A recent major review into ethnic inequalities by the Race and Health Observatory has found ‘particularly poor’ inequalities in treatment for Black communities. The review points to longstanding inequalities in healthcare, despite recent government papers such as the Sewell Race Report claiming racial inequality is not an issue within healthcare.
The review explored differing experiences of access, experience in services, as well as outcomes from services in the following areas:
- mental healthcare
- maternal and neonatal healthcare
- digital access to healthcare
- genetic testing and genomic medicine
- the NHS workforce
The review found that broad inequalities existed across each area. The review acknowledges differences between the experiences of some ethnic minority groups, while certain communities were found to have especially poor access, experiences and outcomes.
The review used already existing academic research, that spanned a 10-year period. One particular area of concern was that all ethnic minority groups experience inequalities in mental health support and provision, specifically in gaining access to mental health ‘talking therapies’.
Researchers discovered that GPs were less likely to refer anyone from a minority ethnic background to the Improving Access to Psychological Therapies (IAPT) programme, when compared to experiences of White patients. Another barrier identified, was that many individuals actually delayed or entirely avoided seeking help for their mental health due to a fear of racist treatment from NHS mental healthcare professionals.
Worryingly, this pattern of difficulty accessing services as well as avoiding services in adults was seemingly reflected in the experience of the younger population
One study the review looked at found that Black children were 10 times more likely to be referred to Child and Adult Mental Health Services (CAMHS) via social service interaction rather than their GP service, again in comparison with White British children.
“It is clear that existing evidence on the stark health inequalities faced by ethnic minority communities has not led to significant change. This is why the Observatory has been established: to synthesise what already exists, translate it into actionable policy recommendations, and to challenge leaders to act.” Dr Habib Naqvi, director of the NHS Race and Health Observatory.
The review also zeroed in on some of the impact that racism has on the NHS workforce, which revealed that there may be evidence of an ethnic pay gap, primarily affecting, Black, Asian, Mixed and Other groups.
This rapid review by the Observatory has now said it urges ‘further ‘critical action’ to be undertaken by organisation including NHS England, NHS Improvement and NHS Digital’
An academic team from University of Sussex undertook a comprehensive ‘stock-take’ of all already existing research on ethnic inequalities in healthcare in the UK. They screened over 13,000 research papers to eventually identify a total of 178 studies included in the final review. Speaking to this experience, Dr Laia Becares, Senior Lecturer in Applied Social Science at the University of Sussex said:
“Our review shows the role of structural barriers – including racism and experiences of racial discrimination – in patterning stark ethnic inequalities in health care…We provide concrete recommendations for change, including within research, policy, and practice, that if taken forward by NHS and political leaders would ensure a fairer and more inclusive system for all.”
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Mental health charity Mind, and leading mental health advocacy and activist organisation the Royal College of Psychiatrists (RcPsych) have responded to the Review.
On the confirmation in the review, of what was already known and understood by many in the sector, Paul Farmer, Chief executive of Mind said: “This represents nothing less than institutional and structural racism that will require a sustained and concerted effort by health service providers and UK Government to tackle.”
He continued: “This review should act as a wakeup call to the UK Government and health services…In addition to following the recommendations made within this report, the UK Government must take thoughtful, determined and dedicated action during every step of their post-pandemic rebuilding of the healthcare system to address these inequalities, including building trust with diverse communities, listening to what is needed and commissioning effective, culturally appropriate and trauma-informed support. Anything less would only continue to fail ethnic minority communities.”
This review should come as no surprise to many who have been paying close attention to the numerous bodies of evidence and research, over the past 10 years, that have pointed to stark inequalities in access and experience of mental health care.
Acknowledging it and speaking to it, however, is no longer enough. Dr Rajesh Mohan, Presidential Lead for Race and Equality at RcPsych emphasised this saying:
“It’s time for warm words to end and for the government to act. They must strengthen the Health and Care Bill currently being debated in Parliament to ensure data and monitoring systems are in place that enable the NHS to identify and address discrepancies in access, experience and outcomes for all minority groups.”
Dr Mohan also acknowledged the importance within the NHS to simultaneously and autonomously ensure that “deeply embedded” problems within healthcare are being questioned, challenged and importantly, changed. He said:
“This requires a systematic shift in culture and practice, including designing and commissioning services collaboratively with people from ethnic minority backgrounds.”