Type 1 diabetes is associated with higher plasma levels of biomarkers of neurodegeneration and neuroinflammation.

Racism is established as a determinant of physical and mental health, with significant associations that persist after adjusting for other characteristics. The pathways through which they act are increasingly understood, with structural discrimination seeping into the functioning of institutions and systems, including health systems, subsequently impacting on health. Structurally embedded discrimination perpetuates disparities in power, constraining access to resources and opportunities, which, in turn, cause health inequalities. In the UK, adults from minoritised ethnicities who have faced racial discrimination are more likely to experience limiting longstanding illness, poorer physical and mental functioning, greater psychological distress, worse life satisfaction and poor self-rated health, after adjusting for age, sex and socioeconomic factors including household income and education. The recent national review of child mortality shows one of the starkest examples of racial health inequalities. Reviewing data over the last five years, infants of Black Caribbean or Black African ethnicity were twice more likely to die than infants of White ethnicity. A report revealed that the average age of death for people with a learning disability who are from an ethnic minority background is 34 years, just over half the life expectancy of their White counterparts at 62 years of age, with the report highlighting potential factors influencing this, including poorer healthcare access, experience and outcomes. Racial bias, however, is not always about measurable health outcomes; it can be as simple as the language used to describe patients. A study that reviewed health records found that Black patients are more than twice as likely to receive negative descriptors, such as ‘resistant’ or ‘non-compliant’, compared to White patients. Although longstanding, these inequalities gained widespread attention during the COVID-19 pandemic due to its disproportionate impact on racially minoritised groups, alongside heightened awareness from the Black Lives Matter movement following the murder of George Floyd, exposing structural racism across UK institutions, with recognition that centuries of racial discrimination are hard-wired in the NHS. The Workforce Race Equality Standard (WRES) and, more recently, the Medical Workforce Race Equality Standard (MWRES) have revealed disparities in career progression, experience and opportunities for people from ethnically minoritised staff. The NHS Race and Health Observatory was also set up in 2021 to examine and tackle inequalities experienced by Black and ethnically minoritised patients, communities and staff. There has been a parallel push to improve equality, diversity and inclusion (EDI), but anti-racism differs by actively addressing racism through changes to systems, structures, policies, practices and power. As healthcare professionals, we must acknowledge the racist and discriminatory ideologies and practices that underlie modern medicine and ensure that future practice views the structures that underpin health systems through a critical lens, to enable us to provide the best quality care for all patients.