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Many dread being invited for their cervical smear test - but Laurie Hodierne found it exhausting to have to keep asking for appointments, and trying to chase up the result. He is one of a number of transgender men who still have a cervix but are no longer registered as female at their GP surgery. Laurie was re-registered as male without requesting it, he says. And this means he could miss out on potentially life-saving cervical smear tests because he is not automatically called up for screenings. As a doctor, Laurie worries others who might be less able to navigate the health system will simply give up trying to get their smear test. "I understand how the systems work and the language - and despite all of that I find it exhausting," he says. "You keep coming up against a brick wall. It's a healthcare inequality in the sense that you aren't able to get access to the screening programme in the same way." NHS patients registered as female are invited to a cervical-cancer screening every three years between the ages of 25 and 50, and then every five years until they are 65. But anyone who has a cervix can develop cervical cancer. The disease often has no symptoms in its early stages and can be fatal. Read full story Source: BBC News, 17 May 2021

Black women face a significantly higher risk of having a miscarriage than white, research suggests. The Lancet analysis of data on 4.6 million pregnancies in seven countries suggests being black increases miscarriage risk by 43%. It calls for people in the UK to be given support after their first pregnancy loss. Currently, referral to specialist clinics usually occurs after three consecutive losses only. Most countries, including the UK, do not collect statistics, but researchers estimate: 15% of pregnancies end in loss 1% of women will experience recurrent miscarriage. Some estimates of miscarriage rate are higher, but this is due to differences in how countries define pregnancy loss, which can be from a positive pregnancy test or from a scan. The report also found that women who suffered miscarriage, from all ethnic backgrounds, are more vulnerable to long-term health problems, such as blood clots, heart disease and depression. Read full story Source: BBC News, 27 April 2021

Infant mortality is not "openly discussed" among some communities, a charity worker in Birmingham said, as the city attempts to tackle a long-standing problem. For the last decade, Birmingham has had one of the highest rates of infant mortality in England. The city council has set up a taskforce in a bid to halve the number of deaths. It heard rates were highest in deprived areas and among Black, Pakistani, and Bangladeshi heritage families. Shabana Qureshi is the women wellbeing manager for the Ashiana Community Project, a charity which works to improve quality of life for those living in Sparkbrook. Figures from the 2011 census show 87% of its population identified as being from an ethnic group other than White British, with the largest ethnic group being Pakistani. Many of women she works with, she said "don't know how to ask the right questions" and so are "not informed" about issues. Many people in the communities they work with, she said, have low education levels and are more likely to suffer with maternity health issues, but find it difficult to access services. "[Infant mortality] is not something that is discussed openly," she said. "A lot of women live within extended families and are sometimes not aware of the risks, they live with these conditions and health inequalities." She said any services which hope to tackle these problems need to involve communities, and be designed to be relatable, culturally sensitive and maintain trust. Read full story Source: BBC News, 22 April 2021

Fears that their data would be shared with the Home Office following the Windrush scandal left some people from ethnic minorities afraid to access cancer services during the pandemic, an NHS England document has revealed. The paper from the West Midlands Cancer Alliance said there was a “perception” the government was “accelerating immigration removals” and that, as a result, “individuals (particularly those affected by the Windrush scandal) are then fearful of accessing cancer treatment and may not participate in screening programmes for fear their information will be inappropriately shared with the Home Office”. The news comes after figures released last week showed the fall-off in referral and treatment of Black-British patients for cancer during the early stages of the pandemic was sharper than for their White-British counterparts. Referrals and first treatments for cancer dipped across the board in April last year. However, by July, White patients were receiving 77 per cent of the treatment volumes they had done 12 months before. The figure for Black patients was 67 per cent. This 10 percentage point difference continued in August and September, as treatment volumes for White-British patients recovered to 83 and 91 per cent respectively. Parity was achieved from October to December 2020, the latest period for which data is available. Read full story (paywalled) Source: HSJ, 22 April 2021

