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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. -
News Article
Sickle cell: NHS to investigate racial inequalities for first time
Patient Safety Learning posted a news article in News
Sickle cell patients’ experiences of barriers to treatment and racial inequalities will be investigated by an NHS body next month, The Independent has learned. The NHS Race and Health Observatory has collaborated with Public Digital, a consultancy group, to lead original research into the experiences of people with sickle cell, including listening to NHS patients’ and carers’ first-hand accounts of acute emergency hospital admissions and managing the condition at home. Research will focus on a series of interviews and ‘experience mapping’ workshops, the findings of which are anticipated to inform recommendations that will help improve emergency care and treatment pathways. “As a priority, we need to discover new measures and treatment plans that can help eradicate the often unacceptable, substandard care people with sickle cell have historically received whilst being unwell and in acute pain,” Dr Habib Naqvi, Director of the NHS Race and Health Observatory, said. This move comes after a parliamentary inquiry into avoidable sickle cell deaths called upon the Observatory to undertake work into sickle cell care in relation to race and ethnicity. The inquiry published a report, ‘No one’s listening’, in November 2021, which uncovered the bleak reality of patients grappling with racism in the NHS while attempting to access healthcare. Only half of healthcare professionals feel they have sufficient tools to manage the long-term damage that sickle cell disease brings, new research from Global Blood Therapeutics found, following extensive studies carried out across 10 countries including the UK, US and Canada. Read full story Source: The Independent, 22 September 2022 -
News Article
Revealed: ‘disturbing’ race divide on cancer patients’ wait times in England
Patient-Safety-Learning posted a news article in News
Black and Asian people in England have to wait longer for a cancer diagnosis than white people, with some forced to wait an extra six weeks, according to a “disturbing” analysis of NHS waiting times. A damning review of the world’s largest primary care database by the University of Exeter and the Guardian discovered minority ethnic patients wait longer than white patients in six of seven cancers studied. Race and health leaders have called the results “deeply concerning” and “absolutely unacceptable”. The analysis of 126,000 cancer cases over a decade found the median time between a white person first presenting symptoms to a GP and getting diagnosed is 55 days. For Asian people, it is 60 days (9% longer). For black people, it is 61 days (11% longer). Michelle Mitchell, the chief executive of Cancer Research UK, which funded the research, said that while the differences are “unlikely to be the sole explanation for the inequalities in cancer survival”, at the very least “extended wait times may cause additional stress and anxiety for ethnic minority patients”. Read full story Source: The Guardian (28 August 2022) -
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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News ArticleA quarter of Black, Asian and minority ethnic (BAME) non-executive directors of NHS trusts have seen or experienced discrimination in the course of their work, a report reveals. While almost four out of five (79%) of these BAME non-executives said they challenged such behaviour when they encountered it, only half (50%) said that led to a change of policy or behaviour. The other half felt they had been ‘fobbed off’ or subjected to actively hostile behaviour for having spoken up,” says a report commissioned by the Seacole Group, which represents most of the BAME non-executive board members of NHS trusts in England. It adds: “This level of discrimination is unacceptable anywhere and even more so in the boardrooms of NHS organisations. Too many Black, Asian and other ethnic NEDs (non-executive directors) are being subjected to it and left to deal with it on their own.” Read full story Source: The Guardian, 21 July 2022
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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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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 ArticleOlder generations are becoming more diverse than ever, but also more unequal. Tackling these inequalities is important to ensure that everyone is able to live a good later life. This set of downloadable 'evidence cards' by the Centre for Ageing Better highlights the severe inequalities experienced by Black, Asian and Minority Ethnic groups approaching retirement age, and what causes these inequalities. The evidence cards are available to download as both PDF and image files.
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Content ArticleThe recent workforce race equality standard report described how staff from a Black and minority ethnic background are less well represented at senior levels of the NHS, and that they have worse day-to-day work experiences and face more challenges in progressing their careers. In this Nuffield Trust chart, Billy Palmer shows how stark some of the differences are.
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Content ArticleIn this blog for Refinery 29, journalist L'Oréal Blackett discusses the additional risk and associated worries faced by black pregnant women in the UK. With black women four times more likely to die in childbirth than white women, and 40% more likely to suffer a miscarriage, she examines what action the government is taking to improve outcomes for black women and their babies. She speaks to a number of campaigners who highlight the importance of including black women at every stage of research and policy to tackle race-based health inequalities, and who question whether this is being done by the UK government's new Maternity Disparities Taskforce. She also argues that empowering women to make informed, evidence-based decisions is the most effective way to improve maternal safety for black women.
