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Br J Gen Pract. 2009 December 1; 59(569): 951.
PMCID: PMC2784542

Institutional ageism

The government's ready agreement to make ageism in the NHS illegal suggests a preference for a political gesture rather than a real commitment to improve services.1

Leading doctors involved in the care of the elderly claim that the poor quality of hospital care for older people is the result of ‘institutional discrimination’ in the NHS.2 In response Health Secretary Andy Burnham has announced that discrimination against older people will be covered by the new Equality Bill due to be introduced next year.1 But is this stand against ageism more a political gesture than a real commitment to improve services?

The popularity of the concept of ‘institutional discrimination’ stirred memories of a book I bought in 1968, which included an exposition of the politics of Black Power by the American activist Stokely Carmichael to a conference on ‘The Dialectics of Liberation’ at the Round House in Camden Town. Carmichael, a leading figure in the Black Panther Party, distinguished between ‘individual racism’, expressed in violent attacks upon black people, and ‘institutional racism’, which resulted from ‘the overall operation of established and respected forces in society’.3

More than 30 years later, Sir William Macpherson quoted Carmichael's definition of ‘institutional racism’ in his report on the death of the black teenager Stephen Lawrence in South London.4 But the content of this concept had undergone a fundamental transformation. Whereas Carmichael emphasised the pervasive effect of discrimination in law, employment, housing, and other areas of public life, Macpherson focused attention on the ‘canteen culture’ of the metropolitan police. For this elite barrister, racism was not — as it had been for Black Power activists — a political problem rooted in the state and the establishment, but an educational or psychological failing of individual police officers.

It is not surprising that Macpherson's concept of ‘institutional discrimination’ has proved popular. At a time when the official ideology of British society has shifted from racism to multiculturalism, anti-racist initiatives provide a source of legitimacy for authorities in all areas of civic life — including the police, the education system, local government, and sport. Blaming people at the lowest levels of the social hierarchy for racist attitudes allows the authorities to evade responsibility both for the explicit racism of the past and for persisting discrimination expressed in immigration legislation.

The ascendancy of a culture of victimhood means that any claim for recognition or resources, whether from an individual or a group, can be most effectively advanced by claiming the status of being a victim of abuse or discrimination. In taking up the slogan of ‘institutional discrimination’ voluntary groups claiming to represent older people are following the lead of anti-racist groups and those campaigning on behalf of people with mental illness and learning disabilities.5 For their part, ministers are only too happy to respond to demands for anti-discriminatory gestures: these cost nothing and allow them to posture as egalitarian and progressive.

The contrast between the responses of ‘established and respected forces in society’ to demands for action against ageism today and the Black Power challenge to ‘institutional racism’ in 1960s US is stark. Within 3 years of Carmichael's speech at the Round House, the Black Panthers were effectively wiped out: more than 30 were killed in shootouts with the police and the rest were either in prison or, like Carmichael himself, on the run.


1. Williams R. Equality bill takes aim at ‘institutional ageism’ in NHS. Guardian. 2009. 22 Oct: (accessed 16 Nov 2009)
2. Oliver D. Age based discrimination in health and social care services [editorial] BMJ. 2009;339 b3378. doi:10.1136/bmj.b3378. [PubMed]
3. Carmichael S. Black power. In: Cooper D, editor. The dialectics of liberation. London: Penguin; 1968.
4. The Stephen Lawrence Inquiry. Report of an inquiry by Sir William Macpherson of Cluny. (accessed 17 Nov 2009)

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners