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News Article
Covid vaccine: 72% of black people unlikely to have jab, UK survey finds
Patient Safety Learning posted a news article in News
Advisers from the Scientific Advisory Group for Emergencies (Sage) have raised fresh concerns over Covid vaccine uptake among black, Asian and minority ethnic communities (BAME) as research showed up to 72% of black people said they were unlikely to have the jab. Historical issues of unethical healthcare research, and structural and institutional racism and discrimination, are key reasons for lower levels of trust in the vaccination programme, a report from Sage said. The figures come from the UK Household Longitudinal Study, which conducts annual interviews to gain a long-term perspective on British people’s lives. In late November, the researchers contacted 12,035 participants to investigate the prevalence of coronavirus vaccine hesitancy in the UK, and whether certain subgroups were more likely to be affected by it. Overall, the study found high levels of willingness to be vaccinated, with 82% of people saying they were likely or very likely to have the jab – rising to 96% among people over the age of 75. Women, younger people and those with lower levels of education were less willing, but hesitancy was particularly high among people from black groups, where 72% said they were unlikely or very unlikely to be vaccinated. Among Pakistani and Bangladeshi groups this figure was 42%. Eastern European groups were also less willing. “Trust is particularly important for black communities that have low trust in healthcare organisations and research findings due to historical issues of unethical healthcare research,” said the Sage experts. “Trust is also undermined by structural and institutional racism and discrimination. Minority ethnic groups have historically been underrepresented within health research, including vaccines trials, which can influence trust in a particular vaccine being perceived as appropriate and safe, and concerns that immunisation research is not ethnically heterogenous.” Read full story Source: The Guardian, 16 January 2021 -
News ArticleWhen 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
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News ArticleRachel 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
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News Article
Covid: Pulse oxygen monitors work less well on darker skin, experts say
Patient-Safety-Learning posted a news article in News
Experts have warned that a device used to detect signs of oxygen level drops may not work as well on darker skin. According to NHS England and MHRA, pulse oximeters may sometimes overestimate oxygen levels. Now, NHS England is updating their guidance advising patients patients from black, Asian and other ethnic minority groups to seek advice from their healthcare professional, but to continue using pulse oximeters. "We need to ensure there is common knowledge on potential limitations in healthcare equipment and devices, particularly for populations at heightened risk of life-changing illness, this includes black, Asian and diverse communities using pulse oximeters to monitor their oxygen levels at home," says Dr Habib Naqvi, director of the NHS Race and Health Observatory. Read full story. Source: BBC, 1 August 2021 -
News Article
Major trust faces bullying concerns from hundreds of senior doctors
Patient Safety Learning posted a news article in News
Concerns over bullying and discrimination have been raised in a survey of hundreds of doctors at a major hospital trust, HSJ can reveal. University Hospitals of North Midlands Trust’s medical staff committee carried out a survey of its doctors earlier this year, after bullying concerns were raised by members of the British Association of Physicians of Indian Origin at the trust. A summary of the survey findings, published in a newsletter sent to all doctors at the trust last week and seen by HSJ, showed more than two-thirds of the 348 respondents claimed to have experienced bullying, harassment or victimisation at work. Nearly 80% said they had witnessed bullying or harassment, while 50 per cent of respondents said the bullying and harassment was due to race or ethnicity. Fifty-five per cent of those answering the survey also said they had not reported concerns as they had “no confidence in the investigative process within the organisation”. Read full story (paywalled) Source: HSJ, 2 June 2021 -
EventuntilThe results from the Five X More nationwide survey on Black women’s maternity experiences will be officially launching on Tuesday 24th May "No decisions about us, without us" For many years Black women and birthing people in the UK have experienced poorer health outcomes and lower quality of care. This is particularly true within maternity. In the recent MBRRACE reports, clear racial variations in maternal deaths were observed, showing that Black women are four times as likely to die as white women during pregnancy, delivery or postpartum, yet the reasons for the differences in maternal outcomes remain unclear. We believe a crucial step to solving this is to understand how maternity care is delivered from the perspective of women from the Black community. Join us as we delve further into the statistics of this landmark study completed by over 1300 respondents and hear updates from our special guest keynote speakers TBA.
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Content Article
ARMA - MSK Health inequalities resources
Patient-Safety-Learning posted an article in Health inequalities
The Arthritis and Musculoskeletal Alliance (ARMA) has compiled relevant and useful resources and information specifically about musculoskeletal health inequalities. The resources include research studies, reports and reviews, and cover these areas: Social deprivation Ethnicity Sex, gender and sexual orientation Health literacy and education level Multiple factors Children and young people Webinars -
Content ArticleMaternal outcomes for Black women are significantly worse than for white women - Black women are four times more likely to die during pregnancy, labour, or postpartum and are twice as likely to have their baby die in the womb or soon after birth. They are also at an increased risk of readmission to hospital in the six weeks after giving birth. This report by the organisation Five X More presents the findings of a survey into black women's experiences of maternity services in the UK. The survey aimed to understand how maternity care is delivered from the perspective of women from the Black community, and 1,340 Black and Black mixed women responded, sharing their experiences. It seeks to highlight the real life encounters behind the known disparities in maternal care. Women reported far more negative experiences than positive, and most of these experiences centred around interactions with healthcare professionals. The authors highlight three factors related to healthcare professionals that contribute to damaging interactions, to do with their attitudes, knowledge and assumptions. The report includes many quotes from Black women about their experiences of NHS care and the damaging long-term consequences of this, such as fear of having another baby, reluctance to engage with health services and mental health issues.
