Equality is expected to be a core principle of the NHS.
In its constitution, it reads that the service ‘is available to all irrespective of gender, race, disability, age, sexual orientation, tenuate interactions religion.’
It is a pledge that is integral to the foundations of our national health service, yet research has found, Black people’s experiences of healthcare in this country are often unequal to that of white people.
For many, racial inequality is an underlying condition that has been festering in the bowels of the NHS, spreading unchecked, for decades. The symptoms are wide-ranging and impact patients, carers, healthcare workers, and seemingly any person of colour who has to interact with the system.
In some cases, these symptoms are fatal – with inequalities in the NHS leading to a disproportionate and unnecessary loss of life.
Research published just this week by the Black Equality Organisation revealed that 65% of Black Brits have reported being discriminated against by a healthcare professional because of their race. A figure that rises to a shocking 75% for those aged 18-34.
Meanwhile, a damning report from February this year found ‘vast’ and ‘widespread’ inequity in every aspect of healthcare it reviewed, and concluded that the health of millions of patients was at risk.
The study, commissioned by the NHS Race and Health Observatory, revealed that ‘ethnic inequalities in health outcomes are evident at every stage throughout the life course, from birth to death.’
Despite these findings, and repeated pledges of action, researchers said no ‘significant change’ has yet been made in the NHS.
The crisis of systemic racism in healthcare affects anyone who is not white, and the study concluded ‘radical action’ is needed to tackle this problem.
However, according to Dr Habib Naqvi, director of the NHS Race and Health Observatory, these latest discoveries simply add to a teetering pile of evidence that has been saying the same thing for many years.
‘There is decades of data and evidence which show Black, Asian and ethnicity minority populations are impacted by late diagnosis, disproportionate and higher incidences of illnesses and death across a wide range of health conditions including diabetes, heart disease, hypertension and stroke,’ Dr Naqvi tells Metro.co.uk.
‘Evidence-based action to address health inequalities is a critical concern to the Observatory and gaps such as late diagnosis and disparity in cancer screening outcomes between people from Black and white backgrounds, must be urgently closed and accounted for.’
Dr Natalie Darko, associate professor of sociology at the University of Leicester, tells Metro.co.uk that although positive steps forward have been made, there is still a lot of work to be done.
‘I think everyone is trying to address the problem, but too often it is tokenistic,’ she explains. ‘There is also a focus on equality rather than equity. So there is usually a blanket approach – people focus only on language translation, or just look at the data, or a certain area that might be Black maternal health – but they haven’t looked deeper into the rest of the data, or at how to address the issues in terms of equity and individual experiences.
‘The approach has to be intersectional, and at the moment that is what’s missing.’
No matter the reason for seeing a doctor or accessing a healthcare service, for many people, the colour of their skin will have an impact on their health outcomes in almost every circumstance.
From new mothers to the elderly, cancer patients to Covid patients – research has found that if they are Black, they are more likely to have a negative experience, more likely to be ignored or have your pain dismissed, more likely to die.
For them, racism really is a matter of life and death.
In maternal healthcare, Black women are four times more likely to die during childbirth than white women in the UK, according to a British Medical Journal (BMJ) 2020 report. The study found that over a two-year period, 34 Black women died among every 100,000 giving birth, compared with eight white women in 100,000.
All too often, Black patients report being ignored, not listened to and denied basic pain relief. This is exactly how PR professional Barbara Phillips felt.
After major gynaecological surgery in 2016, she recalls how the team of nurses who were responsible for her aftercare – who were white and south Asian – failed to recognise how much pain she was in, and feels did not respond adequately to her pleas for help.
‘I had a reaction to anaesthetic when I was coming around, I felt like my head was in a vice,’ Barbara tells Metro.co.uk. ‘I rang the bell once. Nobody. Two times, three times.
‘Eventually a nurse popped his head in and said I would have to wait because they were busy. And disappeared. I rang again, this time crying with pain and afraid my eyes were going to pop out of my scull because of the pressure.
‘The nurse came just into the door way and said “what?” I was sobbing by this time and told him my symptoms and he said – “what do you want me to do? It’s the anaesthetic.” I asked if I could be examined and a least get pain killers.’
Barbara fell back to sleep, only to be woken again an hour later by the pain. She rang for help yet again, and a nurse told her to stop ringing the bell.
‘She said I was being very rude and that I was making a fuss,’ remembers Barbara. ‘She said I should not expect any special treatment. This was around two hours after the original request and I was dozing in and out of consciousness. Finally, a more senior person came and examined me, adjusted my bed and gave me painkillers.
