“Of all the forms of inequality, injustice in health care is the most shocking and inhumane”Martin luther king jr
Racism affects all aspects of life. Whether that’s in politics, education, entertainment, business, law, healthcare or any other field, racism intrinsically exists and will only ever create inequalities, inequities and injustice. No-one is born with racist ideas, it’s taught and integrated into the societies and systems we live and grow up in. But, we have been the given the ability to make our own judgements and understand right and wrong for ourselves. Black people face injustice and oppression disproportionate to other races and this is something we must acknowledge, speak up against and actively play a role in changing.
A lot of my research since undergrad and even in my PhD looks at racial disparities in health and it’s evident that Black and Minority Ethnic (BAME) groups face the worst health care and health outcomes in the UK and US. A number of factors play a role in this, but, at the core of it is racism and discrimination from which determinants like poverty, education, socioeconomic status etc stems. Working in the field of public health, it is devastating to witness such disparities in health, something which should be basic human rights for everyone! It is impossible to cover everything about racial disparities in health but I aim to cover a few important points focusing on access to health in the UK and provide some further reading resources for anyone who wants more of an insight.
Equitable access to healthcare and interventions is vital for tackling health inequalities between ethnic groups. Equitable access to healthcare and interventions should be timely, cost effective, appropriate and sensitive to the needs of each individual in society, regardless of race, socioeconomic status, age, gender etc. It means that everyone can access their healthcare needs easily and with confidence that they will be welcomed and treated with respect. However, differential access, experiences and outcomes have been documented between ethnic groups and a lot of this stems from structural racism.
Health literacy is lower among migrant and minority ethnic groups. This means vital health information lack the requirements and needs for ethnic minority groups to understand and be responsive towards. This can be in the form of language, accessibility or acknowledgement of unique needs. Poor health literacy leads to health inequalities in the use of preventative health services. An example of this is uptake of the national breast screening programme which saw the lowest rates of uptake among Bangladeshi and Black African women. There were no associations found with socioeconomic status so why is there this disparity? It comes down to the fact that healthcare services do not acknowledge and implement appropriate programmes for these ethnic minority groups. Language, stigma, cultural sensitivity are not implemented into programmes for these ethnic minority groups. Similar trends are seem in immunisation, smoking cessation and many more preventative health services.
Primary & secondary care services
Data shows that services for common mental disorders are less accessible to minority ethnic groups with evidence showing that Black people are more likely to be turned away when seeking mental health services, compared to White individuals. When it comes to satisfaction with primary care services, 45% of Pakistani and 37% of Bangladeshi respondents replied “no” when asked if they were able to book advance appointments with their GP. This compared to 24% of White people. Within hospital mental health services, minority ethnic groups face excessive restraint and medication leading to lower rates of recovery, particularly in Black groups. Black people with serious mental illness are more likely than other groups to come into contact with secondary care services through non-health agencies, in particular, the police.
All these, and many, disparities stem from the core of racism that exists within this country. Neglecting and ignoring these issues is racism. Just collecting data but not implementing real world changes is racism. Keeping black and minority ethnic groups at a disadvantage in society which prevents them from accessing adequate healthcare is racism.
There are so many more examples where BAME groups face inequities within healthcare. We have the data and evidence, however, there are lack of recommendations provided. For example, the recent COVID-19 report from Public Health England highlights the racial disparities, however, fails to give recommendations for what should actively happen to tackle these issues.
Senior leadership and policy. we need more members of BAME communities to be represented in senior roles in policy. There should be specific roles for individuals that understand the unique needs of BAME groups to form policies and interventions that directly address these needs. Without this representation, health services will always be tailored towards the White majority, when in fact, many of the times the needs are greater in BAME communities.
Involve leaders from different religious organisations. Religion plays a huge role in many BAME communities. Therefore, involving religious leaders into the formation of health services will make for more appropriate programmes. It will also increase the confidence within BAME groups to be able to approach and utilise these services as faith can be a big source of comfort for many individuals.
Strict monitoring and assessing of primary and secondary health care and their staff. Primary and secondary care facilities must undergo more strict monitoring by, for example, clinical care groups in how they enable equitable access and treatment for BAME individuals. Public should be involved in monitoring the effectiveness of these services making sure each ethnic group is represented equally. Services should be held accountable for their performance.
Education: Medical and healthcare students should be educated with the needs and characteristics of each ethnic group in mind. Diseases and conditions are often taught within a very narrow ethnic lens, for example Kawasaki disease which presents differently on darker skin, but is taught on predominantly lighter skin. This must be changed and the curriculum has to incorporate these changes.
Data collection and dissemination: In academia, research on BAME groups needs to, only increase, but be widely disseminated, with proper recommendations for healthcare and policy incorporated. We tend to see less articles get accepted if they are about minority ethnic groups and this discrimination in academia must stop. Data collected must be representative of the population we live in and be analysed and presented accordingly.
These are only a few recommendations that come to mind, however, there is so much more we can do to tackle racial disparities in health. I have listed a few resources below which provide more insight into racial inequalities. These resources encompass both UK and US information and provide useful knowledge on the different ways racism affects health and recommendations. Health is a basic human right, and every single human regardless of race has the right to access effective, cheap, timely and fair healthcare.
Local Action on health inequalities: understanding and reducing ethnic inequalities in health
Health Inequality Actually Is a “Black and White Issue”, Research Says
Racial and ethnic disparities in health care
Fixing health disparities requires ‘the right data,’ says UK doctor
Brilliant to see this issue highlighted. I have been delivering cross cultural safeguarding training in the North East for the last decade and we repeatedly see staff from health, housing, police and social care express a lack of knowledge from their core training on how to engage with BAME communities and have open and informed conversation about health issues and approaches to treatment. Rosa are a charity that will support initiatives in this area, especially in respect of women.
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Absolutely, it’s something that definitely needs more action and it’s great to see the work you’re doing!