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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

Maternity Action’s new research has found worrying failings in the administration of the NHS charging programme, leaving vulnerable women anxious and fearful about debts they cannot pay and deterring them from attending for care. Maternity Action’s new report Breach of Trust: a review of the implementation of the NHS charging programme in maternity services in England details how the implementation of the government’s NHS charging ‘overseas visitors’ programme within NHS Trusts poses a significant risk to migrant women’s health and wellbeing. The government insists that women who are vulnerable are adequately protected because the regulations make certain vulnerable groups exempt from NHS charging, such as refugees, asylum seekers, women who have been victims of modern slavery. The government have also stated that all maternity care should be deemed ‘immediately necessary’ and not refused due to an inability to repay. However the report has found that these legal safeguards are simply not working upon implementation in Trust settings. Many migrant women living in the UK are put at risk because they are deterred from accessing essential maternity care. Read full story Source: Maternity Action, 16 September 2021

Life expectancy in England has fallen to its lowest level since 2011, a Public Health England (PHE) report has said. Deaths were 1.4 times higher than expected between 21 March 2020 and 2 July 2021, according to the report’s findings. The increase, largely driven by the pandemic the report said, resulted in a life expectancy decrease of 1.3 years in males, to 78.7, and a 0.9 year decrease in females, to 82.7 years - the lowest life expectancy since 2011. Life expectancy inequality is also widening between people in the most and least deprived areas. The gap in male life expectancy between the most and least deprived areas in England is 10.3 years in 2020, which is a year higher than the 2019 level. Similarly for females, this same gap was 8.3 years in 2020, 0.6 years greater than in 2019. The PHE report said the inequality gap reached its highest since it began recording data on deprivation linked life expectancy over two decades ago. Its report stated: “This demonstrates that the pandemic has exacerbated existing inequalities in life expectancy by deprivation. Read full story Source: The Independent, 16 September 2021

At a certain point, it was no longer a matter of if the United States would reach the gruesome milestone of 1 in 500 people dying of COVID-19, but a matter of when. A year? Maybe 15 months? The answer: 19 months. The burden of death in the prime of life has been disproportionately borne by Black, Latino, and American Indian and Alaska Native people in their 30s, 40s and 50s. “So often when we think about the majority of the country who have lost people to covid-19, we think about the elders that have been lost, not necessarily younger people,” said Abigail Echo-Hawk, executive vice president at the Seattle Indian Health Board and director of the Urban Indian Health Institute. “Unfortunately, this is not my reality nor that of the Native community. I lost cousins and fathers and tribal leaders." The pandemic has brought into stark relief centuries of entwining social, environmental, economic and political factors that erode the health and shorten the lives of people of colour, putting them at higher risk of the chronic conditions that leave immune systems vulnerable to the coronavirus. Many of those same factors fuel the misinformation, mistrust and fear that leave too many unprotected. Many people don’t have a physician they see regularly due in part to significant provider shortages in communities of colour. If they do have a doctor, it can cost too much money for a visit even if insured. There are language barriers for those who don’t speak English fluently and fear of deportation among undocumented immigrants. “Some of the issues at hand are structural issues, things that are built into the fabric of society,” says Enrique W. Neblett Jr., a University of Michigan professor who studies racism and health. Read full story (paywalled) Source: The Washington Post, 15 September 2021

Following a government announcement, a new body set to tackle health disparities in the UK will launch on Friday 1 October. The Office for Health Improvement and Disparities (OHID) aims to tackle health inequalities across the country and will be co-led by newly appointed Deputy Chief Medical Officer (DCMO), Dr Jeanelle de Gruchy. The OHID will play a vital role in the Department of Health and Social Care, driving the prevention agenda throughout the government to minimise health disparities, many of which have been exacerbated by the pandemic, and improve the public’s health. Unfortunately, health disparities around the UK are austere. For example, a woman living in Blackpool will on average live 16 fewer years in good health than a woman born in Brent, London. The government is also aware that ethnicity can impact health and health outcomes. Health disparities can consequently undermine a person’s ability to work and live a long, healthy and independent life, whilst putting pressure on the NHS, social care and other public services. Read full story Source: National Health Executive, 7 September 2021

A new study has revealed poorer communities are facing higher rates of smoking-related cancer than richer areas. Cancer Research UK now want tobacco companies to help fund more stop smoking campaigns to help poorer areas go smoke free. According to new figures from Cancer Research UK, there are nearly twice as many cancers caused by smoking among the poorest people in England compared to the richest. In a new study looking at quantifying the effect of avoidable cancers linked to smoking, researchers have said there were 11, 000 cases of smoking related cancers in groups that had the lowest income, compared to 6,000 in groups with the highest income. “Smoking has accounted for more deaths than Covid-19 in the past year. Public health and prevention services play a vital role in tackling health inequalities as well as improving health and wellbeing across England. This has come into even sharper focus since the pandemic, which has exposed where investment in these services has fallen behind." Says Public health expert, Professor Linda Bauld. Read full story. Source: The Independent, 3 August 2021

