Racism, discrimination and poor ethnicity data have for years “negatively impacted” the health of black, Asian and minority ethnic people in England and radical action is needed to tackle the “overwhelming” inequalities, found an independent report commissioned by the National Health Service (NHS).
The study found that “vast” and “widespread” inequity in every aspect of healthcare it reviewed was harming the health of millions of patients.
The review, reports The Guardian, was commissioned by the NHS Race and Health Observatory, an independent expert body appointed by the NHS to investigate race issues in health care, and exposed for the first time the scale of health inequalities faced by ethnic minorities.
“Ethnic inequalities in health outcomes are evident at every stage throughout the life course, from birth to death,” says the review, the largest of its kind. Yet despite “clear”, “convincing” and “persistent” evidence that ethnic minorities are being failed, and repeated pledges of action, no “significant change” has yet been made in the NHS.
From mental health to maternity care, the sweeping 166-page review led by the University of Manchester paints a devastating picture of a healthcare system still failing minority ethnic patients, despite concerns previously raised about the harm being caused.
“By drawing together the evidence, and plugging the gaps where we find them, we have made a clear and overwhelming case for radical action on race inequity in our healthcare system,” said Habib Naqvi, the director of the NHS Race and Health Observatory, an independent body established by the NHS in 2020 to investigate health inequalities in England.
The review concludes that inequalities in access to, experiences of, and outcomes of healthcare in the NHS “are rooted in experiences of structural, institutional and interpersonal racism”. For “too many years”, it adds, the health of minority ethnic people in England has been “negatively impacted” by a lack of appropriate treatment, poor quality or discriminatory treatment by NHS staff, missing ethnicity data from NHS systems, and delays in seeking help for health issues “due to fear of racist treatment from NHS healthcare professionals”.
The year-long review, which examined 13,000 papers and interviewed policy experts, NHS staff and patients, was led by Dharmi Kapadia, an investigator at the Centre on the Dynamics of Ethnicity, the UKʼs leading research centre into minority ethnic, racial and religious inequalities. Kapadia, a sociology lecturer at the University of Manchester, said she and her co-authors had uncovered “crucial” evidence of persistent health inequalities that harmed patients’ health on a daily basis.
In mental healthcare, for example, the review found minority ethnic patients faced “clear inequalities” in regard to Improving Access to Psychological Therapies (IAPT), an NHS programme established in 2008 to transform the treatment of anxiety and depression in England.
Minority ethnic groups were less likely to be referred to IAPT by GPs than white people, the report said. Minority ethnic patients who do get a referral are less likely than white British patients to receive an assessment. Minority ethnic people with psychosis are also less likely to be referred for cognitive behavioural therapy (CBT).
The review found “strong evidence” of “clear, very large and persisting ethnic inequalities” in compulsory admission to psychiatric wards, particularly affecting black people. It uncovered evidence of harsher treatment for black patients, who were “more likely to be restrained in the prone position or put into seclusion”.
Minority ethnic parents reported their children faced the same barriers to accessing health services as they did. Black children are 10 times more likely to be referred to children and adolescent mental health services (CAMHS) via social services – rather than through their GP – compared with white children, the report says.
Maternity services were also found lacking, reports The Guardian. The review found evidence of negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity, leading to some minority ethnic women feeling “othered”, unwelcome, and poorly cared for. Some women whose first language was not English were denied access to quality interpreting services, the report adds.
The researchers aid any efforts to improve health outcomes among minority ethnic patients were being thwarted by the shambolic collection of health information by NHS staff and organisations.
Racism within the NHS workforce persisted, with report uncovering a pay gap affecting black, Asian, mixed and other groups. The review also uncovered minority ethnic health inequalities in areas as diverse as digital access to healthcare, genetic testing and genomic medicine.
An NHS spokesperson said: “The pandemic has shone a stark light on health inequalities across the country and the NHS is already taking action to improve the experiences of patients and access to services.”
NHS Final-Report
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