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Gavin: Hello and welcome to the Lancet Voice. I'm Gavin Cleaver and I'm here as ever with my co host Jessamy Baganal. It's July 2022 and it's also South Asian Heritage Month here in the UK. The month runs from July 18th every year, which is the date in 1947 that the Indian Independence Act gained Royal Ascent from King George The sixth and the month seeks to commemorate to Mark and celebrate South Asian cultures, histories, and communities to talk about South Asian Heritage Month, what it means, and about South Asian culture in the uk.
Member of the Lancet Voice editorial team, Mandeep Alula. Spoke with Benita Kane, co-founder of South Asian Heritage Month. Dr. Cain is a consultant respiratory physician in Manchester and a member of Independent SAGE, an independent group offering advice on the COVID pandemic here in the UK.
Mandip: So hi Benita and thank you for joining this episode of The Lancet Voice. Hi, thank you so much for having me. So South Asian Heritage Month is now in its third year, and this year marks the 75th anniversary of the partition of India, and 50 years since South Asians were expelled from Uganda. In 2017, you featured in a BBC documentary series, My Family, Partition and Me, which was part of a season commemorating the 70th anniversary of the partition.
Can you tell us about that experience and how you later came to co founding South Asian Heritage Month?
Binita: Thank you. Yes, gosh, it seems like a long time ago now, 2017, but I, this, this opportunity just landed on my lap to take part in this BBC documentary. And it was, what they did was they took second and third generation Asians.
back to retrace their family history and and walk in the footsteps of their families at the time of partition. So I was the first member of my family in 70 years to go back to what is now Bangladesh, but was then. East Bengal and and relive what my family went through. And it was quite incredible because I knew my dad's story on an individual basis, but I don't think I'd ever realized that wider context of partition, what a huge event in history it was, you know, biggest forced migration of humans.
ever known. And the fact that the British had, had such a central role and, and, and then when I discovered the, the timeline of events, it's really quite astonishing how quickly this all happened and, and how the impact of those decisions that were made in 1947 still reverberate around the world. To this very day, and it was just such a revelation when I came back the, the program aired.
The, the British public were very much of that same astonishment of like, Gosh, I don't, didn't really know anything about partition, never heard of it, never taught in schools. And that led me on to starting a campaign around commemoration. I thought, look, there's all these hundreds of thousands, potentially a couple of million people who died in the aftermath of partition, including my grandfather.
And there is not even a plaque. There is nothing to commemorate these folk. So I started that campaign about partition commemoration day, and then also set up a group that was looking at education and how we incorporate. the teaching into the school curriculum and we teach the next generation about British, very British history.
And then I teamed up with Jasvir Singh, who's the other co founder in 2018 and over a cup of chai, we, we came up with the concept of South Asian Heritage Month, which then brings in the celebration element. So our strapline is celebrate, commemorate, educate and the rest is history really.
Mandip: So, what's the significance of the dates?
It begins on the 18th of July and it ends on the 17th of August. Can you just tell listeners what those dates mean? Yes, we, we,
Binita: it does raise a few eyebrows because people say, Gosh, those are really random dates. And we did go round in circles a lot about what the dates would be, especially as the majority of the month falls in the school and university holidays, which isn't ideal.
However, they are very, very British dates. So the, the 18th of July was when King George VI assent to the division of the subcontinent and the 17th of August is when Sir Cyril Radcliffe's lines were published and people knew where the borders for Eastern West Pakistan would be and what side of that border people would, would be living on.
And then when you think about the initial announcement that Partition was going to happen by Lord Mountbatten was only the 3rd of June, I think it just really illustrated to us that timeline of Partition. And so that's why we chose those dates, because the month is really about British and South Asian relations and, and being British South Asians and, and reclaiming our identity.
And we thought that was fitting that we would have dates that had such significance.
Mandip: So this year's theme is Journeys of Empire and the 1948 British Nationality Act recognized the rights of citizens of the colonies. to come and work in Britain, and many went on to join institutions like the NHS. The NHS workforce remains diverse today, I think with Asians making up about 30 percent of the medical staff.
But there have been reports of racial discrimination in the organisation. Can you tell us about your experience as a British South Asian consultant?
Binita: First thing I would say is, Again, this was massive history that I just was unaware of, that all those waves of migration after partition and how many people were recruited from the, the, the subcontinent to come and work here.