‘I said at the time that I thought this behaviour was racially motivated as the first two nurse didn’t want to examine me and ignored my obvious pain.’
The coronavirus crisis revealed a similar picture of disparity and inequality, as multiple reports found that Black people were more likely to become severely unwell or to die of the virus.
According to ONS analysis, the mortality rate for Covid deaths was highest among Black men – at 256 deaths per 100,000, and lowest among white men – at 87 deaths per 100,000. For women, the pattern was similar with the highest rates among those of Black women and white women experiencing the lowest.
It’s a disparity that can’t simply be explained away by socioeconomic factors or a higher likelihood of deprivation. Even after adjusting for region, population density, socio-demographic and household characteristics, the raised risk of Covid death for Black people – of all ages – was twice as great for men and 1.4 times greater for women compared with white people.
In cancer care, a study from September 2022 revealed a ‘deeply concerning’ race divide on cancer patients’ wait times in England. Analysis of 126,000 cancer cases over 10 years found the median diagnosis time for cancer of the stomach or oesophagus in white people is 53 days. For Asian people it is 100 days. In myeloma, a type of blood cancer, the median wait time for white people is 93 days. For Black people, it is 127 days – again, more than a month longer.
For geriatric healthcare, again it is Black and ethnic minority people who are likely to fare worse as they get older. 2021research from the Universities of Sussex and Manchester found that health inequalities accumulate over the course of a lifetime, with Black Caribbean men and South Asian men and women reporting the poorest health over the age of 40.
The pandemic has put a greater spotlight on the longstanding differences in health experienced by different groups across the country
Mental health is not exempt from racial inequality either. According to a 2020 BMJ report, ethnic minority patients receive worse mental healthcare than white patients, with doctors ‘more uncertain’ in diagnosing emotional problems and depression in non-white patients.
In the year to March 2021, Black people were almost five times as likely as white people to be detained under the Mental Health Act, with 344 detentions per 100,000 people, compared with 75 per 100,000 people.
But what is causing this problem?
The NHS Long Term Plan for reducing healthcare inequalities sets out key principles for levelling the healthcare playing field and ensuring equal access and quality of treatment for people of all racial backgrounds.
This plan includes restoring NHS services inclusively, mitigating against digital exclusion, and ensuring datasets are complete and timely. These action points go some way in explaining why racial inequalities persist within the NHS – from issues of accessibility in marginalised communities, to a lack of data, to barriers of communication, culture and language.
‘The pandemic has put a greater spotlight on the longstanding differences in health experienced by different groups across the country,’ explains Dr Bola Owolabi, director of health inequalities at NHS England. ‘While there are many factors contributing to these differences, the NHS is playing its part in narrowing the gap by ensuring equal access to services and taking targeted action where needed to improve outcomes.
‘The NHS has already set out a number of key areas for improvement which local health services are working with their communities and partners to deliver, building on the success and learning from the vaccine programme, and we continue to work with patient, staff and expert groups nationally to identify further contributions the NHS can make.’
However, some experts believe these reasons often blame communities and put the onus on them to take full responsibility for their health, and some argue there are deeper systemic issues of bias, racism and neglect at play within the NHS that leaders must acknowledge and tackle head-on.
Professor Anandi Ramamurthy led a study earlier this year which exposed widespread and ‘entrenched’ racial inequality in the NHS, and produced a film of powerful first-hand accounts.
Her research found that 77% of healthcare staff who challenged racism said they had not been treated fairly. While 59% said they had experienced racism during their working lives that was so bad it made it difficult for them to do their job.
Prof Ramamurthy believes that racism faced by NHS staff is a public health concern, and directly impacts how Black and ethnic minority patients will experience healthcare in the UK.
‘What is happening is actually systemic neglect of a central part of the NHS workforce,’ she tells Metro.co.uk. ‘Now, if that’s how you’re treating the people that you’re working with, of course Black and brown patients aren’t going to get the same care.’
The study revealed that incidents of racism against staff – either from patients or from within the institution – were being minimised and often going unchallenged. Staff were made to feel invisible and unheard, rather than supported, which Prof Ramamurthy identifies as a step towards dehumanisation. She says the same thing happens to Black patients.
‘If you don’t see someone as fully human, you’re not actually registering, for example, pain,’ she explains. ‘This is well documented within midwifery and within mental health – why is it that our loved ones are referred later? And often in extreme circumstances? They didn’t get the care at the point when they needed it. That is a failure to respond to our mental and emotional pain.
