Systemic: How Racism Harms Health – and What We Can Do About It by Layal Liverpool

Jill Parker, our Head of Operations at Gloucestershire VCSE Alliance, reviews Systemic. Jill’s background is in consultancy to VCSE sector organisations, with a particular focus on turning national policy into practice and coproducing initiatives that address health inequalities

In Systemic, Layal Liverpool investigates how deeply rooted racism impacts on health. Through accessible science and powerful personal stories, she exposes both the scale of the problem and its human cost.

The result is a book that is both shocking and inspiring. Liverpool’s interweaving of data and personal testimonies brings the research to life: readers are drawn into the broader structural picture while remaining grounded in the stories of individuals. These narratives give the book its urgency and humanity. Importantly, Systemic does not stop at diagnosis. It concludes with a set of practical solutions that could lead towards a healthier and more equitable world.

Liverpool challenges the way race itself has been portrayed as the major driver of unequal health outcomes. Instead, she makes a compelling case that systemic racism is the true cause. Our race and ethnicity have a profound effect on our health, starting with the moment we are born and persisting across the course of our lives. Racial and ethnic disparities in health are longstanding and worldwide. However, they also exist within nations, including here in the UK.

In England and Wales, infant mortality rates for Pakistani, Black Caribbean and Black African babies are around twice those of White British babies. Black British women are four times more likely than White women to die during pregnancy and childbirth. Black and Asian people in England wait longer for a cancer diagnosis than White people. These figures underscore how inequality is embedded within healthcare systems themselves.

Yet Liverpool is clear that inequalities are not confined to health care, but pervade the wider social determinants of health, such as socioeconomic status, employment, housing and access to clean air and green spaces. Prior to the Covid-19 pandemic, 43% of Black households in the UK were living in persistent poverty, compared with 19% of White households. Lower income is closely linked to poorer health and increased vulnerability to disease. During the pandemic, racially minoritised people were more likely to work in “essential” roles that could not be done from home, increasing their exposure to the virus. These jobs were often poorly paid, reinforcing a vicious cycle of inequality.

‘A deeper understanding of inequality, Liverpool argues, is a crucial step towards creating healthier places to live’

The environments in which people live also play a decisive role in shaping health. In the UK, people from marginalised racial or ethnic groups and those on lower incomes are more likely to live in “food deserts”, where access to healthy food is limited, or “food swamps”, where unhealthy options dominate. Disparities also exist in access to green spaces. Areas with fewer than 2% racially or ethnically minoritised residents have, on average, six times as many parks as areas where these communities make up more than 40% of the population. Even the air we breathe is unequal: exposure to harmful air pollution is disproportionately borne by marginalised communities.

Having convincingly argued that it is time to stop pathologising race and instead recognise racism as the disease, Liverpool concludes that health inequalities are not inevitable. The better we understand how racism is embedded in our systems, the better equipped we are to dismantle it. Identifying gaps in data can help set priorities for research funding, while policies that tackle wider social inequalities can address the root causes of poor health.

She highlights concrete examples of action. For example, in the UK, “Ella’s Law” is being championed by a cross-party group of London MPs to enshrine clean air as a human right. The bill is named in memory of nine-year-old Ella Adoo-Kissi-Debrah, the first person to have air pollution formally recorded as a cause of death.

Ultimately, Systemic reminds us that change is not solely the responsibility of governments or institutions. One thing all of us can do is to listen better. This isn’t just about clinicians listening to patients, but it’s about all of us listening to how racism shapes the daily lives of people in our communities, workplaces and families. A deeper understanding of inequality, Liverpool argues, is a crucial step towards creating healthier places to live.

For Gloucestershire, as for everywhere else, that understanding could make the difference between entrenched disparity and working together to create a fairer, healthier county for everyone.