The Labour Party will call on the government to commit to a target of ending the Black maternal mortality gap during a landmark debate about the topic later on Monday. This comes as shocking figures show Black women are over four times more likely than white women to die during or after pregnancy or childbirth in the UK. MPs will debate a petition relating to Black maternal healthcare and mortality. Scheduled to take place at 6.15pm this evening, the session will be led by Petitions Committee Chair Catherine McKinnell MP. Read full story Source: The Independent, 19 April 2021

Public services are dismissing sickle cell patients because the illness disproportionately affects Black people, campaigners have warned. The blood disorder is prevalent among African and Caribbean communities and advocacy groups say this means it remains poorly understood within state institutions, often leading to the needless suffering and even death of those diagnosed. The issue has gained wider attention following the high-profile cases of two Black men, Richard Okorogheye and Evan Nathan Smith, who lived with the disease and died amid claims their vulnerabilities were overlooked by the NHS and police. Chris Abdullahi, co-founder of charitable initiative Sound of Sickle, told The Independent it is common for sickle cell patients’ painful symptoms to be ignored by healthcare practitioners. He said he has heard similar accounts “well over 100 times” from across the UK. “Just last week someone else mentioned that they were in hospital and had to battle their nurses for pain medication from opioids to something as simple as ibuprofen,” the 27-year-old, who also lives with sickle cell, said. These experiences serve to further entrench the “massive sense of distrust” in the healthcare system which is evidenced through lower vaccine uptake in Black communities, Mr Abdullahi explained. A lack of awareness about the disease has led sickle cell patients to often form informal support networks, through which information can be exchanged about the best hospitals at which to maximise the chances of their condition being taken seriously. Read full story Source: The Independent, 18 April 2021

Feeling manipulated into having medical procedures, dismissed by professionals and labelled with racial stereotypes are among the complaints of parents who responded to a national inquiry into racial injustice in UK maternity care. A panel established by the charity Birthrights is investigating discrimination ranging from explicit racism to racial bias and microaggressions that amount to poorer care. It comes as parliament is due on 19 April to debate the large racial disparity in maternal mortality in British hospitals, after a petition from the campaign group Five X More gathered 187,519 signatures. Black women are four times more likely than white women to die during pregnancy or childbirth in the UK. Testimonies include that of a British Bangladeshi woman who said her labour concerns were dismissed. “I felt unsafe and like maternity professionals are not used to being challenged by brown women,” she said. “There is a stereotype of Asian women that we are tame, quiet and compliant people who have no voice and will be obedient. “I was treated like a vessel, not like a human. The experience left me feeling humiliated, disempowered and ashamed.” Read full story Source: The Guardian, 13 April 2021

Devices which measure blood oxygen levels could be giving “seriously misleading” results for Black and minority ethnic people, possibly contributing to increased Covid-19 mortality, experts have warned. Pulse oximeters attach a clip-like device to a person’s finger, toe or earlobe and send a beam of infrared light to measure oxygen levels in the blood. The resulting reading can be used to monitor oxygen levels of people with a variety of conditions, including by people at home with coronavirus, and to assess patients in hospital. At the moment, coronavirus patients who call an ambulance but are not yet deemed sick enough to go to hospital are being given new home oxygen monitoring kits to help spot those who may deteriorate earlier, and over 300,000 oximeters have been sent out by NHS England. But a new paper cites a “growing body of evidence” that pulse oximetry is less accurate in darker skinned patients. This could be contributing to health inequalities such as the increased COVID-19 mortality rates of ethnic minority patients, according to a review conducted for the NHS Race and Health Observatory. It is now calling for the Medicines and Healthcare products Regulatory Agency (MHRA) to urgently review pulse oximetry products for ethnic minority people used in hospitals and by the wider public. Read full story Source: The Independent, 27 March 2021

The CQC will consider equality and human rights policy issues that have arisen from the COVID-19 pandemic under an agreement with the Equality and Human Rights Commission (EHRC). In a statement published on the new memorandum of understanding (MoU), the CQC and the EHRC confirmed they will work together on five ‘key areas of focus’. These also include looking at how leadership can reduce inequalities in patients’ access to – and outcomes from care – in local areas, and ‘collaborating for better leadership on equality for staff working in the NHS and social care’, the regulator said. In a separate blog on the agreement, Ted Baker, CQC’s chief inspector for hospitals, said: ‘We will continue to work together to respond to the equality and human rights issues that have arisen from the COVID-19 pandemic. This includes the EHRC contributing to our work on use of DNACPR and CQC supporting the dissemination of key findings relating to health and social care from EHRC key reports and briefings.’ The memorandum, which applies to all providers regulated by the CQC, also outlines how both organisations will share information on human rights issues. Read full story Source: Management in Practice, 15 March 2021

