Why do we need allies in healthcare?

The fact that social inequalities exist results in the need for allies and allyship, to ensure marginalised voices are heard and acted on. Unequal access to healthcare results in poor outcomes for marginalised groups. These groups already experience reduced power and privilege. When we look at the wheel of power of privilege, we see how far away they are from power. This can mean even when they advocate for change, they are not listened to by the dominant systems of power. As allies in healthcare we can work with them to elevate their voices and enact change together.

The World Health Organisation (WHO), defines health equity as:

“the absence of unfair, avoidable or irremediable differences among people, whether these groups are defined socially, economically demographically, geographically or by other dimensions of inequality. Social factors and norms shape the distribution of power and the availability and distribution of health resources”.

Covid 19 exacerbated health inequalities. Both physical and mental health consequences are being understood only now.

There is plenty of evidence of the impact on patients of poor behaviour.

• BMA reports show evidence of racism, LGBTQ+ phobia, sexism and sexual harassment in healthcare.
• There is evidence of the negative effect on clinicians including loss of confidence, leaving their profession or avoiding certain specialities.
• Patient outcomes are worse with reduced patient safety.
• We considered power and privilege in healthcare in Week 1 and detrimental effects of discrimination, bullying and harassment on patients and colleagues.
• A particular issue in healthcare is power imbalance, with evidence in reports where medical students and junior colleagues experienced the most abuse from senior colleagues and consultants.
• There is global evidence for lack of inclusion in many healthcare systems.

Sylk Sotto-Santiago explains the importance of equity and belonging (Sotto Santiago, 2023). As well as health equity, we need equity in teaching, to make the changes required in our organisations. This means recognising and adjusting for the fact everyone does not start from the same position. She also shows the importance of belonging, which is the experience of being accepted, included and valued.

Thinking back to our work on kindness, kinship and intelligent kindness earlier on this week, do you think belonging is an aspect of this?

The General Medical Council (GMC), in Good Medical Practice 2024 requires that doctors call out discrimination. This is explored in detail in Week 3 when we will look at a type of allyship – being an ‘active bystander’ (upstander in Canada and USA).

Structural competence

What is structural competence? It is how healthcare systems reflect racially diverse patients. This can include pathogenesis, hospitalisation and life chances.

In one example of structural competence, Dr John Frain, one of our course educators, in his book ‘Exploring symptoms’, (Frain 2025), starts each chapter with an explanation of the symptom and disease experience of patients from different ethnic communities, women, and those with LGBTQ+ backgrounds. Clinicians can then approach all their patients with confidence that they have better knowledge to interpret symptoms in marginalised groups, thereby improving equality.

In summary, we can see the evidence of inequality in healthcare. Poor health outcomes for marginalised groups are clear to see. Delivery of good healthcare is hampered by lack of inclusion for all healthcare workers. These problems need to be tackled in many ways at a global, international, national and local level. Allyship and active bystanding are one part of tackling health inequalities, and we will go on to discuss ways of teaching and embedding these principles in our workplaces and organisations.

References

Frain J. 2025. Exploring symptoms – an evidence-based approach to the patient history. Oxford: Wiley, 2023.

Sotto-Santiago S. Teaching equality, diversity and inclusion in healthcare. Chapter 13 in Imitaz-Umer S, Frain J. ABC of Equality, Diversity and inclusion in healthcare. Oxford: Wiley, 2023.