And I believe at one stage in the 1960s, between 30 and 40 percent of all doctors in the NHS were from South Asia and the legacy lives on in people like me. And my father was, was one of those came here as a British citizen, two out of the three offspring have become doctors as well. So we, we, we continue to, to prop up the NHS.
workforce. And again, I hadn't quite realized the impact of that. And I think people like my dad who came in the 1960s really have paved the way for an easier life for us. He faced quite abject racism when he first came on. It was just the accepted norm. at the time, and, and despite that, he managed to progress very, very successfully in his career, but it was, it was despite that not because he was enabled, and at that time, of course he was advised that he should go and work in, in North Wales, and they were not encouraged to work in the big teaching hospitals and the, the, the kind of, the professorial academic units.
and sort of were sent off to what they would call the Cinderella specialties. And that went on for a long time. I think from my own perspective as a South Asian woman who has made my way through the NHS, my experience has been very much easier than my father's. But I just think you just have to work that little bit harder to get the same.
recognition. And again, it just is, is, is the norm. And I think because I'm used to it, I don't really think about it an awful lot. I can't say I've suffered overt racism, maybe only once or twice in my career, but I would say I still do face microaggressions, unconscious bias, and sort of discrimination on a much more subtle level than my father would have, for example, where it was much more overt.
So things are improving, but of course we know from the BMA surveys, from Res, that there's an awfully long way to go and there's still a huge amount of institutional racism that needs tackling.
Mandip: So going a bit further, how do you think, say, Britain's colonial history affects health outcomes today?
Binita: This is something that really fascinates me as, as again, I've been on this real journey of discovery over the last six years.
I think it hugely impacts on our health inequalities and the pandemic has really laid that bare in a way that we haven't seen before. If you look at who is disproportionately impacted by COVID, it's been people who are black and brown. The reasons for that are quite complex and multi layered. But one of the reasons would be the hangover from our colonial past where people from the South Asian subcontinent, from commonwealth countries, came and took jobs which there were huge workforce gaps in, like factories, like the lower paid, more menial jobs often.
And you have more people of colour living in poverty, perhaps living in areas where there's high levels of air pollution, and that feeds into poor diet, they're often public facing jobs, and all of those social determinants of health lead to poorer outcomes. And then when you look at structural problems and institutional racism across multiple different industries and organizations that stops people of color from progressing in, themselves out of that situation.
It's a perfect storm. So, so it's cultural, it's political, it's societal. And I think when you scratch under the surface and go deeper into it, a lot of it, you know, if not all of it, harks back to our imperial past.
Mandip: So you're also a member of Independent SAGE and an advocate for kids living with long COVID.
Can you tell us a bit more about your work in that area? We're seeing a lot of A high number of cases of COVID in the UK at the moment, aren't we?
Binita: Yes, I wish I wasn't an advocate for children with long COVID in many ways because it's come from my personal experience of having a daughter who has long COVID.
So she's been ill since January 2020. 21 and it's had quite a devastating impact on her life and our life as a family. Her school attendance has been was about 20 percent for the whole of last year and it's only recently where we've actually gone abroad and, and sort of help that her condition started to improve.
So I have become an advocate for people, I think, with long COVID in general, but post viral illnesses like ME CFS. I'm terribly worried about what's happening at the moment. We've got uncontrolled spread of COVID. We've got people having infection after infection after infection. And there's now thousands of publications about the detrimental impact of the virus.
Both on an individual basis, but our population health basis where we're seeing increased incidents of heart attacks, strokes, kidney disease, diabetes, you name it, the risks if you've had COVID are worse than if you haven't had COVID. COVID and I don't think we're going to see the impact of this for a number of years to come, particularly in children.
So I am worried about it. There is, there's very little focus on it. We seem to have hospitalizations as deaths as an end point for all the decisions we're making. about the pandemic and, and even, you know, even that's not great because we're still seeing high numbers of hospitalizations. We're still seeing deaths and actually there's been so much disruption to healthcare because of COVID and sickness.
With the uncontrolled spread, the backlogs are just getting bigger and bigger. I'm really disappointed at the moment that we have no public health messaging whatsoever. Our leaders seem to have thrown all caution to the wind. And in Dependents Age we're doing what we can to try and raise awareness of these risks.
As I say, I wish I didn't have to do that role. But, It's become a sad necessity.
Mandip: So finally, I'm going to take it back to South Asian Heritage Month now. You mentioned the strapline is Celebrate, Commemorate and Educate. Thinking about education, what would you like people to take away from this month's events?
Binita: In a similar vein to what I've just said, I wish there was no need for South Asian Heritage Month to exist because actually people would celebrate our heritage. We would have a country that was educated about why South Asians are here. I think if people can learn one thing from the month that they didn't know before, then that's a good result for me.
