I went to the Black Health Inequalities Summit with a question I have been sitting with for a long time. The summit did not answer it. But it confirmed that every senior Black health leader in the country is asking it too.
On 20 April, over 1,200 people gathered at The Mermaid in London for the third annual summit, hosted by CAHN and London Inspire, under the theme Equity at the Centre of Systems Change. The keynotes included Prof Bola Owolabi CBE, Dr Lade Smith CBE, Prof Kevin Fenton CBE, Dr Paulette Hamilton MP and David Knott, among others.
What the Room Confirmed
As someone named Muhammed, growing up in South London alongside the communities this summit was built for, I know what shared struggle feels like. The discrimination is not the same. But the solidarity is real, because the structural pattern is the same: your race, your religion, your name become predeterminants for how you are treated. In my case, sometimes before anyone even saw me. Just from the name. The BHIS was a room where I recognised that shared experience, as someone who has grown up within and alongside these communities, spent five years tackling these inequalities at Centric Community Research, and who continues that work through Elysium London.
But what struck me was not just the solidarity. It was the analytical sharpness. Owolabi named frameworks without implementation. Smith showed the same failure in mental health. Knott asked whether we are even reaching the right communities. Every speaker arrived at the same diagnosis from a different vantage point. When that happens, the diagnosis is no longer in question. The question is what we do about it.
Across the day, the depth of leadership on display was striking. From clinical practice to public health to community organising, the summit showed a breadth of progress across the Black health equity space that deserves recognition. One example I want to highlight is the work of Dr Veline L’Esperance and the Black Health Legacy project at Queen Mary University of London. Their research identified that a common genetic variant, carried by one in seven Black men without their knowledge, leads to inaccurate results on the blood test used to diagnose type 2 diabetes across the NHS. A finding with real-world clinical impact, produced through community-engaged research in one of the most difficult trust environments in health.
Near the close of the summit, Oveta McInnis, Chair of the Enfield Caribbean Association, spoke about the critical work on the ground between public health and community. Ken Allen founded the ECA in 1986 from a Portacabin in Enfield. For nearly four decades it was run entirely by volunteers. Friday luncheon clubs for elderly residents, exercise classes for the over-50s, careers talks in schools, Black film nights that sell out every week. No national framework asked them to.
But across the keynotes, a harder question kept surfacing. The progress is real. The leadership is there. So why do the outcomes for Black communities remain the same?
Frameworks Without Legs
Prof Bola Owolabi CBE named it first. Core20PLUS5 was a national framework designed to force the question: who are your most deprived 20%, and what are you doing about it? She described it as an excuse remover and a place to start.
But the framework was not integrated into organisational culture or operational ways of working. It sat as a strategic layer above the day-to-day. A framework without legs.
The story she told shows why. A Black man needed to be checked for gene variants that could cause adverse reactions to chemotherapy. Prof Owolabi advocated for the test. It fell on deaf ears. He did not survive the treatment. The treatments existed. The evidence existed. The system did not act.
But this is not a story about a framework that failed. Core20PLUS5 has driven real outcomes. Expanded digital care plans for sickle cell patients. Gene-editing therapy access that was a first in Europe. Maternal health networks across eight integrated care systems. Owolabi has since moved to CQC, where she is embedding health equity into primary care inspection standards. The framework works. The system around it does not always follow.
Her challenge to the room: the next time someone presents data, ask them “so what?” What intervention is it going to create?
I see this pattern everywhere. The commitment is in the strategy document. The language is in the funding application. But the relational work, the accountability to communities, the people who stay when the funding cycle ends, is absent.
The framework has no legs because no one has built the ground for it to walk on.
Data Without Action
Dr Lade Smith CBE, President of the Royal College of Psychiatrists, brought the same directness to mental health. Black people are 3.5 times more likely to be detained than white people, often arriving via police rather than clinical pathways. The new Mental Health Act, with a ten-year implementation timeline, names no specific provisions for Black communities.
The barrier is not willingness. It is a system that has not earned trust. That does not meet people where they are. That intervenes too late with too little.
Her message was blunt: stop gaslighting the data. 80% of people who access the right treatments get better.
She has matched that bluntness with action. Under her presidency, RCPsych rolled out the Patient and Carer Race Equality Framework. It is now part of how CQC inspects mental health trusts. The Mental Health Act received Royal Assent in December 2025. The infrastructure is being built. The question is whether it will be built fast enough.
Working in Proximity to Harm
David Knott, CEO of the National Lottery Community Fund, shifted the frame to a question I raise in every PPIE engagement I advise on: where are we still working in capacity instead of proximity to harm?
In my experience, most organisations default to the communities they can already reach, not the communities most affected. The research gets done. The boxes get ticked. But the people living at the sharp end of mental health crisis, violence and economic deprivation remain on the periphery of processes designed to serve them.
Knott spoke about embedding lived experience alongside professional experience, and about acting at the pace the moment requires. That is proximity taken seriously.
And he is putting resource behind it. In October 2025, TNLCF launched a £50 million Health Inequities Partnership, selecting organisations with demonstrated track records of embedding communities with lived experience in decision-making. It is one of the clearest examples I have seen of a funder structuring accountability around proximity rather than capacity.
Closing the Gap
Prof Kevin Fenton closed the summit by naming the failure plainly. We do not lack evidence. We do not lack policy. What we lack is the infrastructure to translate what we know into what communities experience: accountability that survives the funding cycle, and translation work that bridges institutions and communities at scale.
From Dr Paulette Hamilton MP to Prof Patrick Vernon OBE to the community organisers who came without institutional backing, every voice in that room had arrived at the same place. The evidence is not the problem. The infrastructure is.
Fenton knows this. He has been placing community-centred researchers directly into public health teams through UCL’s Researchers in Residence programme. His office is building the infrastructure he described, with measurable outcomes attached.
Everyone I spoke to at that summit brought their own perspective on the problem and the work they are doing to close it. We know the gaps. We know the answers. The question is whether we close them.