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Content Article
Being an anti-racist clinician (4 February 2022)
Patient Safety Learning posted an article in Health inequalities
Racism is a pervasive problem in Western society, leading to mental and physical unwellness in people from racialised groups. Psychology began as a racist discipline and still is. As such, most clinical training and curricula do not operate from an anti-racist framework. Although most therapists have seen clients with stress and trauma due to racialisation, very few were taught how to assess or treat it. Furthermore, clinicians and researchers can cause harm when they rely on White-dominant cultural norms that do not serve people of colour well. This paper from Racism is a pervasive problem in Western society, leading to mental and physical unwellness in people from racialized groups. Psychology began as a racist discipline and still is. As such, most clinical training and curricula do not operate from an anti-racist framework. Although most therapists have seen clients with stress and trauma due to racialisation, very few were taught how to assess or treat it. Furthermore, clinicians and researchers can cause harm when they rely on White-dominant cultural norms that do not serve people of colour well. This paper from Williams et al. discusses how clinicians can recognize and embrace an anti-racism approach in practice, research, and life in general. Included is a discussion of recent research on racial microaggressions, the difference between being a racial justice ally and racial justice saviour, and new research on what racial allyship entails. Ultimately, the anti-racist clinician will achieve a level of competency that promotes safety and prevents harm coming to those they desire to help, and they will be an active force in bringing change to those systems that propagate emotional harm in the form of racism. -
Content ArticleThe Mental Health Foundation proudly support Black Maternal Mental Health Week in this blog for The Motherhood Group on the experiences of Black mothers.
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Content ArticleIn general approximately 1 in 5 women from all different backgrounds experience perinatal mental health difficulties – that is mental health challenges during the perinatal period which is defined as one year after the birth of a baby. However, for black women perinatal mental health difficulties often go unidentified, and thus untreated, placing them at a disadvantage when it comes to seeking professional help. For this year's Black Maternal Mental Health Week, Global Black Maternal Health is proud to support The Motherhood Group as they continue to raise awareness on black maternal mental health, with a focus on equity and inequality for black mothers.
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Content ArticleThe rapid uptake of digital healthcare channels offers huge benefits, but evidence also suggests a close correlation between digital exclusion and social disadvantage. People with protected characteristics under the Equality Act are among those least likely to have access to the internet and the skills needed to use it. Experts from across health and care came together to contribute to "Access Denied", a new whitepaper on digital health inequalities. This whitepaper sets out recommendations to ensure that those innovating in digital healthcare can do so in a way which addresses healthcare inequalities.
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Content ArticleThe UK health system is under unprecedented strain. The COVID-19 pandemic exacerbated these pressures, but it did not create them. The Academy of Medical Royal Colleges and its member organisations believe that as a country we are not facing up to the scale of the current challenges and we are not producing any coherent strategy to tackle the problems. Only when we confront these challenges will we be able to begin to fix the NHS. A combination of pressures means that the system is providing care and services which are sub-standard, threaten patient safety and fall below what should be expected in a country with the resources of the United Kingdom. If we do not act with urgency, we risk permanently normalising the unacceptable standards we now witness daily, to the detriment of us all.
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Content ArticleThe aim of the Patient safety inequalities Task and Finish Group (PSIT) is to develop an understanding of solutions to improve patient safety healthcare inequalities. Attached is the group's Terms of Reference.
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Content ArticleGender is emerging as a significant factor in the social, economic, and health effects of COVID-19. However, most existing studies have focused on its direct impact on health. Here, we aimed to explore the indirect effects of COVID-19 on gender disparities globally. The most significant gender gaps identified in our study show intensified levels of pre-existing widespread inequalities between women and men during the COVID-19 pandemic. Political and social leaders should prioritise policies that enable and encourage women to participate in the labour force and continue their education, thereby equipping and enabling them with greater ability to overcome the barriers they face.