People in prisons are at an increased risk of COVID-19, with a death rate more than three times higher than that of the general population, and should be made a vaccine priority, according to public health experts. There were 118 deaths related to COVID-19 among people in prisons in England and Wales between March 2020 and February 2021, representing a risk of dying more than three times higher than that of people of the same age and sex outside secure environments, the research team at University College London (UCL) found. The higher rate of death comes despite extensive physical distancing measures, including prisons keeping many inmates in their cells for 23 hours a day. The lead author of the study, Dr Isobel Braithwaite of UCL Institute of Health Informatics, said: “Our findings show that people in prisons are at a much higher risk of dying from COVID-19 than the general population, and we make the case that both they and prison staff should be given high priority in the rollout of vaccines." “We believe the current methods of regime restriction are not enough to protect people adequately, and a systematic, ‘whole-prison’ approach to vaccination is key to preventing further outbreaks and reducing overall deaths in prisons.” The Ministry of Justice challenged the authors’ work, however, arguing it failed to adjust for worse health among the prison population than the community and movements of prisoners in and out of prison. Read full story Source: The Guardian, 16 March 2021

Women and girls in England are being asked to share their experiences of the health system as part of a government strategy to address inequalities. Ministers say there is "strong evidence" services for female patients need improving. Fertility, maternity and menopause care are among the areas to be discussed. Campaigners say they are "delighted" steps are "finally" being taken to close the so-called "gender health gap". While women in the UK have a longer life expectancy than men, the Department for Health and Social Care says they are spending less of their life in good health. Nadine Dorries, minister for women's health, said: "Women's experiences of healthcare can vary and we want to ensure women are able to access the treatment and services they need. "It's crucial women's voices are at the front and centre of this strategy so we understand their experiences and how to improve their outcomes." Studies suggest gender biases in clinical trials are a contributing factor. Less is also said to be known about many female-specific conditions and how to treat them. Patients have repeatedly reported to the BBC that they have felt overlooked when talking to doctors about conditions like endometriosis or complications following a pelvic mesh repair. Read full story Source: BBC News, 6 March 2021

The NHS is increasing efforts to reach out to ethnic minority communities in more deprived areas of England as analysis by The Independent shows poorer areas are vaccinating fewer at-risk people. Among the most deprived parts of the country, fewer people aged over 80 and in their mid-70s had received their first dose of vaccine against coronavirus by 7 February when compared with more affluent areas, sparking concerns communities most at risk are being left vulnerable. Comparing local NHS vaccination data with Public Health England’s deprivation scores for each NHS region reveals six of the most deprived parts of England were in the bottom 10 local areas for vaccine uptake among the over-80s and those aged over 75. The worst performing NHS region was East London, with just 73& cent of over-80s vaccinated by 7 February. East London was also one of the worst-affected areas during the second wave of the virus as hospitals became overwhelmed early on in the crisis. Dave Finch, a senior fellow at the Health Foundation, said: “Lower vaccine uptake in the most deprived areas is worrying as these areas have seen some of the very highest Covid-19 death rates. A higher likelihood of having poorer pre-existing health increases their risk of more severe symptoms if they do get the virus. And people living in poorer areas are increasingly showing signs of intense financial hardship as a result of lockdown measures." “The government must prioritise understanding why vaccine uptake has been lower in these areas and take urgent, targeted action to address this. However, in the longer term, there must be a focus on investing across the UK to address major health inequalities in order protect everyone’s health and wellbeing.” Read full story Source: The Independent, 18 February 2021

