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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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Content Article“Structural racism” refers to the ways in which historical and contemporary racial inequities in outcomes are perpetuated by social, economic, and political systems, including mutually reinforcing systems of health care, education, housing, employment, the media, and criminal justice. It results in systemic variation in opportunity according to race or ethnic background — for example, in racial differentials in access to health care. Ansell et al. use the case study of a 60-year-old Black woman with breast cancer as an example of structural racism and propose three critical strategies for addressing structural racism in health care. These strategies hinge on shifting the focus of work on racial differences in health outcomes from biologic or behavioural problems to the design of health care organisations and other social institutions.
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Content ArticleBlack, Latinx, and Native Americans are experiencing disproportionate burdens of infections, hospitalisations, and deaths from COVID-19. Similar disparities are observed in other countries where minority groups face hurdles in accessing health, education, and social services as well as affordable, healthy food. These stark manifestations of health inequities have emerged in the wake of a body of evidence linking obesity and obesity-related chronic diseases, such as hypertension, diabetes, and cardiovascular disease — conditions that disproportionately affect disadvantaged populations — with severe outcomes from COVID-19. Though the factors underlying racial and ethnic disparities in COVID-19 in the United States are multifaceted and complex, long-standing disparities in nutrition and obesity play a crucial role in the health inequities unfolding during the pandemic.
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Content ArticleAs the race to develop a vaccine for COVID-19 has reached phase 3 clinical trials, concerns are increasing about the low rates of trial participation in important subgroups, including Black communities. Recent data show that although Black people make up 13% of the US population, they account for 21% of deaths from COVID-19 but only 3% of enrollees in vaccine trials. This problem threatens both the validity and the generalisability of the trial results and is of particular concern in vaccine trials, in which differences in lifetime environmental exposures can result in differences in immunologic responses that could affect both safety and efficacy. Despite long-standing calls from the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) to improve the participation of underrepresented subgroups in drug trials, the problem persists. Warren et al., in an article in the New England Journal of Medicine, explore what the barriers are to greater participation of Black people in COVID-19 trials.
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Content ArticleAppalling racial inequities in health exist in nearly every realm that researchers have examined. These inequities are a dramatic manifestation of the structural violence that plagues our society. Deborah Cohan, an obstetrician, gives her perspective on this in her article in the New England Journal of Medicine. "How am I confronting the underlying forces that facilitate increased suffering and death among certain groups because of their skin color? Although it’s necessary, it is not enough for me to provide respectful health care to pregnant women of color. If I truly want to be part of the solution, I need to explore those parts of me that are most unwholesome, embarrassing, unflattering, and generally not discussed in the context of one’s career." Her goal is to dismantle the insidious thoughts that reinforce a hierarchy based on race, education, and other markers of privilege that separate her from others. "These thoughts, fed by implicit bias, are more common than I find easy to admit. Although I know not to believe everything I think, I also know that thoughts guide attention, and attention guides actions. Until I bring to light and hold myself accountable for my own racist tendencies, I am contributing to racism in health care."
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Content ArticleDisparities in healthcare exist because of socioeconomic factors, structural racism and implicit bias. The panelists in this video identify the problems and discuss what solutions are in place that could improve health disparities such as medical education, more training for underrepresented minority physicians, more funding for research, and fast-tracking publication of research. Furthermore, the panelists explore how the field of dermatology and other medical specialties can address these issues.
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Content ArticleThis report is the product of a review by Baroness Doreen Lawrence, commissioned by the Labour Party, into the disproportionate impact of Covid-19 on Black, Asian and minority ethnic communities. In her introduction to the report, Baroness Lawrence says: "Black, Asian and minority ethnic people have been overexposed, under protected, stigmatised and overlooked during this pandemic – and this has been generations in the making. The impact of Covid is not random, but foreseeable and inevitable – the consequence of decades of structural injustice, inequality and discrimination that blights our society. We are in the middle of an avoidable crisis. And this report is a rallying cry to break that clear and tragic pattern."
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Black women’s health matters (October 2020)
PatientSafetyLearning Team posted an article in Women's health
To mark Black History Month 2020, blog site Hysterical Women has launched it's first mini series, exploring black women’s healthcare experiences. The contributions of five black writers, shine a light on: black health and healthcare experiences black motherhood, black pain black mental health the experiences of black healthcare professionals.- Posted
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Content ArticleAs the UK emerges from the COVID-19 pandemic ‘Build Back Better’ has become the mantra. Important, but we need to Build Back Fairer. The levels of social, environmental and economic inequality in society are damaging health and wellbeing. The aim of this report from the Institute of Health Equity is three-fold: To examine inequalities in COVID-19 mortality. Focus is on inequalities in mortality among members of BAME groups and among certain occupations, alongside continued attention to the socioeconomic gradient in health – the more deprived the area, the worse COVID-19 mortality tends to be. To show the effects that the pandemic, and the societal response to contain the pandemic, have had on social and economic inequalities, their effects on mental and physical health, and their likely effects on health inequalities in the future. To make recommendations on what needs to be done.