And it's just as much for the wider population as it is for South Asians ourselves. And I think if people can can learn a little bit about history or understand a little bit more about their neighbor's life, why there's a South Asian family next door. That, for me, is a good result. And this is a long term project.
South Asian Heritage Month is here to stay until the point where we, you know, we don't need to exist anymore. I just hope people engage with it and get involved. There's lots and lots and lots of stuff going on. And so if you want to find out more, you can go to our website, which is southasianheritage.
org. uk and there's plenty of information on there about the events and what's going on.
Mandip: Oh, great. Well, thank you so much, Bonita. That was a really interesting conversation. Thanks for having me.
Gavin: Thank you to Mandeep and thank you to Benita for such a fascinating chat. Mandeep was until recently the co chair of GRACE, which is the Group for Racial Equality, a task force of employees here at The Lancet, which meets to address anti racism work across The Lancet journals. Following two years running GRACE with co chair Pamela Das, Mandeep and Pam have stepped down from their roles to be replaced by Diana Samuel and Asal Golshahi.
So Jess, me and I are very pleased to be joined by Diana and Asel now to discuss the work of Grace and what the future holds. Diana, Asel, thanks so much for speaking with us. Why don't we start by you telling us a little bit about your backgrounds and kind of what anti racism work means to you.
Diana: Yes, I can, I can go first.
So my name's Diana Samuel. I'm a senior editor for the Lancet Digital Health. And I'm second generation Indian, born and raised in London. I have a background in biomechanics and moved into publishing in 2017 and started my current role here in January 2020. I think I learned quite early on that publishing is very much lacking.
In racial and ethnic diversity. I'd often attend university campus events and conferences and I'd have opportunities to meet people who worked in publishing, but I didn't meet an editor who looked like me. And not long after joining the Lancet Digital Health, I looked around the office one day and noted how much I But after early conversations with some of my colleagues, I, to some extent, felt comforted to know that I wasn't alone in feeling that way.
Really, being able to talk to someone about that and share your experiences, it makes it much less isolating. I attended an external meeting where someone commented that a journal should reflect its readership. And that really struck a chord with me and I truly believe representation is vital at all levels, from the content a journal publishes, to the authors it commissions articles from to the editors and other staff steering and shaping the journal's scope and future.
So that was really my my motivation for joining G. R. A. C. E.
Asal: So, I'm Asar Golshoe, and I'm an Editorial Assistant at The Lancet, and I've been here for almost three years now in the Journal Office team. Before G. R. A. C. E. and my role at The Lancet, I had been, and still am, on the Diversity and Inclusion Committee of iGEM.
a synthetic biology education non profit as a volunteer and that was very globally focused. So I've, I've learned some things through that. And by October, 2020, once I felt like I could commit the time, I thought I could bring some of that experience to grace. And I was interested in engaging on and learning about race and ethnicity related.
EDI issues with my colleagues across departments. It was a way of forming some sense of community in the lockdown and also just learning more about my colleagues and kind of just, yeah, just having a space where we could talk to each other. So in terms of backgrounds. So I'm first generation Iranian and I've been to about six different schools.
And so one thing I realized is that schools, Scotland and England had like very different environments, I guess, like my first experience in an office environment was. It's in a high street solicitors firm that was run almost wholly by, by black men and women and had been it had won like local like Nigerian business awards and which seemed really unremarkable to me at the time, but I was in a bubble and for a while I just thought London was a super diverse place and that diversity would be reflected in all workplaces, which isn't.
Which, you know, isn't as true as we'd like it to be. For me, engaging with diversity and inclusion issues in general is ultimately about caring about people, listening to people when they offer pieces of their thoughts, and experiences that are different to yours. And trying not to hurt people and trying to understand it when people hurt me.
And I think Grace definitely offers a platform for that. It offers a space where we can all do that.
Gavin: Dana, Asal, you're taking over Grace as the new chair. It's been, it's been going for two years so far at The Lancet. What does it mean to both of you to be, to be leading this group now?
Diana: I mean, it's, it's an absolute honor.
I feel, incredibly proud just to even be a part of this group but also about all we've accomplished these past two years and I'm really looking forward to achieving more in the future. As I mentioned, you know, the Lancet group as a whole is not very racially diverse, but, you know, I'm proud that the Lancet has taken a strong stand in this area such as through the diversity pledge and they very much embrace the need for change, but I now have the opportunity to play a bigger part in effecting that change, and that's That's definitely not a, a responsibility I take lightly.