An urgent inquiry to investigate how alleged systemic racism in the NHS manifests itself in maternity care will be launched on Tuesday with support from the UK charity Birthrights. The inquiry will apply a human rights lens to examine how claimed racial injustice – from explicit racism to bias – is leading to poorer health outcomes in maternity care for ethnic minority groups. Data published last month by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the country) showed black women were four times more likely than white women to die in pregnancy or childbirth in the UK while women from Asian ethnic backgrounds face twice the risk. Barrister Shaheen Rahman QC, who will lead the inquiry, said: “In addition to these stark statistics there are concerns about higher rates of maternal illness, worse experiences of maternity care and the fact black and Asian pregnant women are far more likely to be admitted to hospital with COVID-19. “We want to understand the stories behind the statistics, to examine how people can be discriminated against due to their race and to identify ways this inequity can be redressed.” Read full story Source: The Guardian, 7 February 2021

In a Channel 4 documentary, emergency doctor Dr Ronx asks why more men die of COVID-19? Cancer and HIV too. They also challenge many dangerous gender assumptions in medicine impacting on women's health. View documentary (6 days left)

Black people over the age of 80 were half as likely as their white peers to have been vaccinated against Covid by 13 January, a large study suggests. This is despite the fact black people are four times more likely to die with COVID-19 than their white counterparts. People living in deprived areas or who have severe mental-health conditions or learning disabilities were also less likely to have received a vaccination. The study was based on more than 20 million patient records in England. The OpenSafely study, by the University of Oxford and the London School of Hygiene and Tropical Medicine, found of the million of those over 80 but not living in a care home: 43% of the white people had been given their first dose of the vaccine 30% of the Bangladeshi and Pakistani people had 21% of the black people had. Bangladeshi and Pakistani people are twice as likely to die with COVID-19 as white peple. Birmingham-based business owner Tru Powell told BBC Radio 5 Live of a "lack of trust between the government and people of colour". "People of colour have been subject to institutionalised racism within the healthcare system," she said. "We are five times more likely to be detained under the Mental Health Act and four times more likely to die in childbirth." Read full story Source: BBC News, 28 January 2021

People in high-risk minority ethnic groups must be prioritised for Covid immunisations, alongside a targeted publicity campaign, experts and politicians have said amid growing concerns over vaccine scepticism. With figures on Monday recording more than 4m Covid vaccine doses now administered across the UK, and the rollout being expanded to all over-70s, public health experts and MPs called for black, Asian and minority ethnic (BAME) communities to be better protected. The Scientific Advisory Group for Emergencies (Sage) has also raised concerns after research showed up to 72% of black people said they were unlikely or very unlikely to have the jab. Prof Martin Marshall, chair of the Royal College of GPs, urged Whitehall to begin a public health campaign. “We are concerned that recent reports show that people within BAME communities are not only more likely to be adversely affected by the virus but also less likely to accept the Covid vaccine, when offered it,” he said. “As such, where appropriate, we’re calling for public health communications to be tailored to patients in BAME communities, to reassure them about the efficacy and safety of the vaccine and ultimately encourage them to come forward for their vaccination when they are invited for it.” His remarks came as the vaccines minister, Nadhim Zahawi, admitted he feared some BAME communities could remain exposed to coronavirus despite high expected uptake of the jabs. Read full story Source: The Guardian, 18 January 2021

When pharmacist Ifeoma Onwuka, known to her friends as Laura, went into hospital to have her daughter, she and her husband hoped the delivery would go smoothly, and that they would soon be able to take their new arrival home  to meet her siblings.  Onwuka's labor was induced at James Paget University Hospital in Great Yarmouth in late April 2018. Things progressed quickly and there were soon signs that her baby was in distress, causing staff to begin preparations for an emergency Caesarian section, but Onwuka's daughter was born in the recovery room. Shortly after the birth, Onwuka's condition began to deteriorate. According to the family's lawyer, Tim Deeming, she began to bleed heavily, and was taken into surgery where attempts were made to stem the loss of blood. Hours later, and only after a second consultant had been called in, she was given an emergency hysterectomy. The mother-of-three died three days later. The coroner, Yvonne Blake, said an expert had told Onwuka's inquest that the delay to surgery contributed to her death, since acting early could have controlled the bleeding.  Black mothers have worse outcomes during pregnancy or childbirth than any other ethnic group in England. According to the latest confidential inquiry into maternal deaths (MBRRACE-UK). Black people in England are four times more likely to die in pregnancy or within the first six weeks of childbirth than their White counterparts.  Read full story Source: CNN. 14 January 2021

