Medical Scepticism as Institutional Feedback

Why are Black communities in Britain sceptical about healthcare, and what does that scepticism tell us about healthcare rather than about the people expressing it?

Over the course of the pandemic, Britain's problem with health inequality finally received widespread attention. People from Black and Asian ethnic groups were disproportionately affected by Covid-19, and public health interventions fractured along racial lines. Relatively high rates of vaccine hesitancy among some Black communities exposed pre-existing problems with healthcare access in the UK, and a past and present of institutionalised racism.

The project started from the position that there are good historical and contemporary reasons why Black communities in Britain might be sceptical about healthcare. It set out to challenge the assumption that people hesitant about vaccines are irrational, illogical or prone to conspiratorial thinking. Scepticism was treated not as a reflection of individual flaws but as a measure of how well healthcare works.

Brixton, in south London. A culturally diverse community whose residents have roots in Trinidad, Jamaica, Nigeria, Somalia, Eritrea, the Congo and elsewhere. It is also a sceptical and activist community, a rich counter-public space for reasons both specific to this urban locale and reflective of the wider history of racism and inequality in the UK. Mainstream healthcare is not automatically or uniformly taken up here, and there is a long history of health activism and of alternatives to formal healthcare structures.

The community researchers. They kept the project team updated on their findings, but they retained ownership of the data and the outputs. The active research was carried out independently of the academic team.

The project set out to model a way of researching health scepticism in which the sceptic and their community remain at the centre. Rather than studying a community in order to change it, the work brought sceptical and activist voices into the mainstream to ask what they reveal about where healthcare has gone wrong, how it has failed the communities it serves, and why it has produced distrust rather than confidence.

Community members were equipped with the skills to conduct research for and with their own community. They were trained in policymaking, news media engagement, how healthcare systems currently function, and historical research methodologies.

They then carried out the research independently.

At the end of the pilot, the same community researchers returned to upskill the project team and its audiences: healthcare professionals, journalists and policymakers. The training ran in both directions.

Being positioned in and of the community meant the research could reach cultural nuance, and could include the people conventionally described as hard to reach, whose voices are not normally accessed by those in the mainstream. Being for the community meant safeguarding it from the sometimes predatory data extraction practices of even well meaning researchers, and making sure the findings stayed relevant, meaningful and local to the community itself.