Asal: Yeah, I, I agree it's a, it's definitely a huge honor and enjoying hitting the ground running. Grace is made up of a great group of people, which Pam and Mandeep have done the hard work of setting up. And it's amazing to be a part of that to help push things forward and to advocate for them.
That said, I feel like every single member makes Grace What It Is more than individual leaders. And we're lucky to be leading a group of enthusiastic, hard working people with lots of ideas and initiative.
Gavin: We've talked about Grace on to Pam and Mandeep's leadership over the last two years and we talked to Pam and Mandeep on this podcast before but that was kind of at the beginning when the group had just been formed.
How important do you think this organization within the Lancet has become over the last couple of years?
Diana: Personally I think it's incredibly important, first and foremost for its members. You know, a group like this is, it's something that I think so many of us have been waiting for. It's a safe space for our members to speak openly and freely about our lived experiences.
ethnic minorities to share our thoughts on inclusion and diversity within publishing more broadly. And also any concerns or ideas we have regarding the Lancet's editorial processes the content we handle and also the composition of our, our workforce. But I also see grace as a kind of a reckoning and a symbol and driver for change.
And tangentially, I also think Grace has been, as, as Asal has said, a great source of connection. You know, it came into being in, in mid 2020, so not long after the start of the COVID 19 pandemic, and whilst we were working from home, and whilst I myself was still fairly new to the Lancet family.
So, being a part of this group and, and getting to know all of these wonderful, inspiring members has been a truly, a truly wholesome experience for me.
Asal: Yeah, I I definitely agree with Diana. I think grace is definitely important for its members. First as a space to share thoughts and experiences without judgment, and also for the Lancet as a space to advocate for change, both within the Lancet workforce and in the content that we publish what I love is how enthusiasm and ideas are embraced in grace, no matter who or where they come from.
And there is very thoughtful engagement from members in meetings, over teams, over emails whatever works for each member. We kind of try and adapt to each other and we listen to each other and people are so respectful and appreciative of each other's ideas all the way across. the hierarchy in all directions.
Across the Lancet, there's been more proactive thinking about how people from different backgrounds will perceive certain content and more acknowledgement that we don't all think the same and are shaped by our experiences as well as our knowledge and skills.
Jessamy: That's great guys. Thanks so much. And I mean, you have kind of covered it a little bit, but if we were to just really focus in what change you think has happened over the last couple of years.
at an organization level. Are there things that you can pinpoint? I mean, obviously recognizing that these things are slow, but, you know, what, what, what would you say are the major, major changes, the tangible things that you can highlight?
Asal: Yeah, I definitely agree that diversity and inclusion work is a slow process.
And I think there's been sustained engagement from the senior management team and the wider Lancet group in our projects wanting updates along the way and listening and long after trends have faded, which has been encouraging. There have been some training that colleagues have found useful.
A lot of journals are also conscious of having greater ethnic and racial diversity on their advisory boards and some have set goals. Our manuscript copy editing team have made an inclusive language guide which is a living changing document that they've been using over the past couple of years. Our comms team made an inclusive image guide that editors use for the margin images in our journal issues.
Our production team and the Lancet Global Health team have taken part in the Elsevier Rising Tide internship program to improve racial and ethnic diversity of qualified candidates. And yeah, generally we've also been marking events and I think people feel comfortable sharing that side of themselves.
Yeah, whether it's impactful though, it's hard to say. And the, sadly, the lack of ethnic and racial diversity among editors hasn't changed substantially. So definitely in terms of systemic changes, there's a long way to go, but then grace didn't exist before 2020 and the gender task force hasn't existed for long either.
So there's already a lot in terms of. being an established group.
Diana: Yeah, I agree with with everything Asal said, and I also think Grace's has helped to keep the Lancet group accountable and it's really helping to turn the Lancet group's diversity pledge into action. You know, we're making more concerted efforts to strive for greater diversity in our international advisory board members, our peer reviewers.
Our authors have commissioned articles and so forth. Authors of research articles are being asked to report data on participant race and ethnicity. And When these data are skewed or unavailable, we ask that they acknowledge this as a limitation and consider the impact this may have on the generalizability of the findings.
One of our journals, eClinical Medicine, launched an article collection on racial inequity in health in June 2021. with the second part of the collection going live in March of this year. And the Lancet itself actually announced a call for papers for a theme issue on advancing racial and ethnic equity in science, medicine and health, which will launch either later this year or early next year.