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Content ArticleWomen are 50% more likely to receive a wrong initial diagnosis; when they are having a heart attack, such mistakes can be fatal. People who are initially misdiagnosed have a 70% higher risk of dying. The latest studies have similarly shown that women have worse outcomes for heart operations such as valve replacements and peripheral revascularisation. As well as being misdiagnosed, women are less likely to be treated quickly, less likely to get the best surgical treatment and less likely to be discharged with the optimum set of drugs. None of this is excusable, but is it understandable? What is behind this bias and how can how it be fixed? Sian Harding, emeritus professor of cardiac pharmacology at Imperial College London, looks at the evidence in this Guardian article. Related reading Dangerous exclusions: The risk to patient safety of sex and gender bias Gender bias: A threat to women’s health Medicines, research and female hormones: a dangerous knowledge gap
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Content ArticleThere is evidence that certain subgroups of the population have a higher risk of developing dementia than others. Aside from the most important risk factor—age,—other risk factors include ethnicity, sex, learning disability and socio-economic status. This report by the UK Dementia Research Institute (UK DRI) details the impact of scientific research on health inequalities for people affected by dementia. In order to make sure dementia diagnosis and treatments are effective for everyone, we need to understand how and why different groups are affected differently, so that we can target interventions where they are most needed and maximise their benefit. The report was produced by leading dementia scientists from the UK DRI who are taking action to reduce health inequalities through their own research. This includes: Researching “blood biomarkers” to pave the way for a blood test to diagnose Alzheimer’s disease. Ensuring both male and female mice are used equally in animal research so that findings can be applied to the whole population. This is policy across the UK DRI. Broadening understanding of the implications of ethnicity on risk of Alzheimer’s disease through genetic studies. Working to make clinical trials more accessible to all. Pioneering accessible, scalable, and affordable new therapies. Investigating rarer forms of dementia to plug the knowledge gap and support people living with these diseases. Addressing the environmental and lifestyle factors that impact brain health to better understand the link between socio-economic status and dementia risk.
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Content ArticleNaaheed Mukadam and colleagues investigated the incidence of diagnosed dementia and whether age at diagnosis and survival afterward differs among the UK's three largest ethnic groups. They used primary care electronic health records, linked Hospital Episode Statistics and mortality data for adults aged ≥65 years. They compared recorded dementia incidence 1997–2018, age at diagnosis, survival time and age at death after diagnosis in White, South Asian, and Black people. The study found that dementia incidence was higher in Black people. South Asian and Black people with dementia had a younger age of death than White participants and Black participants. The authors concluded that South Asian and Black peoples’ younger age of diagnosis and death means targeted prevention and care strategies for these groups should be prioritised and tailored to facilitate take-up.
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Content ArticleThis review by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) looks at current NCEPOD data to identify themes relating to healthcare inequalities. It was was commissioned by Healthcare Quality Improvement Partnership (HQIP) on behalf of the Healthcare Inequalities team at NHS England and NHS Improvement, as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The review identifies four area of healthcare inequalities: Protected characteristics - age and disability Socioeconomic deprivation Inclusion health groups Organisation of healthcare services
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Content ArticleA handful of immunologists are pushing the field to take attributes such as sex chromosomes, sex hormones, and reproductive tissues into account.
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Content ArticleOn 24 June 2022, the US Supreme Court overruled both Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania v. Casey and returned the question of abortion’s legality to the US. The ruling opens the door to additional State efforts to limit access to medication abortions, prevent third parties from assisting anyone seeking an abortion or punish women who end their pregnancy. This opinion piece in The New England Journal of Medicine looks at the implications of the end of Roe v. Wade beyond abortion, examining how it could affect other aspects of healthcare rights in the USA. The author, Zita Lazzarini from the Division of Public Health Law and Bioethics at the University of Connecticut School of Medicine, argues that the Supreme Court's ruling opens the door for state regulation of other healthcare decisions, including those regarding contraception, end-of-life care, care for LGBTQ patients and fertility treatments. She highlights that common forms of birth control including IUDs and emergency contraception are already being targeted by some states as “abortifacients,” and raises concerns that State laws declaring that life begins at fertilization will potentially endow thousands of frozen embryos with rights, imposing impossible burdens on fertility centres and their clients.
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Content ArticleDespite global consensus that access to pharmaceuticals as a lifesaving commodity is a fundamental human right, 2 billion people globally still lack access to medicines. In this blog, Karrar Karrar, Access to Medicines Adviser at Save the Children, looks at why weak regulatory systems are a major patient safety issue in low- and middle-income countries. He highlights that lack of regulatory capacity results in falsified, substandard and fake medicines making their way into local pharmacies and hospitals. It also delays patient access to new medicines due to lengthy processing times. Karrar argues that governments must prioritise investments in strengthening national regulatory systems and increase cross-country collaboration to strengthen regional and global regulatory networks and systems.
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Last week the Professional Standards Authority for Health and Social Care (PSA) published a new report, Safer care for all – solutions from professional regulation and beyond, which examines the current state of professional health and care regulation in the UK. In this blog, Patient Safety Learning considers this report from a patient safety perspective. PSA's chief executive, Alan Clamp, has also written a blog for the hub on the report, which can be read here. -
Content ArticleThe Institute of Health Equity (IHE) is working with local authorities up and down the country to help them implement the right approaches to reduce health inequalities. The public health department of Luton Borough Council commissioned IHE to support the local authority and other partners to act on health inequalities and become the first ‘Marmot Town’. This report is based on an assessment of data and local evidence and makes recommendations to reduce health inequalities and make Luton a fairer place to live, work, grow up and grow old in.