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Content ArticleIn this analysis, published by the BMJ, professor of public health, Sarah Salway and colleagues, argue that the UK health system must take urgent action to better understand and meet the health needs of migrants and ethnic minority people.
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Content ArticleOn 30 May 2020, NHS England and the NHS Confederation launched the NHS Race and Health Observatory, a new centre to investigate the impact of race and ethnicity on people’s health and to identify and tackle the specific health challenges facing people of black and ethnic minority origin.
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Content ArticleIn medical schools, students seek robust and mandatory anti-racist training. Activists especially want to see their institutions recognise their own missteps, as well as the racism that has accompanied past medical achievements. Read Elizabeth Lawrence's article in the Washington Post.
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Content Article17 September 2020 marks the second annual World Patient Safety Day. The theme this year is 'Health Worker Safety: A Priority for Patient Safety'. In the run up to this special event, Patient Safety Learning are publishing a series of interviews with staff from across the health and care system to highlight key issues in staff safety and gain a clearer idea of the kind of change that needs to take place to keep staff, and ultimately patients, safe. In this interview, Yvonne Coghill, Director, Workforce Race Equality, NHS London and nurse by background, shares her insight.
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Content ArticleMind the Gap is a Handbook to raise awareness of how symptoms and signs can present differently on darker skin as well as highlighting the different language that needs to be used in descriptors.The aim of this booklet is to educate students and essential allied health care professionals on the importance of recognising that certain clinical signs do not present the same on darker skin. This is something which is not commonly practised in medical textbooks. It is important that healthcare professionals are aware of these differences so that care of certain groups is not compromised.
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Content ArticleWith evidence of the impact of COVID-19 on BAME communities, on 15 April 2020 NHS England CEO Simon Stevens convened a meeting of leaders in healthcare and representative bodies such as the British Medical Association and Royal College of Nursing to agree a plan of action to support staff. The NHS response has since been underpinned by three principles of protecting, supporting, and engaging staff.
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Content ArticleThis is a report and survey analysis from Runnymede, the UK’s leading independent thinktank on race equality and race relations. Results show that black and minority ethnic (BME) people face greater barriers in shielding from coronavirus as a result of: the types of employment they hold (BME men and women are overrepresented among key worker roles)having to use public transport moreliving in overcrowded and multigenerational households morenot being given appropriate PPE (personal protective equipment) at work. In all of these areas, most BME groups are more likely to be over-exposed and under-protected compared with their white British counterparts.
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Content ArticleHow is COVID-19 repeating patterns of existing health inequalities? What factors are driving the disproportionate impact of the pandemic on the health of ethnic minority populations? And what needs to happen next? Helen McKenna talks to Natalie Creary, Programme Delivery Director at Black Thrive, and James Nazroo, Professor of Sociology at the University of Manchester.
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Content ArticleThis US study, published in Pediatrics, found that even among apparently healthy children, being African American is strongly associated with a higher risk of postoperative complications and mortality. Mechanisms underlying the established racial differences in postoperative outcomes may not be fully explained by the racial variation in preoperative comorbidity.
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NHS Workforce Race Equality Standard (WRES)
PatientSafetyLearning Team posted an article in Health inequalities
The Workforce Race Equality Standard (WRES) is a set of metrics that would requires NHS organisations to demonstrate progress against a number of indicators of race equality, including a specific indicator to address the low representation of black and minority ethnic (BME) staff on Boards. NHS providers are expected to show progress against a number of indicators of workforce equality, including a specific indicator to address the low numbers of BME board members across the organisation. Follow the link below to find out more about WRES and to access the annual reports.- Posted
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Content ArticlePrevious studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a paediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool was used. The GAPPS analysis revealed racial and/or ethnic and socioeconomic disparities in rates of AEs experienced by hospitalised children across a broad range of geographic and hospital settings. Further investigation may reveal underlying mechanisms of these disparities and could help hospitals reduce harm. This study was published by US-based journal, Hospital Pediatrics.
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Content ArticleThis methodological review of racial/ethnic disparities in patient safety in the United States was published in the Journal of Patient Safety. The paper concludes that although there is extensive evidence on disparities in the process and outcomes of health care, data on racial and ethnic disparities in patient safety remain inconclusive in the United States.
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Content ArticleThe aim of the study, published in the Journal of Patient Safety, was to determine whether race differences exist in voluntarily reported harmful patient safety events in a large 10 hospital healthcare system on a high reliability organisation journey. Findings showed that race differences in harmful events exist in voluntary reporting systems by type and by hospital setting. Healthcare organisations, particularly healthcare high reliability organisations, can use these findings to help identify areas of further study and investigation. Further study and investigation should include efforts to understand the root cause of the differences found in this study, including the role of reporting bias.