Rachel Hardeman has dedicated her career to fighting racism and the harm it has inflicted on the health of Black Americans. As a reproductive health equity researcher, she has been especially disturbed by the disproportionately high mortality rates for Black babies. In an effort to find some of the reasons behind the high death rates, Hardeman, an associate professor at the University of Minnesota School of Public Health, and three other researchers combed through the records of 1.8 million Florida hospital births between 1992 and 2015 looking for clues. They found a tantalising statistic. Although Black newborns are three times as likely to die as White newborns, when Black babies are delivered by Black doctors, their mortality rate is cut in half. "Strikingly, these effects appear to manifest more strongly in more complicated cases," the researchers wrote, "and when hospitals deliver more Black newborns." They found no similar relationship between White doctors and White births. Nor did they find a difference in maternal death rates when the doctor's race was the same as the patient's. Read full story Research paper Source: The Washington Post, 9 January 2021

From the end of 2021, a question on sexual activity of partners in areas where HIV is widespread will be removed from the donor safety check form, in an effort to increase inclusivity among donors. The changes will particularly improve the ease to donate blood for Black African donors. Currently, prospective donors are asked if they have recently had sex with a partner who may ever have been sexually active in an area where HIV is endemic, which includes most of sub-Saharan Africa. If they have, the donor will then be deferred for three months after the last sexual contact with that partner. This can often mean Black African and other potential donors in long-term relationships have been unable to donate blood. Now, the UK Government has outlined plans to remove the question from those asked in the donor safety check, opening the door to a greater number of donations. Increasing blood donor inclusivity for those who are Black African, Black Caribbean, and of Black mixed ethnicity is particularly important because they are more likely to have the rare blood sub-group, such as Ro, that many Black sickle cell patients need. The change, making it easier for people from these groups to donate, will create greater opportunities to meet the ongoing need for rarer blood types and help improve and save lives in the UK. Read full story Source: National Health Executive, 11 October 2021

England’s richest people are living for a decade longer than the poorest, and the life expectancy gap between them has widened to “a growing chasm”, research has revealed. The difference in expected lifespan between some of the wealthiest and poorest areas has more than doubled since the early 2000s, an analysis of official data by the King’s Fund shows. “There is a growing chasm in health inequalities revealed by the data,” said Veena Raleigh, a fellow at the thinktank who specialises in the stark differentials in rich and poor people’s health. “Our analysis shows that life expectancy has continued to increase in wealthier areas but has virtually stagnated in deprived areas in the north with the result that the gap in life expectancy between the richest and poorest parts of the country has grown by almost two-and-a-half years over the last two decades.” The analysis underlines the scale of the challenge facing the health secretary, Sajid Javid, who in a recent keynote speech in Blackpool on “levelling-up” in health, pledged to tackle “the disease of disparity” – dramatic differences in outcomes based on geography, ethnicity and income.R Read full story Source: The Guardian, 10 October 2021

Sajid Javid has said medical device manufacturers should check their products work well for people of all ethnic backgrounds, citing problems that those with dark skin have experienced when using pulse oximeters. Several studies have found oximeters are not as good at identifying hypoxia in people with darker skin. The devices have been widely used during the covid pandemic to monitor people at risk of deteriorating at home. They are meant to trigger a response when needed. Official guidance was updated this summer to encourage caution in their use. The health and social care secretary has identified health inequalities as one of his priorities. He gave the issue as an example of racial bias in healthcare when speaking at the Conservative party conference on Tuesday evening. He said: “It turned out that pulse oximeters, all of them that exist in the world, were giving often the wrong reading for people with dark skin, because they were designed by companies where basically all they were thinking about were white people. Why is that? Because the companies, their market was white countries with a majority of white people.” Mr Javid, who has a British Pakistani background, continued: “They just weren’t thinking whether these things could work on people with a skin colour like mine or just darker skin, and that’s not right. Read full story (paywalled) Source: HSJ, 6 October 2021