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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 ArticleInfographic highlighting statistics on ethnic health inequalities in the UK.
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Content ArticleThis opinion piece in the BMJ by Partha Kar, Director of Equality for Medical Workforce in the NHS, explores racial inequalities in the NHS workforce. Partha is currently leading work on the Medical Workforce Race Equality Standard (MWRES), which aims to challenge trusts and systems openly and transparently about race-based inequalities faced by NHS doctors.
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Content ArticleIt is well known that pausing planned hospital care during the pandemic worsened growing waiting lists, and that waits for routine care now stand at record-breaking levels. This research from the Nuffield Trust, supported by the NHS Race and Health Observatory, looks at how the fallout from the pandemic affected people across different ethnic groups, and whether that impact was spread evenly.
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Content ArticleRacism is unacceptable and it has no place in health and care. But we know that it exists and that the impact on staff can be devastating. All registered professionals have responsibility under the Nursing and Midwifery Council (NMC) Code to challenge discriminatory behaviour, creating an environment where people are treated as individuals and with dignity and respect. This resource is firmly rooted in our professional Code and it is designed to support nurses, midwives and nursing associates, providing advice on the action you can take if you witness or experience racism. It also supports those in leadership roles to be inclusive leaders. This document provides practical examples of how, as nursing and midwifery professionals, you can recognise, and challenge racial discrimination, harassment, and abuse. It also highlights other useful resources and training materials that will support you to care with confidence. This document is a resource for individuals at all levels. This resource does not replace existing NHS England policies and procedures for speaking up and managing racism. It is a resource to support best practice in line with organisational policies and procedures.
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Content ArticleThis is the transcript of a Westminster Hall debate in the House of Commons on Black Maternal Health Awareness Week 2022, dedicated to raising awareness about disparities in maternal outcomes.
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Content ArticleThis article* is an update from Dr Henrietta Hughes, Patient Safety Commissioner for England.
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Content Article
NICE and health inequalities (October 2022)
Patient-Safety-Learning posted an article in NICE
Health inequalities are differences in health across the population, and between different groups in society, that are systematic, unfair and avoidable. This webpage from the National Institute for Health and Care Excellence (NICE) outlines a definition of health inequalities. highlights factors that cause them, explores their effects and talks about how NICE can help health services tackle health inequalities. -
EventWestminster Health Forum policy conference. The agenda: Assessing the impact of COVID-19 on the ethnic minority community, and priorities for improving health outcomes. The health and social care response to inequality through the pandemic and taking forward new initiatives. Understanding the data and risk factors for COVID-19 in ethnic minority groups. Wider health inequalities faced by people in ethnic minorities - addressing underlying factors, and the role of COVID-19 recovery strategies in supporting long-term change. Priorities for providing leadership in tackling health inequalities in the workforce. Driving forward and ensuring race equality in the NHS. Providing support to the ethnic minority health workforce and taking forward key learnings from COVID-19. Next steps for action in race disparity in healthcare. Book
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EventJoin clinical experts, thought leaders, and advocates for a collaborative discussion on the issues of health disparities, structural racism, and medicine as they examine specific dermatologic diseases in a series of four free and open educational webinars from the Harvard Medical School. Structural racism and racial bias in medicine: Wednesday, October 28, 1:00-2:15 PM ET Hair disorders in people of colour: Thursday, November 12, 1:00-2:15 PM ET Pigmentary disorders and keloids: Wednesday, November 18, 1:00-2:15 PM ET COVID-19 Comorbidities and cutaneous manifestations of systemic diseases in adults and children: Wednesday, December 2, 1:00-2:15 PM ET Implicit bias and structural racism play a central role in the development of healthcare disparities. One of the critically important areas in medicine is the misdiagnosis of disease in people with darker skin types due to implicit bias and the lack of awareness among physicians in recogniszing the disease pattern. Clinicians in primary care, emergency medicine, hospital medicine, surgery, pediatrics, and other medical specialties can deliver improved care if they can recognize and diagnose medical conditions based on skin findings in patients of color. This four-part series aims to improve diagnosis in people of color, describe pathogenesis and treatment of diseases, develop cultural competency, and impact change in health care policy so more is done to reduce racial bias in medical practice and medical research. Providing this education, in turn, will ultimately help reduce health disparities and improve the lives of underrepresented minority populations. Register for one event or all four.