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Content ArticleIn this blog for NHS Confederation, Kadra Abdinasir talks about how mental health services have failed to engage with young black men, and describes how services need to change to overcome the issue. She argues that delivering effective mental health support for young black men requires a move away from a crisis-driven response, to investment in system-driven, community-based projects. Kadra looks at learning from Shifting the Dial, a three-year programme recently piloted in Birmingham as a response to the growing and unmet needs of young black men aged 16 to 25. A recent report on the project found that most young men involved in Shifting the Dial reported good outcomes related to their wellbeing, confidence, sense of belonging and understanding of mental health.
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Content ArticleIn the 1790s, François Marie Prevost, a young French surgeon fresh from his medical training in Paris moved to Port-de-Paix, Haiti. “Of course at that time Haiti was France's most economically valuable colony”, says historian Deirdre Cooper Owens. “So there he began some experimental work on enslaved Haitian women, trying to perfect the caesarean section.” Prevost's sojourn coincided with the leadership of Toussaint Louverture, who had been born a slave, the fight for Haitian independence, and the abolition of slavery. And so Prevost left Haiti for Louisiana. “He moved to a little town outside of Baton Rouge, and began experimental surgery on enslaved women there, perfecting the caesarean section, and he did this in the 1830s, the era before the civil war that ends slavery.” It was also an era in which Louisiana surgeons were reluctant to attempt the experimental surgery on white women. Of the 15 caesarean sections done by Prevost and others in Louisiana between 1820 and 1861, all were performed on enslaved women. “At the time, in the 19th century, during the time of slavery, they couldn’t consent”, she explains. “But this is the really interesting thing: from the 1830s all the way to the 21st century, Louisiana has been in the top three states with the most caesarean sections on Black women patients…So what's going on, did all of these women need to have caesarean sections?”
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News Article
Experts warn of racial disparities in the diagnosis and treatment of Long Covid
Patient Safety Learning posted a news article in News
It has long been clear that Black Americans have experienced high rates of coronavirus infection, hospitalisation and death throughout the pandemic. But those factors are now leading experts to sound the alarm about what will may come next: a prevalence of Long Covid in the Black community and a lack of access to treatment. Long Covid — with chronic symptoms like fatigue, cognitive problems and others that linger for months after an acute coronavirus infection has cleared up — has perplexed researchers, and many are working hard to find a treatment for people experiencing it. But health experts warn that crucial data is missing: Black Americans have not been sufficiently included in Long-Covid trials, treatment programmes and registries, according to the authors of a new report released on Tuesday. “We expect there are going to be greater barriers to access the resources and services available for Long Covid,” said one of the authors, Dr. Marcella Nunez-Smith, who is the director of Yale University’s health equity office and a former chair of President Biden’s health equity task force. “The pandemic isn’t over, it isn’t over for anyone,” Dr. Nunez-Smith said. “But the reality is, it’s certainly not over in Black America.” In the first three months of the pandemic, the average weekly case rate per 100,000 Black Americans was 36.2, compared with 12.5 for white Americans, the authors write. The Black hospitalisation rate was 12.6 per 100,000 people, compared with 4 per 100,000 for white people, and the death rate was also higher: 3.6 per 100,000 compared with 1.8 per 100,000. “The severity of Covid-19 among Black Americans was the predictable result of structural and societal realities, not differences in genetic predisposition.” "Many Black Americans who contracted the coronavirus experienced serious illness because of pre-existing conditions like obesity, hypertension and chronic kidney disease, which themselves were often the result of “differential access to high-quality care and health promoting resources,” the report says. Read full story (paywalled) Source: New York Times, 29 March 2022 -
News Article
CDC is asked to release race and gender data on Long Covid
Patient Safety Learning posted a news article in News
Lawmakers say minorities may disproportionately suffer from long-term symptoms of coronavirus infection. A pair of Democratic House members asked the Centers for Disease Control and Prevention (CDC) in a letter Tuesday to release data on the number of Americans who suffer lingering symptoms of coronavirus infection, including breakdowns along race, gender and age. The National Institutes of Health and the CDC have launched detailed studies of Long Covid, but those examinations are expected to take years. In the meantime, policymakers lack good information about how many people in the United States and worldwide suffer from long-term, debilitating effects of the disease. “People suffering from Long Covid have been ignored and overlooked for far too long. Collecting and publishing robust, disaggregated demographic data will help us better understand this illness and ensure that we are targeting lifesaving resources to those who need them most,” said Rep. Ayanna Pressley, who co-signed the letter Tuesday to the CDC.“We’re calling on the CDC to publicly report this data because that which gets measured gets done — and we can’t have an equitable recovery from this pandemic without it.” Read full story Source: The Washington Post, 25 January 2022 -