More than one in three middle-aged British adults are suffering from at least two chronic health conditions, including recurrent back problems, poor mental health, high blood pressure, diabetes and high-risk drinking, according to research that warned that health in midlife is on the decline. The study of “generation X” adults born in 1970 found that those who grew up in poorer families were 43% more likely to have multiple long-term health conditions than their peers from wealthier households. Those who had been overweight or obese as children, who had lower birthweight and who had experienced mental ill-health as teenagers were also at increased risk of poor health in midlife. Dawid Gondek, the UCL researcher who authored the paper, said: “This study provides concerning new evidence about the state of the nation’s health in midlife. It shows that a substantial proportion of the population are already suffering from multiple long-term physical and mental health problems in their late 40s, and also points to stark health inequalities, which appear to begin early in childhood.” Read full story Source: The Guardian, 28 July 2021

In a new report, Michael Marmot has found Greater Manchester had a 25% higher rate of death incidences from Covid-19 than anywhere else in England. A report commissioned by the Greater Manchester Health and Social Care Partnership outlines several key recommendations such as increasing Greater Manchester's budget for prevention, increasing funding and support for training, identifying the minimum income needed for healthy living and investing in routine data collection. The report outlines that now is the time to take these recommendations as actions to address the inequality issues. Read full story. Source: BMJ, 30 June 2021

New research has found the death rate in Manchester was 25% higher than the rest of England during the pandemic. The report describes how Manchester is experiencing a number of avoidable health inequalities that needs to be addressed. The Mayor of Manchester has said people on lower incomes are less able to control their exposure to the virus and that more needs to be done to help communities hit hardest by the pandemic. Read full story. Source: BBC News, 29 June 20201

The Royal College of Nursing (RCN) has submitted evidence to a consultation run by the Department of Health and Social Care. The RCN has raised concerns that female patients are not listened to which results in delayed diagnosis and poor patient outcomes. It has also been suggested that there needs to be a bigger focus on designing services for women's needs and provide better support for women in the workplace, particularly in the healthcare sector. Read full story. Source: RCN, 10 June 2021

A new report published by Devon Clinical Commissioning Group, consultancy Nous reveals worrying examples of discrimination towards ethnic minority staff. It has been noted that attempts at progress and improving equality has had 'limited effectiveness' with ethnic minorities experiencing minimal resources to carry out their roles. Findings showed ethnic minorities faced barriers to appropriate care with staff experiencing "substantial inequalities". Read full story.(paywalled) Source: HSJ, 10 June 2021

A hospital trust has decided to prioritise people with learning disabilities for elective treatment, after analysis showed they were disproportionately affected by lengthy waits for care, along with some people who have a minority ethnic background. The decision forms part of wider analysis at Calderdale and Huddersfield Foundation Trust of how the impact of covid, and work to recover from it, can exacerbate health inequalities and how this can be addressed. The FT said in a board paper it would “initially prioritise [people with a learning disability] for treatment after cancer and urgent patients”. Papers said it wanted to prioritise patients “around health inequalities and need based” rather than chronologically, as part of its covid elective recovery work. It made the decision about people with a learning disability as they have a shorter average life expectancy “and therefore the impact of waiting for treatment can both further reduce this as well as disproportionately impact on their quality of life whilst waiting,” according to trust board papers. Read full story (paywalled) Source: HSJ, 4 June 2021

New data indicates the dental crisis shows no signs of slowing, with four in five people (80%) struggling to access timely care during the last COVID-19 lockdown. Access to NHS dental care continues to be a problem for people across England, with Healthwatch recording a 22% rise in calls and complaints about dentistry between January and March 2021.   A review of 1,375 people’s experiences shared with Healthwatch found a lack of consistency across the country when it comes to accessing a dental appointment. Whilst some people were asked to wait an unreasonable time of up to three years for an NHS appointment, those able to afford private care could get an appointment within a week. Healthwatch are calling for greater ambition and urgency from NHS dental reform plans to create more equitable and affordable dental care. Imelda Redmond CBE, National Director of Healthwatch England, said: “The twin crisis of access and affordability hitting NHS dentistry means many people are not able to access timely care – and the poorest are hardest hit. Those human stories show that oral health is a social justice and equity issue." Read full story Source: Healthwatch, 24 May 2021

‘Disparity ratios’ highlighting how staff with minority ethnic backgrounds are represented at different levels in each trust have been created by the national workforce race equality standard programme to help tackle ‘racist practice’ in the NHS. NHS England head of WRES Professor Anton Emmanuel said the data had been created to indicate the differences in progression between white people and those from an ethnic minority background through the ranks of each organisation. Detail of the methodology used to calculate the ratios has not been published, but it appears they have been determined by comparing the share of staff by ethnicity in different bands. Speaking at the Ambulance Leadership Forum last week, professor Emmanuel, said: “We have gone through each of the seven regions of the country and presented to them the local disparity ratios for each trust and put that into a heatmap…The whole point is to make that data digestible and actable on.” The data can be adapted to look at different points in a trust’s progression routes and can also be used with other groups, such as disabled staff. Read full story (paywalled) Source: HSJ, 24 May 2021