The first new sickle-cell treatment in 20 years will help keep thousands of people out of hospital over the next three years, NHS England has said. Sickle-cell disease is incurable and affects 15,000 people in the UK. And the National Institute for Health and Care Excellence said the hope of reducing health inequalities for black people, who are predominantly affected and often have poorer health to start with, made the drug worth recommending. It called it "an innovative treatment". Read full story Source: BBC News, 5 October 2021

Where Healthcare Is Improving and Where It Needs More Work While the public discourse on health equity has increased in recent years, there are still many problems in health disparities research and in care delivery. Health systems are struggling to tackle health equity issues as highlighted by a recent study that evaluated online consumer reviews of hospitals and experiences of racism. However, organizations are making a positive impact toward health equity in a variety of areas. Walmart is partnering with virtual care company Grand Rounds Health and Doctor On Demand on a digital health program aimed at tackling health disparities among African American workers. Women's health company Tia is looking to welcome female-identifying patients in an effort to improve inclusivity in health tech. For more content on companies that are addressing health equity gaps, including specialized care for women and individuals with female biologies, check out the recent blog post where we collaborated with Rock Health: Building comprehensive women+ digital health: Eight sectors serving women+ needs.

The Office for Health Improvement and Disparities (OHID) has been officially launched by the UK Government, aimed at preventing health disparities across the country and supporting people to live longer, healthier, and happier lives. OHID will focus on stopping debilitating health conditions before they develop and represents a distinct step-change in focus from the Government towards a more preventative, rather than reactionary, approach to health. One of the key intentions of this is to reduce the backlog and also put social care on a long-term sustainable footing, tackling health issues much earlier in their presentation, tackling the underlying causes of many of these, or preventing them altogether. The new government office will see Professor Chris Whitty, Chief Medical Officer, provide professional leadership to the organisation. Announcing the official launch of OHID, the Government pointed to some of the clear trends shown in recent figures, which highlight how geographical location can play a significant role in a person’s life expectancy and the years that they can expect to live a healthy life. For example: men in the most deprived areas in England are expected to live nearly 10 years fewer than those in the least deprived. Women in the same areas can expect to live 7 years fewer smoking is more prevalent in more deprived areas and one of the leading causes of inequalities in life expectancy; an international study found it accounts for half the difference in mortality between the least and most deprived men aged 35 to 69 obesity is widespread but more prevalent among the most deprived areas; prevalence is almost 8% higher among those living in the most deprived decile of local authorities (66.6%) compared to those in the least deprived areas (58.8%) Under its new remit, OHID will work to coordinate across local and central government, the NHS and wider society – utilising expert advice, analysis, and evidence – to drive improvements in the public’s health which may be able to have preventative roles and level up health across the UK. Preventative approaches to health can, it is intended, reduce the pressure on existing healthcare services, saving significant resource and money, and ensure that record investments into health and social care services can go further. Source: National Health Executive Health and Social Care Secretary, Sajid Javid said: “The pandemic has laid bare the health disparities we face not only as a country, but as communities and individuals. “This must change, and this body marks a new era of preventative healthcare to help people live healthier, happier and longer lives. “The Office for Health Improvement and Disparities will be the driving force across government, supported by communities, academics, industry and employers, to level up the health of our nation, which will reduce the pressure on our NHS and care services.”

The NHS backlog is being disproportionately shouldered by people in poorer areas, according to new research, amid a stark warning that waiting lists are likely to “grow significantly” because millions of people did not seek help during the pandemic. Waiting lists for routine treatments have grown by 50% in the most deprived parts of England, compared with nearly 35% in the most affluent areas. Those in deprived areas were also nearly twice as likely as those in the wealthiest to wait more than a year for treatment, according an analysis by the King’s Fund. Jonathan Ashworth, the shadow health secretary, warned that the long waiting lists were in danger of leading to privatisation of the NHS. “Waiting times have got so bad that you’ve got people taking out payday loans, sometimes even remortgaging their homes, because they cannot bear the pain, or the disruption to their lives, or fear they will lose their lives,” he said. “That is eroding the fundamental universal system that we created.” Read full story Source: The Guardian, 27 September 2021