Following a government report into racial and ethnic disparities in the UK published in March 2021, the NHS Race and Health Observatory has published a follow-up review on ethnic inequalities in healthcare. The original report was met with criticism as it failed in the most part to acknowledge the longstanding injustices faced by minority ethnic people in the UK.
The new review, published on 14 February this year, collates evidence on ethnic inequalities in the following five broad categories:
- Mental health services
- Maternal and neonatal healthcare
- Digital inclusion and access to health services
- Genetic testing and genomic medicine studies
- NHS workforce
Inequality in access to, and delivery of healthcare, was found across the board, either in the form of evidence or, equally troubling, in the absence of evidence, where data on the experiences and outcomes of minority ethnic patients had never been gathered.
Mental health services
The experiences of minority ethnic people accessing mental healthcare are characterised by distrust and a well-founded fear of discrimination and its devastating consequences. Findings were as follows:
- Barriers were experienced to accessing mental health services in the form of distrust, fear of discrimination and a lack of appropriate interpreting services.
- The review found “large and persisting” inequalities in compulsory admissions to psychiatric facilities, particularly amongst Black, mixed Black and white, and South Asian people.
- Black patients were more likely to face harsher treatment whilst in these facilities, such as being restrained and put into seclusion.
- Many of these troubling findings were reflected in the mental healthcare experienced by younger populations, highlighting that the problem is not improving.
The review noted that it had less evidence from some minority ethnic groups, which may serve to highlight the distrust and lack of engagement due to barriers in access to services that these groups experience.
Maternal and neonatal healthcare
The situation was no better for new mothers and their babies:
- A lack of appropriate interpreting services was also an issue in providing good maternal and postnatal care, as well as a lack of trusting and positive relationships between women and their healthcare providers.
- Minority ethnic patients experienced stereotyping, disrespect, discrimination, and cultural insensitivity. Of course, these shortcomings only further reinforce the distrust and fear many women may face when trying to access healthcare for themselves and their babies.
- The review again noted the lack of data regarding ethnic inequalities in the access to, and receipt of, some services such as caesarean deliveries, breastfeeding support, and antenatal appointments.
This section of the report also points out the lack of specifically community-based support for new parents from minority ethnic backgrounds.
It also highlights the importance of intersectionality. This is the concept that everyone has a unique experience of discrimination or oppression, and multiple factors such as a person’s ethnic origin, as well as their social status, employment status, and sexual orientation (amongst many others) will all play a part in what this experience is.
This is an important reminder that ‘ethnic minority’ people are not a homogenous group, but individuals with multiple confounders outside of their ethnic origin affecting their lived experiences. Within this data, it means acknowledging all the factors that might impact on a woman’s equality of care, in addition to her minoritized ethnic background, such as also being an asylum seeker or a young mother.
Digital inclusion and access to health services
The review again cites a lack of research in this area and is therefore unable to draw many conclusions. However, the recurring themes of a lack of availability of resources in languages other than English, and a mistrust of the intended use of data are present here.
Genetic testing and genomic medicine studies
Minority ethnic people were not well represented in large genomic wide association studies. Many only used ‘European ancestry’ participants, despite the fact that cohorts with a greater range of ethnicities may give a greater predictive power across ethnic groups and would therefore be very valuable.
NHS workforce
We already know that minority ethnic individuals face worse health outcomes in relation to the Covid-19 pandemic. The review states that this is also the case for NHS staff from these backgrounds:
- Adequate access to PPE was lower in minority ethnic staff members, and the pandemic had a greater negative effect on their mental health.
- Minority ethnic staff as a whole faced racist abuse from patients as well as other staff members. However, there was no research into most individual ethnic groups.
Action points: better data collection and communication
While the review found clear evidence of institutional, individual-level, and persistent ethnic inequalities in all facets of our healthcare system, a major limiting factor was the lack of data across many areas. This reflects a healthcare system and wider society which has thus far disregarded the experiences and needs of people from minority ethnic backgrounds.
The review goes on to propose action points for each of the five areas, many of which involve more comprehensive data collection services and open channels of communication between affected populations and the healthcare providing bodies.
Should these recommendations be taken into account by the healthcare system, it will undoubtedly be a step in the right direction to addressing the inequities the report has highlighted. But, whilst pertinent to understanding the context, research is only the first step in effecting positive outcomes.
Tackling the deeper causes of NHS inequalities
The UK population demographic is rapidly changing, with people identifying as being of ‘mixed’ background being the fastest growing ethnic group. This is against the backdrop of a complex society where other factors such as social class and gender can further magnify existing inequalities faced by those from a minority ethnic background. As the landscape of our country’s population changes, so too must our approach to delivering effective and sustainable healthcare which meets the needs of our population.
But this means recognising that the issue has roots much deeper than just within the NHS and cannot be dealt with by altering out healthcare alone. It reflects a need for identifying and addressing disparities in access to education, representation in the government and beyond, and other entrenched disparities such as the ethnicity pay gap.
Only once we begin to tackle the deeper causes of the findings in the review, can we make real progress towards solving them.
