So I wondered whether, Heidi, you might pick out what you thought were the main findings on outcomes in the report, and what dimensions were covered. So we obviously have alluded already to education, to employment, but what were the main takeaways on the outcomes evidence?

Heidi Safia Mirza:

You know, I actually cried when I was thinking about the outcomes, and when I was writing the report with Ross, who I have to say is an absolutely brilliant statistician and economist, who really got race. Looking at the outcomes, one of the things that made me cry was that the Black Caribbean community won't exist in 20 or 30 years’ time. And I am a daughter of the Windrush generation. My father came here in the 1950s. We're celebrating 75 years of the Windrush, and they've become sort of iconic. The Caribbean people are seen as very central culturally, how Britain sees itself as a multicultural country, carnival, the patties and jerk chicken, all of these things are valued, but at the same time, this community is being destroyed, through issues around the criminalisation of the young people in those communities, and the conditions of work that have worn down, and Shabna just very beautifully talked about, the conditions for women of colour and Black women and Asian women in the workplace.

So you have poor conditions of work, low wages, and families that are constantly under attack by the systems of the state. And this group fared so poorly during COVID. The highest rates of death were amongst Black men. And so we've got to really look at the holistic picture when we are seeing different ethnic groups. And what makes me sad, that they won't be there, because like the British population, they're getting older. In fact, the Black Caribbean population mirrors the same age profile. So they're getting older, and they're dying, and the young people are not flourishing, and they are becoming increasingly more mixed race. So we are finding that, as a group, they're not being replenished from the Caribbean because of racist immigration. We've seen that with the Windrush scandal. So we have a group of people that are completely racialised as Black others. They don't flourish in schools, they're not seen as intelligent, and that's the history of enslavement, that's the history of the British psyche that we need to look at.

So one of the things that I'm saying in terms of outcomes is that we really need to think about reparations, historical reparations, for people to understand where racism comes from in this country, that it isn't just about name-calling or whatever. It is about the deep psyche of race that produces an outcome like that, where they're not treated as equal, where the inequalities in health, wages, and everything represents the way in which they are perceived. Because why can't they reach the top? They climb up the same ladder of education as all migrants do, but they don't get the good results in higher education.

And I've worked all my life in higher education. I have seen the racism that Black students face in universities, and the struggle that they've had to get there. There are so many barriers that some face, and so many that others don't face. So we're always looking, when you look at ethnicity, at the Black and the migrant and the othered, but we are not looking at white privilege, and we don't look enough at wealth. And one of the things in the Deaton Review is they look at those contours of wealth and pensions and income and housing that allow certain groups to flourish and others not to flourish.

And one of the things, of course, with the Black Caribbean population, but also with the Pakistani and the Bangladeshi, is housing. They're least likely to have their own homes and build up wealth. The Pakistanis and Bangladeshis may have more homes, because they live in the North where homes were cheaper, but they have the highest rates of poverty. Child poverty is at nearly 70% in the Pakistani community. They went down in the mid-'90s, but they're going up. Bangladeshi and Black children are in terrible states of poverty, and the health outcomes and the wellbeing outcomes of course will come from that.

Jennifer Dixon:

In your paper, Heidi, you say there is no unified story across different ethnic groups, and you explain why that is the case and show the data. But you do say that certain groups are persistently disadvantaged, particularly with poverty and unemployment, and you specifically pick out three groups. One is the Black Caribbean youth, which you've just talked about very cogently. Another is Gypsy Travellers, and another is Muslim men. On the Black Caribbean youth, when you were writing this paper and you saw those statistics to the point of tears, what is it specifically about this group perhaps as opposed to other Black groups? What's happening here?

Heidi Safia Mirza:

Even though Africans and Afro-Caribbeans may look the same on the surface, they might go for a job and be seen as the same, or they may be walking down the street and seen by the police in a particular racist way, which we know that happens on a massive scale, even though they are outwardly similar, culturally and migration-wise, they are uniquely different. So the Africans who came in the mid-1990s, and many of them were from not affluent, but more middle-class backgrounds, with education. The Caribbeans are now almost the fourth generation now here in Britain. So they are a much older population who have weathered the brunt of racism through the years. And I'm Indo-Caribbean, by the way, grew up in Trinidad, and came in the '70s with the very, very in-your-face racism, which has really structured my career in a way. Your life chances, the time you migrated, all impact your health and wellbeing and your outcomes through your life.