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Content ArticleThe life expectancy of people with severe mental illness (SMI) is shorter than those without SMI, with multimorbidity and poorer physical health contributing to health inequality. Screening tools could potentially assist the optimisation of medicines to protect the physical health of people with SMI. The aim of this research from Carolan et al. was to design and validate a medicines optimisation tool (OPTIMISE) to help clinicians to optimise physical health in people with SMI.
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Content ArticleResearch suggests that there is a wide gap in knowledge about how medical conditions affect men and women differently, and about the conditions that only affect women. As a result, women are receiving poorer medical advice and diagnosis, often leading to worse outcomes. This handbook published by digital healthcare provider Livi looks at some of the evidence surrounding sex-based health inequalities and how they are affecting women in the UK.
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Content ArticleGPOnline Editor, Emma, speaks with Dr Carey Lunan, a GP in Edinburgh and chair of the Deep End GP Group in Scotland, and Dr David Blane a GP in Glasgow and clinical research fellow in General Practice, University of Glasgow, who is the academic lead of the Deep End GP Group. The Deep End Group covers the 100 most deprived practices in Scotland and the discussion highlights what the group is doing to tackle health inequalities, the impact of COVID-19 and what other practices can learn from their work.
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Content ArticleThe Patients Association has put together a jargon buster dictionary designed to give straightforward explanations for many healthcare terms. The document was developed by the Patients Association's lived experience advisory panel, Patient Voices Matter. During its meetings, it became clear that members didn't always know the meanings of some of the words and terms they were hearing during consultations with doctors and other healthcare professionals. Letters from the NHS were identified as a source of a lot of jargon. You can also suggest words and phrases to add to the dictionary.
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Content ArticlePatient Voices Matter (PVM), a lived experience advisory panel set up by The Patients Association, has highlighted how important it is to make information accessible to all potential users. In this blog, Sarah Tilsed Head of Patient Partnership, and Ray, a member of PVM, talk about the impact of jargon on health inequalities and the accessibility of health services. They also discuss their presentation in August 2022 to the NHS Health Inequalities Improvement Network.
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Content ArticleThe Women’s Health Strategy promises to address the poor experiences and worse health outcomes that women endure. The underlying cause of these issues is that the health system has historically been built by men for men. Consequently, women are often not listened to or believed by the health and care system. So, the crucial question is, will this strategy change the culture in the NHS of women not being listened to about their health and wellbeing?
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Content ArticleThis report revisits the conclusions of The Health Foundation's Covid-19 impact enquiry, which found that poor health and existing inequalities had left parts of the UK more vulnerable to the virus and had influenced its devastating impact. A year on from the impact inquiry, more than 90% of the UK population have had at least one Covid-19 infection, and 74% of adults had received three vaccinations by April 2022. This report considers: the further direct impact of Covid-19 on health outcomes. the broader implications for social determinants of health. the extent to which previously highlighted risks to health have been addressed. the implications for the country of ‘living with Covid-19’.
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Content ArticleThis report by Richard Norrie, director of the Statistics and Policy Research Programme at Civitas, aims to scrutinise the Race and Health Observatory (RHO) rapid evidence review into ethnic inequalities in healthcare published in February 2022. The report highlights inconsistencies in the review's use of research and data and argues that its conclusions do not reflect the full body of evidence available concerning race and health outcomes. The author suggests that the review makes a false assumption that the needs of all ethnic groups are the same, which leads to its potentially inaccurate conclusions about the prevalence and causes of health inequalities.
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Content ArticleThis statement from Chair Peter Wyman addresses allegations of bullying and racism within NHS Blood and Transplant as reported in The Times on 21 August 2022. In the statement, Peter Wyman says, "I cannot overstate the importance we place in ensuring we have a strong, positive and inclusive culture so we can serve the public and patients who need us. “Issues of racism and bullying came to light in parts of our organisation two years ago after an in-depth staff listening exercise. We’ve moved on a lot in the past two years. Our actions have included providing a safe way for staff to raise and discuss issues by appointing a Freedom to Speak Up Guardian, improving recruitment processes to be more inclusive, matured how we manage conflict and grievances and refreshing our code of conduct so we all know the behaviours that are expected of us. We continue to measure progress through ongoing staff engagement. “We are making progress but like every good organisation we should always be challenging ourselves to do even better. In particular, I want to ensure we have a culture that enables each of us to be our best, that encourages everyone to speak up without fear or favour if they see something wrong or something which might be done better. I want a culture where everyone is valued for who they are and what they contribute. "There can be no place for any form of discrimination, bullying or harassment.”
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