News ArticleThe NHS has been accused by a major charity of failing to address the emerging gap in Covid booster vaccine coverage for racialised communities. Blood Cancer UK has told The Independent it has “serious concerns” over what it claims is a “shocking” lack of urgency from the NHS in addressing the gap in booster vaccine doses for immunocompromised people from black and minority ethnic communities. The charity has said NHS England has failed to set out any “concrete” plans since it revealed 84% of immunocompromised people from a white British background had three vaccine doses by mid-December, compared to just 43% of immunocompromised people from a Pakistani background. The news comes after the government announced people over 75 and immunocompromised children would be eligible to receive a fourth Covid vaccine by Spring. According to an analysis published by Open Safely, a team of data scientists at Oxford University, of those who are part of the shielding population, as of the 22 February just 72% of Black people have had their booster does, and 73% of south Asian people. This compares to 89% of white people. NHS England has highlighted a number of actions it is taking to address the situation such as using pop-up sites within communities and providing free transport. Speaking with The Independent chief executive of Blood Cancer UK Gemma Peters, said: “We have serious concerns about how the poor roll-out of third doses for the immunocompromised has left people from some communities much less well-protected than people from a white British background. But while it is deeply troubling that a racial disparity in access to third vaccine doses has been allowed to develop, just as shocking has been NHS England’s apparent lack of urgency in addressing it." Read full story Source: The Independent, 25 February 2022
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News ArticleMedical records contain a plethora of information, from a patient’s diagnoses and treatments to marital status to drinking and exercise habits. They also note whether a patient has followed medical advice. A health provider may add a line stating that the patient is “noncompliant” or “non-adherent,” signalling that the patient has been uncooperative and may exhibit problematic behaviours. Two large new studies in the US found that such terms, while not commonly used, are much more likely to appear in the medical records of Black patients than in those of other races. The first study, published in Health Affairs, found that Black patients were two and a half times as likely as white patients to have at least one negative descriptive term used in their electronic health record. About 8% of all patients had one or more derogatory terms in their charts, the study found. The most common negative descriptive terms used in the records were “refused,” “not adherent,” “not compliant” and “agitated.” The second study, published in JAMA Network Open, analysed the electronic health records of nearly 30,000 patients at a large urban academic medical centre between January and December 2018. The study looked for what researchers called “stigmatising language,” comparing the negative terms used to describe patients of different racial and ethnic backgrounds as well as those with three chronic diseases: diabetes, substance use disorders and chronic pain. Overall, 2.5% of the notes contained terms like “nonadherence,” “noncompliance,” “failed” or “failure,” “refuses” or “refused,” and, on occasion, “combative” or “argumentative.” But while 2.6% of medical notes on white patients contained such terms, they were present in 3.15% of notes about Black patients. Looking at some 8,700 notes about patients with diabetes, 6,100 notes about patients with substance use disorder and 5,100 notes about those with chronic pain, the researchers found that patients with diabetes — most of whom had type 2 diabetes, which is often associated with excess weight and called a “lifestyle” disease — were the most likely to be described in negative ways. Nearly 7% of patients with diabetes were said to be noncompliant with a treatment regimen, or to have “uncontrolled” disease, or to have “failed.” The labels have consequences, warns Dr. Schillinger, who directs the Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. “Patients whose physicians tend to judge, blame or vilify them are much less likely to have trust in their doctors, and in the medical system overall,” Dr. Schillinger said. “Having health care providers who are trustworthy — who earn their patients’ trust by not judging them unfairly — is critical to ensuring optimal health and eliminating health disparities.” Read full story (paywalled) Source: The New York Times, 20 February 2022
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Content ArticleIn this blog for the Hospital Times, Tracy Bignall, Senior Policy and Practice Officer at the Race Equality Foundation, writes about how ethnicity impacts on women's health experiences. She argues that the The Department for Health and Social Care (DHSC) Vision for the Women's Health Strategy released in December 2021 does not give adequate attention to the influence that ethnicity has on women's experience of, and outcomes in healthcare. The article outlines instances in healthcare where ethnicity has an impact on women's health and calls for specific action to address how ethnicity influences health inequalities.
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Content ArticleMovements change the world. Throughout history, loosely organised networks of individuals and organisations have sought changes to societies – and won. From the abolitionist struggle and campaigns for voting rights to #MeToo and #BlackLivesMatter, the impact of movements can be seen everywhere.