So the African population are more likely to be in the professions. Some aren't, some are. You have to look at where they come from and the period that they were in. The Caribbeans haven't fared that well, because of the unrequited connectivity to enslavement. So for example, I do a lot of work in education, and people tell me, ‘Do we have learn anything more about Tudors and World War II?’ That's what our syllabus tells us, but we don't learn about the history of British colonialism and the impact of that, the way that it has shaped the world, the way it shapes [inaudible 00:24:00] around people. And so without that understanding, there's a lot of trauma in our communities, because it hasn't been recognised or vocalised or even owned by the British of what they did to our communities in India and Africa and in the Caribbean.

So I think that trauma plays out, and when we look the health outcomes for Black men, mental health is the highest. And we also see that, during COVID, they suffered the most. Unemployment is high. It's slightly different for Africans from Africa, but it's that whole conundrum of thinking that race is just a simple thing. Race is historical. Race has a sociocultural impact, and it plays out in our bodies. And I think we need to recognise that.

And also for Bangladeshis and Pakistanis, they're the poorest group. In fact, what's very interesting, again around change in continuity, is that they have the most children, they're the youngest populations. In fact, you mentioned the [inaudible 00:25:02] Leeds University study, which I thought long and hard before putting it into the report, because it feeds very much the racist projections and the racist right wing that say, ‘Well, we're going to be overrun by Muslims, and we're going to be overrun by Pakistanis.’ And the Islamophobia that that conjures up. Because the ethnic groups are going to grow by 150%, and the white population has grown by less than 2%. So the white population is declining, but the ethnic population is growing at a very large and a very high percent with very young populations, but living in dire poverty on the whole. So again, we've got to try and understand both the racialisation that's going on and the outcomes.

Jennifer Dixon:

Shabna, what were the main takeaways from this paper on the outcomes, and was there anything surprising to you?

Shabna Begum:

Sadly, a lot of what the paper does is bring together a lot of the information that we have that is dispersed. And so I'm very glad of the collation of that, but I think the key highlight for us perhaps from the Runnymede Trust's perspective, is really thinking about the income and wealth inequalities and what an important role that plays in the health experiences and outcomes of different minority ethnic communities. And I think that, at the Runnymede Trust, we really have been looking at the cost-of-living crisis, and the impact of that on different minority ethnic communities. We wrote a report just before the pandemic called The Colour Of Money, where we looked at the wealth inequalities that are experienced and persistent. And so for every £1 of white British wealth, we know that Pakistani households have around 50p, Black Caribbean households have around 20p, and Black African and Bangladeshi households have around 10p. So those wealth inequalities have allowed some people to be protected, and others to be more exposed to what we know has happened during this cost-of-living crisis.

And austerity measures, those that saw cuts in public services as well as rolling back of some of the social security benefits, again, we know that the Women's Budget Group has just published a report on this, looking at the interactive nature of gender and race, and looked at how is that women of colour from Black Africa and from Bangladeshi communities had more taken away and have lost more as a result of austerity. So for us, the report and its focus on income and wealth inequalities is another asset to the conversation to really think about how do we address some of those things going forward.

Jennifer Dixon:

One of the things that might be surprising to some listeners is looking at the figure on life expectancy for different ethnic groups. And the group with the lowest life expectancy is the white population, for both men and women, which I think is probably counterintuitive to many listeners. And I wondered what you both made of that.

Heidi Safia Mirza:

I was really surprised by that. There's many surprises in this report, by the way. The life expectancy is lower for the white population than the ethnic minority groups, and yet COVID outcomes were much worse for the ethnic minority groups than the white groups. So you have all these contradictions. I don't know the reason. I do know that, in the health data that's in the report, that some of the comorbidities for the ethnic minority groups are higher around things like diabetes. We know this stuff. We have lots of ways of looking after ourselves in our communities, and that when we think about the health and the imposition of various ways of what is good health, the ways we should eat, the way we should live, when in the pandemic, lots of ethnic minorities and particularly Black groups did not want to take the vaccine, it was because we have our own ways communities, our own health ideas of what we should eat and what we should do.

And we have ways of looking after ourselves in our communities, and not looking after ourselves at the same time. And I think we need to be more cognizant sometimes of those sensitivities, instead of imposing what is really a white Western view of health and wellbeing. We need to listen to communities better about how they look after themselves. Maybe, yes, we might stay at home and eat too much sugar, Asian and Black people. But at the same time, maybe when we live in communities and we live together, we support each other more when we live in families, the large families in Bangladeshi and Pakistani communities, although they are very, very stressed with the lack of wages and employment and housing insecurity and so on. But at the same time, family and community actually does rise that boat of caring. This is what I mean about a holistic understanding of our communities.

Jennifer Dixon:

And Shabana, I'd be interested in your view, specifically on that point about the white population having the lowest life expectancy, lower than any other ethnic group, according to this figure.

