Radical action is urgently needed to tackle the “crushing” ethnic health inequalities of minorities in the NHS, leading experts have said, after a damning study found that the “vast” and “ widespread” in every aspect of health care she examined was harming the health of millions of people. of sick.
Racism, racial discrimination, barriers to accessing healthcare and ethnicity data collection have ‘adversely impacted’ the health of black, Asian and minority ethnic people in England for decades. years, according to the study commissioned by the NHS Race and Health Observatory, which reveals the true extent of health inequalities faced by ethnic minorities for the first time.
“Ethnic inequalities in health outcomes are evident at every stage of life, from birth to death,” says the review, the largest of its kind. Yet despite ‘clear’, ‘compelling’ and ‘persisting’ evidence of ethnic minority failure and repeated promises of action, no ‘meaningful change’ has yet been made to the NHS, it adds .
The 166-page report, seen by the Guardian, is due to be published in full this week.
From mental health to maternity care, the University of Manchester’s in-depth review paints a devastating picture of a healthcare system that is still failing ethnic minority patients despite previously raised concerns about the harm done .
“By bringing together the evidence and filling in the gaps where we find it, we have made a clear and compelling case for radical action against racial inequality in our healthcare system,” said Habib Naqvi, Director of NHS Race. and Health Observatory, an independent body set up by the NHS in 2020 to investigate health inequalities in England.
The Covid pandemic has taken a disproportionate toll on ethnic minorities, prompting new questions about the inequalities that permeate the practice of medicine. The observatory commissioned the review last year to synthesize evidence, translate it into “workable policies” and “inspire leaders to act”.
“This report is the first of its kind to analyze the overwhelming evidence of ethnic health inequality through the lens of racism,” Naqvi said.
His findings are shocking. The review concludes that inequalities in healthcare access, experience and outcomes in the NHS “are rooted in experiences of structural, institutional and interpersonal racism”. For ‘too many years’, he adds, the health of ethnic minorities in England has been ‘negatively affected’ by a lack of appropriate treatment, shoddy or discriminatory treatment by NHS staff, ethnic data missing from NHS systems and delays in seeking help for health issues “for fear of racist treatment from NHS healthcare professionals”.
The year-long review, which examined 13,000 papers and interviewed policy experts, NHS staff and patients, was led by Dharmi Kapadia, a researcher at the Center on the Dynamics of Ethnicity, the leading research center of the United Kingdom on the ethnic, racial and religious inequalities of minorities. . Kapadia, a professor of sociology at the University of Manchester, said she and her co-authors had uncovered “crucial” evidence of persistent health inequalities that harmed patients’ health every day.
“The evidence of poor health care outcomes for many ethnic minority groups across a range of services is overwhelming and compelling,” she said.
The report is littered with stark examples and evidence of inequity in the NHS. In the area of mental health, for example, the review found that ethnic minority patients faced “clear inequalities” in improving access to psychological therapies (IAPT), a flagship NHS program set up in 2008 to transform the treatment of anxiety and depression in England.
Minority ethnic groups were less likely to be referred to IAPT by GPs than white people, the report said. Ethnic minority patients who are referred are less likely than white British patients to receive an assessment. People from ethnic minorities with psychosis are also less likely to be referred for cognitive behavioral therapy (CBT).
The review found “strong evidence” of “clear, very significant and persistent ethnic inequalities” in compulsory admission to psychiatric wards, particularly affecting black people. He found evidence of harsher treatment for black patients, who were “more likely to be restrained in a prone position or placed in solitary confinement”.
Ethnic minority parents said their children faced the same barriers to accessing health services as they did. Black children are 10 times more likely to be referred to child and adolescent mental health services (CAMHS) through social services – rather than through their GP – compared to white children, the report says.
Maternity services were also lacking. The review found evidence of negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity, leading some ethnic minority women to feel ‘other’, unwanted and unsupported. Some women whose mother tongue was not English were denied access to quality interpreting services, the report adds.
“Our review shows the role of structural barriers – including racism and experiences of racial discrimination – in shaping strong ethnic inequalities in health care,” said co-author Laia Bécares, senior lecturer in social sciences. applied at the University of Sussex.
The review revealed a lack of research in specific areas. Despite screening 10 years of research, the review team found only one study examining health inequalities in newborn care.
It showed that Asian babies are overrepresented in neonatal home unit admissions for jaundice. Visual estimation of jaundice in babies “may be particularly unreliable” for babies with darker skin, the review says, raising the possibility that “routine postnatal care practices may systematically disadvantage unborn babies.” whites by delaying access to care”.
The researchers also said that all efforts to improve health outcomes for ethnic minority patients were being thwarted by the chaotic collection of health information by NHS staff and organisations.
Racism within the NHS workforce persisted, they said, and the report found evidence of a pay gap affecting black, Asian, mixed and other groups. The review also revealed ethnic minority health inequalities in areas as diverse as digital access to healthcare, genetic testing and genomic medicine.
“Persistent inequalities in health care and health outcomes between ethnic groups remain, despite past commitments to address the problem,” said co-author Sarah Salway, professor of public health at the University of Sheffield.
“As a nation, we are proud of our NHS. It’s one of the few health services in the world with a reputation for free quality care at the point of access, so it can be hard to discuss how things can go wrong. This report, however, gives us the opportunity to identify how we can do things better, for a healthier and fairer society.
An NHS spokesperson said: “The pandemic has brought health inequalities to light across the country and the NHS is already taking steps to improve patient experience and access to services.
“The NHS has set out what local health services should focus on over the next year so they can make these improvements in their local communities and is already working closely with the Race and Health Observatory to advance the recommendations set out in this report.