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News ArticleEfforts to end health inequalities should be ‘in the mix’ of metrics used to determine the NHS’ progress against key performance targets, say race inequality experts. In an exclusive interview with HSJ, NHS Race and Health Observatory (RHO) director Habib Naqvi said organisations’ performance on the issue should be scrutinised by an external body to ensure they are held accountable and “not marking their own exam answer”. It comes as the RHO publishes a report that warns the appointment of health inequalities leads across the NHS risks becoming “tokenistic” if they are not adequately supported and held accountable. The report by The King’s Fund think tank has recommended several actions to prevent the introduction of board-level leads from becoming a “hollow gesture”. In August 2020, NHS England asked all NHS organisations to have a named executive board member responsible for tackling inequalities by October that year. The RHO estimates there to be more than 450 of these named leads across the country. The report welcomed this but added “frameworks” of support and accountability should exist to “empower individuals and motivate change”. The recommendations include putting inequalities on an “equal footing” with key performance metrics, as well as a long-term policy focus that puts addressing inequalities “at the heart of system development”. Read full story (paywalled) Source: HSJ, 1 December 2021
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News Article
NHS race body commits to avoiding blanket terms such as ‘BAME’
Patient Safety Learning posted a news article in News
An independent body set up by the NHS to tackle health inequalities has formally committed to never use blanket acronyms such as “BAME” after feedback that they are not representative. The NHS Race and Health Observatory launched a four-week consultation with the public in July on how best to collectively refer to people from black, Asian and minority ethnic groups. The Observatory said it has become the norm in public policy to use initialisms to refer to a “hugely diverse” group of people, but that renewed scrutiny has been spurred on by the Black Lives Matter movement. It said terminology that “crudely conflates” different groups “does not just erase identities; it can also lead to broad brush policy decisions that fail to appreciate the nuance of ethnic inequality in the UK”. Generic collective terms such as “BAME”, “BME” and “ethnic minority” are “not representative or universally popular”, the Observatory said after receiving responses from 5,104 people. It found no single, collective umbrella term to describe ethnic groups was agreed by the majority of respondents. The body had previously said it was committed to avoiding the use of acronyms and initialisms, but has now formalised this as one of five key principles it is adopting in its communications. Where possible it will be specific about the ethnic groups it is referring to, but where collective terminology is necessary it will “always be guided by context and not adopt a blanket term”. Read full story Source: The Independent, 26 November 2021 -
News ArticleThe system for assessing who should be asked to pay for NHS services “incentivises racial profiling”, an investigation has found. A study by the Institute for Public Policy Research found that overstretched NHS staff sometimes racially profile patients in order to determine who is not “ordinarily resident” in the UK, and therefore must pay for their care. The report is critical of the more stringent charging regime introduced by NHS England over the past decade as part of a series of measures devised to create a hostile environment for people living in the UK without the correct immigration status. Overseas visitors officers have been appointed by NHS trusts, responsible for identifying chargeable patients, as part of a cost recovery programme launched in 2014. One of the officers told the IPPR study they had felt forced to discriminate between patients based on their name. “If you’ve got a, I don’t know, Mohammed Khan and a Fred Cooper, you’re obviously going to go for [investigating] the Mohammed Khan … Even for someone who’s, you know, well I’d like to think hopefully open-minded, like myself, you’re just trying to save yourself time because there’s not enough hours in the day,” the officer said. A hospital employee also reported that discrimination on the basis of ethnicity was used to determine who should be billed for treatment. “It’s a system that is designed to benefit [white] people like me, not people like … the patient on intensive care who is black and British and was unconscious and sent a bill. So why did someone think he was not eligible for care? Given he was unconscious most of the admission, significantly unwell, probably not his accent, more likely his skin colour,” the health worker said. Under the rules, anyone “not ordinarily resident” in the UK should be charged 150% of the NHS national tariff for most secondary (non-urgent) healthcare, but the report found that processes varied across the country, with a lack of consistent training and widespread confusion over the 130-page rules for the charging system. Some healthcare staff told IPPR researchers that they disliked the extra burden of having to consider whether to refer a patient for charging, which they felt distracted them from their core medical responsibilities. Read full story Source: The Guardian, 23 November 2021
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Content Article
House of Commons Debate - Black Maternal Health Week (14 September 2021)
Mark Hughes posted an article in Maternity
This is the transcript of a Westminster Hall debate in the House of Commons on Black Maternal Health Awareness Week, dedicated to raising awareness about the disparities in maternal outcomes for Black women. -
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