Shabna Begum:

I think that's really interesting, and I think the need to drill down into some of this data is really important, because I think that what we'll find is, if we look at that data around life expectancy for white British population, you'll find it's significantly different whether you live in the North or North East versus the South. And so this kind of data is really important, because what it does is it exposes the kind of structural inequalities that we have across the country, and how they are shaped by geography, deprivation levels, where we live. And so it's really important that we are better at both getting that data in in a more granular way, so we can really look at what's happening. And I think the other part of that is also to think about quality of life, as well as life expectancy, and the number of years spent in good health versus in bad health. We know that it also has different outcomes in terms of minority ethnic groups. So again, I think there are so many things that this data raises that really should be at the heart of this new Labour government, really thinking about what are the inequalities, how are the systems structures, socioeconomic experiences that different groups experience underpinning these sometimes very, very poor health outcomes?

Jennifer Dixon:

So that leads us to the very last question, and that is the policy implications from this fascinating paper. What do you think are the top two or three takeaways for a new government, how they might address inequalities in race and ethnicity?

Heidi Safia Mirza:

Well, if you've got me in a room with Keir Starmer, though that's very unlikely, I would say to him, you have this dynamic, fabulous workforce, and they are living in poverty. They are struggling, they are young, they are full of hope, and you need to invest in them. And I would say the social mobility is a very striking part of this report, because no matter how much these communities are struggling and being beaten down, they love education, and they see this as the way in which they can advance. And that's the migrant story. It's always education, education, the mantra of our communities. But they are locked into poverty.

And I had the most amazing experience going up to Bradford and working with Leeds Trinity University. And I met people from the Born in Bradford project, and we were at a conference together, and Mon-Williams, who was academic lead in that project, gave an amazing paper looking at the conditions for Bangladeshis and Pakistanis in the North and in Bradford. There were simple things, like they've got a programme called Glasses for Classes, getting dentists into schools, because they realised that Bangladeshi young children weren't going into school because their teeth hurt, because they needed dental care. And it wasn't because they didn't want to go to school, it's because they were not well enough to go to school. And also they couldn't read because they needed glasses. So they brought opticians into the schools and they brought dentists into the schools to support the parents who don't even have £10 in their pocket.

So we're talking about extreme poverty and the consequences to those children's health. And because Born in Bradford works in such a way, they can connect across policy lines and get things done quickly, rather than going through central government and getting funding, which will take 5 years or whatever, they get it done immediately. Things like that, teeth, eyes, wellbeing in every single way. And then he was asked at the conference, ‘What is one thing that you would do?’ And he said, ‘Housing.’ He said, ‘Housing makes people sick. They're damp, they're cold, they're run down. And even new housing makes people sick.’ So housing and social mobility is what I would tell Keir Starmer to look at.

Jennifer Dixon:

Shabna, what would you say?

Shabna Begum:

There are lots of things that this government needs to do. The reports and its findings really tell us about the need to take that really holistic approach. I would talk about their mission approach to government and building an NHS fit for the future. And I think they need to work with bodies like the NHS Race Health Observatory, which is an independent expert body. I'm a member of the board. And that organisation really does the research to look at how to make the NHS work better, both for the workforce, but also in terms of the health care provision and experiences for Black and minority ethnic people. So I think that mission about an NHS fit for the future needs to be in conversation with expert bodies that are really looking at the racialised experience of the NHS. I think that we also need to see a really radical cross-governmental approach in terms of public health and that preventative agenda that Heidi was just outlining there.

And I think that sounds so big and it's so complex and it is, but I think we need to move towards building some consensus around what that public health approach needs to look like, and then designing the structure systems and the processes we need to deliver that. And that really needs to be done in conversation with experts. Health Foundation, I know you've done an incredible amount of work on the idea of the building blocks for health. There are lots of organisations like ourselves who are talking about those from the racialised perspective. That conversation about a public health approach. What that means, looking at structural inequalities from all of the different facets that are outlined in Heidi's report, are really important.

Jennifer Dixon:

So we must leave it there. Thank you so much to Heidi and Shabana. I hope you agree it was a very interesting conversation with lots of food for thought. I'm going to put in the show notes some of the links to what we were referred to. Certainly Heidi and Ross's paper that was the subject of today, but also some other work that's forthcoming, which is a report that the Health Foundation is doing with the Runnymede Trust that Shabana leads on ethnic inequality and the wider determinants of health, so watch out for that.

Do join us next month for our next podcast, and in the meantime, as ever, an enormous thanks to Sean and to Leo at the Health Foundation, to Paddy and his team at Malt Productions. And it's goodbye from me, Jennifer Dixon.