So there's definitely been some some profound changes. And at an Elsevier wide level as well Asal's already covered quite a few things, but another thing that launched recently was a talent program specifically for employees who identify as minorities. The goal being to, strengthen the minority talent pool by giving them the tools they need to advance their career, which I think will hopefully lead to changes in terms of creating greater equity among senior leadership in the future.
Jessamy: That's a super comprehensive answer. Thanks so much for that. And I guess what you're sort of, you know, what you've very nicely highlighted is that. Change can happen both internally through editorial processes and the way that we advise and what we request from authors, but also externally in what we publish, you know, raising attention to this in special issues and theme issues, call for papers.
What would you like to see over the next couple of years as? in an ideal world as, as, as more tangible steps, you know, going further, both internally in terms of our editorial processes and externally in terms of the content that we publish and, and making sure that we're, you know, at the very cutting edge of, of this sort of intersection between race and health.
Diana: Yeah. So I think at this juncture, obviously with Sal and I now taking on the position of, of co chairs of Grace. I mean, for starters, we definitely have some Very big shoes to fill. Pam and Mandeep did a fantastic job co chairing Grace these past two years and have been really inspiring and courageous leaders.
I think now is a great time for us to reflect on the past two years, you know, revisit the list of goals we set ourselves, which I think were also outlined in the comment that we published shortly after Grace was formed. Take stock of what we've accomplished. What we still need to work towards and what new goals we can set for ourselves.
So basically create a roadmap for the future. One thing we're hoping to do going forwards is is to collaborate with the Lancet's gender and diversity task force because we have some, some shared goals. And we're also looking forward to working towards greater representation in senior leadership, greater diversity among research participants and data sets.
More journal content that explicitly explores the impact of racism on people's health and their healthcare experience just to name a few. And particularly with the Lancet's 200th anniversary approaching, it's, it's really important to take a look back at our history, you know, what we got right, what we did wrong and what we need to change going forward.
I think it's also an opportunity to celebrate, you know, to two years ago, as much as I, I wanted it to be, I didn't think a group like grace would ever exist. And the fact that it does, to me, that's a solid acknowledgement that our voices are our opinions and our expertise matter. And I'm also very aware that, you know, I'm standing on the shoulders of those who, who came before me, you know, people who fought for racial justice and laid the foundations for us and be it through small or big changes.
I hope that Grace can help do the same for future generations.
Asal: I couldn't have put it better. I would love to see Grace work with other groups to consider certain issues through an intersectional lens. And I'd just like to see more psychological safety within the Lancet group, beyond Grace. Which I think will improve both the working environment for everyone and the content you publish.
And we've started piloting this in the comms team, which is great. It's amazing. And I'd love to see this expand across the whole of the Lancet.
Jessamy: And then just one final quick one for me that's off the cuff that you might, you know, not want to answer. But, I mean, looking around, not only at other journals, but at other organisations, are there examples and, you know, things that are being done that you think, oh, I wish we were doing that, or isn't that a great idea?
Diana: We've discussed this actually among the group previously, that We may want to consider something akin to Cell Press's inclusion and diversity statement, which for those who don't know, is a brief optional author statement that appears in the published article and it's generated based on authors responses to a form, and it highlights aspects of the study design or authorship.
Or both, that are relevant to inclusion and diversity. So, things like whether they ensured gender balance in the recruitment of research participants and if one or more of the authors identifies as an underrepresented ethnic minority in science. And it, it provides something that we really need in this space, which is data.
So, you can do analyses to see, for instance, what percentage of accepted articles. That circulated surveys to participants, made an effort to ensure those surveys were prepared and distributed in an inclusive way. So that's, that's one idea to revisit.
Asal: I definitely agree with Diana. I think that's really insightful.
I would also add that many companies, including in scientific publishing, have started funding paid equity, diversity, and inclusion teams and putting more resources into EDI strategies, especially improving recruitment and retention of staff from ethnic minority backgrounds. And it's definitely an area that Pam and Mandeep also care a lot about over time.
I hope to see the Lancet put more resources into this.
Gavin: That's it for this episode of the Lancet voice. If you want to carry on the conversation, you can find Jessamy and I on Twitter on our handles at Gavin Cleaver and at Jessamy Baganal. You can subscribe to the Lancet voice if you're not already, wherever you usually get your podcasts. And if you're a specialist in a particular field, why not check out our In Conversation With series of podcasts tied to each of the Lancet specialty journals, where we look in depth at one new article per month.
Thanks so much for listening and we'll see you again next time.