Read: Addressing health inequality: If not now, then when?
There has been a steady stream of research over the last few months which has highlighted the significant and persistent health inequalities experienced by people from ethnic minority backgrounds in the UK. That has culminated in a new report which shows that inequalities in these communities are evident at every life stage, from birth to death, across every aspect of healthcare.
The review, undertaken by the University of Manchester and commissioned by the NHS Race and Health Observatory, looked at academic research over a ten-year time span. It is seen as the first report of its kind to analyse all the evidence of ethnic health inequality through the lens of racism. It concludes that racism, racial discrimination, barriers to accessing healthcare and poor data collection have all had a negative impact on the health of people from ethnic minority backgrounds over a sustained period.
The review particularly focused on the differences relating to access, experiences and outcomes in mental healthcare, maternal and neonatal healthcare, digital access to healthcare, genetic testing and genomic medicine and the NHS workforce. There were differences between different ethnic minority groups, and some communities were found to have fared particularly badly but, in every area that was examined, ethnic health inequality was clear.
Some of the worst inequalities were found in mental healthcare and the support provision people received, with many delaying or avoiding seeking help due to their fear of racist treatment from NHS healthcare professionals. GPs were less likely to refer people from ethnic minority backgrounds to ‘talking therapies’ compared to white patients and, if they were referred, they were less likely to receive an assessment. The review also found persistent inequality in compulsory admission to psychiatric wards, particularly for those from the black communities, and in harsher treatment where they were more likely to be restrained or put in seclusion.
Shockingly, this inequality was replicated in young people, with one study showing that Black children were ten times more likely to be referred to Child and Adolescent Mental Health Services (CAMHS) by social services rather than their GPs, compared to white children.
The review also highlighted the poor experiences of women from ethnic minority backgrounds with respect to maternal healthcare, with evidence of stereotyping, discrimination and cultural insensitivity as well as poor access to translation services. It found that there had been little research into specific areas, including how outcomes differ for babies in neonatal healthcare settings. Despite the ten-year span of the review, only one study had investigated health disparities in the care of newborn babies with parents from ethnic minority groups.
There was also evidence of an ethnic pay gap affecting Black, Asian, Mixed and Other groups, and to a lesser extent Chinese staff, in the NHS workforce. This was combined with the negative impact of racism on careers and professional development. Leading doctors from ethnic minority groups have now added their voices to call for action following the review. Their concern has been compounded by a recent BMA study which showed that over 90% of Black and Asian doctors and medical students believe that racism in the medical profession is an issue, with over three quarters experiencing it at least once in the last two years and 17% experiencing it regularly.
The inequality in mortality that we saw in the pandemic reflects the inequality in health more generally, whether it is linked to the level of deprivation of a community, or where it is in the country. It certainly reflects the experience of ethnic minority groups. In his review Build Back Fairer, Professor Sir Michael Marmot examined the inequalities of COVID-19 on mortality. He also looked at our response to the pandemic and the impact this has had on social and economic inequalities, especially on mental and physical health. Marmot concluded that the cumulative occupational, living and environmental conditions, and the low incomes experienced by many ethnic minority groups were largely responsible for their disproportionately high mortality rates. He was also clear that, as a country it is vital that we seize this opportunity to do things differently and reimagine a better social and economic future.
There can be no effective recovery until we begin to address the structural barriers that exist which exclude large sections of our society from the opportunity that accompanies happy, healthy lives. Health equity should be at the heart of all policy making, involving government, stakeholders and local communities working collaboratively on decisions being taken on programmes and policies that will make a difference. The NHS’s core value is that everyone should be treated equally. The Race and Health Observatory review is clear evidence that the NHS is falling short on delivering that. These findings should be a tipping point for urgent action - so if not now, then when?
By Rt Hon Anne Milton