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Content ArticlePatients from ethnic minority groups are disproportionately affected by Coronavirus disease (COVID-19). Sze et al. performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19. They found that individuals of Black and Asian ethnicity are at increased risk of COVID-19 infection compared to White individuals; Asians may be at higher risk of ITU admission and death. These findings are of critical public health importance in informing interventions to reduce morbidity and mortality amongst ethnic minority groups.
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Content ArticleIn this blog, published by the Institute for Healthcare Improvement, Kedar Mate discusses the need to explicitly address race and racism in order to work towards health equity. "We never legislated long waiting times. We never imposed rules, regulations, customs, and norms for ineffective care. We did, however, legislate inequity."
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Content Article
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Pain is spoken about often within health and social care. Patients might be asked to locate our pain during examinations, to rate our level of pain or to describe the type of pain we are feeling. They may be forewarned of the possibilities of pain occurring during or after procedures or operations. Medical consent forms often include reference to the risk of pain and require a signature to confirm they have been appropriately ‘informed’. Pain can be acute (lasting less than 12 weeks) or chronic (lasting more than 12 weeks), and the way we experience it, our thresholds, can also vary. It can be our body’s way of warning us of potential damage, yet it can also occur when no actual harm is happening to the body.[1] It can cause trauma, physiological reactions, mental health difficulties and chronic fatigue, and can have a huge impact on someone’s quality of life and ability to perform daily tasks.[2] Pain is undoubtedly complex, but is it a patient safety issue?[3] -
Content ArticleThe term “racism” is rarely used in the medical literature. Most physicians are not explicitly racist and are committed to treating all patients equally. However, they operate in an inherently racist system. Structural racism is insidious, and a large and growing body of literature documents disparate outcomes for different races despite the best efforts of individual healthcare professionals. If we aim to curtail systematic violence and premature death, clinicians and researchers will have to take an active role in addressing the root cause. Structural racism, the systems-level factors related to, yet distinct from, interpersonal racism, leads to increased rates of premature death and reduced levels of overall health and well-being. Like other epidemics, structural racism is causing widespread suffering, not only for black people and other communities of colour but for our society as a whole. It is a threat to the physical, emotional, and social well-being of every person in a society that allocates privilege on the basis of race. Hardeman et al. believe that as clinicians and researchers, we wield power, privilege, and responsibility for dismantling structural racism — and in this New England Journal of Medicine article the authors highlight recommendations for clinicians and researchers who wish to do so.
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Content Article
Diagnosing and treating systemic racism (16 July 2020)
Sam posted an article in Health inequalities
For physicians, the words “I can’t breathe” are a primal cry for help. As many physicians have left their comfort zones to care for patients with COVID-19–associated respiratory failure, the role of the medical profession in addressing this life-defining need has rarely been clearer. But as George Floyd’s repeated cry of “I can’t breathe” while he was being murdered by a Minneapolis police officer has resounded through the country, the physician’s role has seemed less clear. Police brutality against black people, and the systemic racism of which it is but one lethal manifestation, is a festering public health crisis. Can the medical profession use the tools in its armamentarium to address this deep-rooted disease? Evans et al. explore this further in an Editorial in the New England Journal of Medicine. -
Content ArticleOur understanding of race and human genetics has advanced considerably, yet these insights have not led to clear guidelines on the use of race in medicine. The result is ongoing conflict between the latest insights from population genetics and the clinical implementation of race. For example, despite mounting evidence that race is not a reliable proxy for genetic difference, the belief that it is has become embedded, sometimes insidiously, within medical practice. One subtle insertion of race into medicine involves diagnostic algorithms and practice guidelines that adjust or “correct” their outputs on the basis of a patient’s race or ethnicity. Physicians use these algorithms to individualise risk assessment and guide clinical decisions. By embedding race into the basic data and decisions of health care, these algorithms propagate race-based medicine. Many of these race-adjusted algorithms guide decisions in ways that may direct more attention or resources to white patients than to members of racial and ethnic minorities. To illustrate the potential dangers of such practices, Vyas et al. have compiled a partial list of race-adjusted algorithms.
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Content ArticleMedicine is a mirror for the racial injustice in our society; it is a field riddled with racial disparities in everything from research funding to patient care to life expectancy. There may be no population of patients whose healthcare and outcomes are more affected by racism than those with sickle cell disease (SCD). Patients with SCD are too often marginalised and dismissed while seeking medical care when their bodies hurt and they cannot breathe. As medical leaders around the United States issue statements denouncing racial injustice and calling for us to “dismantle racism at every level,” we must ensure that these pledges translate into durable improvements for patients with SCD. Alexandra Power-Hays and Patrick T. McGann propose a number of changes to reduce the impact of racism on patients with SCD in the US.
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