Five Questions With…Professor Mala Rao

1. In your view, what is the significance of this report?

This report describes a landmark study by THET to examine the contribution of diaspora health staff to the UK NHS as well as to their countries of heritage. The UK has one of the highest proportions of internationally trained healthcare workers of any OECD country. For example, the reliance on doctors from overseas to help deliver NHS services has been so significant, that senior past political leaders have famously remarked that ‘the NHS would have collapsed if it had not been for the contribution of doctors from overseas’. Despite this, the level of diaspora engagement in global Health Partnerships remains disappointingly low. This report is the first to highlight the breadth of direct and indirect benefits which diaspora are capable of delivering to the NHS and their countries of origin, the structural barriers which have historically prevented their doing so, and how they could be ‘enabled, engaged and empowered’ to achieve their full potential and for the UK and its partner countries to benefit from this contribution.

2. The report highlights the need to view equality, diversity and inclusion as fundamental to leadership. What more needs to be done to support diaspora NHS staff to develop as leaders?

A Royal College of Physicians report published in 2020 entitled ‘Research for All? An analysis of clinical participation in research’ demonstrated how ethnic minority physicians ‘struggle to access research’, and highlighted the ‘culture’ in their employing organisations as an important barrier to their engagement in research. The ethnic minority respondents to this survey are likely to have included diaspora physicians. The report focuses on physicians, but it is likely that the findings would apply to the full range of diaspora staff. It reveals that NHS organisations and research institutions need to design and implement an ambitious action plan to nurture, support and offer more equity of opportunity to ethnic minority staff including diaspora, to develop their potential as leaders of global Health Partnerships.

3. What advice would you give to Health Partnerships who wish to become more diaspora inclusive?

This report sets out an ambitious but achievable set of recommendations for Health Partnerships, the NHS and HEE, as well as the Foreign, Commonwealth and Development Office and the Department of Health and Social Care in their important role as funders, to ‘enable, engage and empower diaspora NHS staff’ to maximise their engagement in Health Partnerships. To become more diaspora-inclusive, the Partnerships need to systematically develop action plans to implement these recommendations, and to demonstrate progress against targets which they set for themselves.

4. How can we better channel the expertise of diaspora NHS staff from ethnic minority backgrounds to address inequality in the NHS?

The disproportionate impact of the Covid-19 pandemic has laid bare the racism and discrimination which define the everyday lives of ethnic minority communities as well as diaspora health staff in the NHS. The exposure of these inequalities has also brought in its wake a determination in the NHS to address the structural barriers to race equality and a recognition that the journey has to begin by establishing the trust and confidence of the communities in NHS institutions. Diaspora staff have the cultural competence and knowledge to greatly strengthen the relationship between the UK ethnic minority communities and the NHS institutions. Furthermore, research evidence from the US has shown that racial concordance between physicians and patients is linked with greater trust in medical advice and consequently, was estimated to be able to reduce, for example, the cardiovascular mortality gap between black and white patients [1]. It has also highlighted that black medical students are more than twice as likely as white students to express a desire to care for ‘underserved communities of color’ [2]. These findings are likely to be generalisable to the UK, suggesting that ethnic minority staff, and diaspora NHS staff in particular, have the potential to make a substantial contribution to addressing inequality in the NHS, if given the opportunity to do so.

7. What do you hope will be the main outcome of the report?

It is my hope that the report will stimulate both the UK government and the NHS to recognise the significant value which diaspora can bring to advancing global health, and will stimulate them to develop and implement systematic action plans to transform the contribution of the diaspora to health improvement in the UK and their countries of heritage.

[1] Diagnosing and Treating Systemic Racism. Michele K. Evans, M.D., Lisa Rosenbaum, M.D., Debra Malina, Ph.D., Stephen Morrissey, Ph.D.,

[2] Bias, Black Lives, and Academic Medicine. David A. Ansell, M.D., M.P.H., and Edwin K. McDonald, M.D. February 18, 2015DOI: 10.1056/NEJMp1500832