‘Healthcare is a sector that only operates successfully with teamwork. If you have a system where one group of staff is not always supporting another group of staff, you’re not effectively working as a team. Mistakes will happen.’
Prof Ramamurthy points to examples from nurses where they would be on shift with members of staff who they knew would not help them do their jobs. Many were put in positions where they would have to choose between neglecting their patient, or taking risks with their own health and safety by doing things on their own.
‘There were even more serious examples, where patient’s lives could have been put at risk because of the bullying and harassment that staff members were facing,’ she adds. ‘This is a problem that affects all of us.’
In 2021, a nurse with Black heritage told the Nursing Times that she had reported she was being ‘bullied’ by her colleagues, blamed for errors that happened when she wasn’t on shift, isolated by colleagues, and even subjected to racist slurs.
Meanwhile, in 2020, agency nurse Neomi Bennet told CNN that racism is so pervasive in the NHS Black nurses have developed a code to warn each other away from wards where they are not welcomed by staff.
She added that she put in complaints after being repeatedly denied proper PPE during the height of the pandemic, and noticing that Black doctors and nurses were more frequently put in high-risk situations.
To solve the problem, there is a clear need for innovation and radical change in how the UK approaches healthcare for different ethnic groups. What is evident is that a one-size-fits-all approach leaves marginalised groups vulnerable to racism and inadequate care.
Researchers from Loughborough University are currently working to develop a machine learning system capable of identifying factors that contribute to harm during pregnancy and birth for Black mothers. The AI technology should be able to pinpoint risk factors, and ultimately help doctors to provide better, bespoke care for Black women.
‘What you often hear is that the mother has been left alone on the ward for a long time, or that she hasn’t been given adequate pain relief. Reading between the lines, you get the picture that sometimes these people were ignored,’ lead researcher Dr Patrick Waterson tells Metro.co.uk. ‘That’s one of the things we want to identify from the data – is it a communication issue, for example, and what are the other different factors involved as well?’
Cutting-edge innovations like these, and improvements in data gathering for Black patients is a vital part of the wider goal of reducing the race gap in healthcare, but there are other things that must be addressed too.
For Dr Darko, one of the most urgent problems to be addressed is the use of generic labels and terminology when looking at the impacts on different racial groups. ‘Black’, for example, is used to cover a vast group of people who may have ancestry from different continents, social and cultural experiences from all over the globe, and heritage that spans a multitude of different countries. She says this lack of nuance contributes to inadequate care.
‘We need to understand people’s circumstances to understand why inequalities persist,’ explains Dr Darko. ‘So, if you don’t break the categories down further than simply saying “Black”, how can we look at the complex and individual inequities that people experience?
‘It’s the same with Gypsy, Roma and Traveller groups who are defined as an ethnic minority group, but then also considered as a white group. So they get pushed into another category, but yet there are greater inequalities and disparities they experience that are related to their social context.’
Dr Darko also suggests that any solution has to start with better data recording.
‘Recent data showed that death rates have gone down since Covid, but they’re still rising across all conditions,’ she explains. ‘But when you try to look at the data, it’s not there, they are still not recording deaths by ethnicity. Even if you’re a statistician looking for the data, you can’t find it, so how can we know how significant the gap actually is?
‘There is still a lot more to do on educating in terms of how we record ethnicity, and not lumping people into huge homogenous groups. In the US, while they have greater health disparities, they have much better mandatory recording of ethnicity, with implications if you don’t collect the information across all health conditions, they also collect the data at a much higher level than we currently do.’
Dr Darko’s work spans the breadth of healthcare, and she says there is no area of medicine untouched by issues of racial discrimination. She believes solutions must be intersectional and focus on all conditions with equal enthusiasm, however backlogs in cancer treatment, the looming spectre of Long Covid, and the growing problem of comorbidities may prove to be of most urgent concern to Black and ethnic minority communities.
‘The challenge is funding,’ warns Dr Darko. ‘We need funding for research into targeted interventions for particular groups who need more support. We need more time and more funding to address structural barriers that contribute to health inequalities.
‘Unless there is more dedicated funding pumped into the system, we will continue to face this challenge.’
Black History Month
October marks Black History Month, which reflects on the achievements, cultures and contributions of Black people in the UK and across the globe, as well as educating others about the diverse history of those from African and Caribbean descent.
For more information about the events and celebrations that are taking place this year, visit the official Black History Month website.
Do you have a story you’d like to share? Get in touch by emailing [email protected]
Share your views in the comments below.
Source: Read Full Article