Written by Carly Lewis-Oduntan
A review from the NHS Race and Health Observatory paints a damning picture of how the healthcare system is failing minority ethnic patients. Writer Carly Lewis-Oduntan explores what this means for women of colour in and whether there are any solutions.
Last week the NHS Race and Health Observatory published its Ethnic Inequalities In Healthcare review. Created in 2020 when it emerged that a disproportionate number of people from ethnic minority groups were dying because of coronavirus, the observatory’s findings are damning.
The review analysed “the overwhelming evidence of ethnic health inequality through the lens of racism”, revealing “longstanding” and “widespread” inequalities in all the areas of the healthcare system it examined. Inequalities that are affecting the health of millions of patients.
In the report, Dr Habib Naqvi, policy lead for the NHS Workforce Race Equality Standard, admits: “There has long been evidence of the stark health inequalities faced by ethnic minority communities in this country,” adding, “existing evidence hasn’t led to significant change”.
This means that despite proof of glaring racial disparities in the standard of healthcare for ethnic minorities (something the World Health Organisation deems a “fundamental” human right) there has been what can only be described as wilful inaction from the NHS to address these repeated failings.
Sadly, this should come as no surprise to people of colour in Britain. While it can be argued we’ve taken positive steps towards becoming a more tolerant and ethnically cohesive society, we’re regularly reminded that in the minds of many, those of us who are not white British will never truly be accepted or respected as citizens of this country.
You need look no further than the disproportionate school exclusion rates (in 2021 the exclusion rate of Black Caribbean pupils was five times higher in some areas of England) and the overrepresentation of ethnic minorities in our prisons (more than one in four prisoners are from a minority ethnic group despite making up 14% of the total population in England and Wales).
Or, look at who is most likely to be the victim of police brutality (the BBC foundMet Police officers are four times more likely to use force against Black people compared with the white population) and the fact that the maternal mortality rates of Black, mixed-race and Asian women also back up this argument.
“If it was really bad you’d be screaming”: the reality for patients
Priya, 25, from Glasgow, is of South Asian descent. When she first went to see her GP complaining of severe lower abdominal pain, she was told it must be either constipation or IBS and was advised to make changes to her diet.
However, her symptoms worsened, and after eight subsequent GP visits, she was still without a diagnosis. At one point the pain was so excruciating she had to go to hospital.
When she was asked by a doctor to rate the pain on a scale of one to 10 she answered, “It’s really bad,” to which the doctor responded. “If it was really bad you’d be screaming.” She tells Stylist: “I just remember thinking, ‘Did he actually just say that? Did a doctor try to insinuate that I might be over-exaggerating?’”
She was eventually given an ultrasound which revealed cysts on her right ovary that had caused it to twist – a condition known as ovarian torsion. Priya’s ovary was so damaged it had to be removed, which raises the question: had her doctors acted sooner, could this have been prevented? “No one has come out and said that directly, but it’s been somewhat implied,” she says.
What the Ethnic Inequalities in Healthcare review found
The findings from the NHS race review, which focuses on mental, maternal and neonatal healthcare; digital access to healthcare; genomic medicine; and the NHS workforce, highlight what happens when racist and xenophobic attitudes go unchecked. They risk becoming an acceptable part of an institution’s culture where thinly veiled biases can lead to catastrophic consequences for patients.
While media outlets and high-profile campaigns champion the importance of deconstructing the harmful stigmas surrounding poor mental health, evidence from the review pinpoints “clear inequalities” in this area.
The review found ethnic minorities are less likely to be referred by their GPs for Improving Access to Psychological Therapies (IAPT) and cognitive behavioural therapy (CBT).
It also found “strong evidence of clear, very large and persisting ethnic inequalities” when it comes to compulsory admission to psychiatric wards, which particularly affects Black groups, but also mixed Black and white groups and South Asian groups.
Additionally, Black people on inpatient wards were also more likely to be restrained or put into seclusion.
Findings from the maternal and neonatal portion of the review found a “consistent theme” of women experiencing “negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity,” with examples of blatant discrimination including “health-care staff uttering stereotypical and racist comments”.
This is unsurprising when you consider the latest data that shows Asian and mixed ethnicity women are twice as likely to suffer maternal death than white women, while Black women are more than four times more likely.
“Do they actually believe me?”
For Paris, 23, it took moving from York to London to be diagnosed with a hereditary skin condition and receive treatment for chronic stiff joints that she’s suffered with since childhood.
She recalls repeatedly being told her symptoms were common for someone “of her ethnicity” but never being asked what her actual ethnicity is (her mother is Nigerian and her father is African American).
When she went to see her doctor with concerns she may have ADHD, she was repeatedly refused tests, before an assessment carried out by her university found she does indeed have the disorder, in addition to dyslexia and dyspraxia.
“I always think, if I was white would I have had so much dismissal?” she asks Stylist. “As a Black person you’re treated differently and you feel it. There’s an assumption you’re either strong or you’re making it up. You question, ‘Do they actually believe me?’”
What can be done?
For Dr Tosin Ajayi-Sotubo, who specialises in general practice, addressing racial inequalities in the NHS will be far from an easy fix.
“It’s a big issue, which means the solution is even bigger,” Dr Ajayi-Sotubo tells Stylist. “There’s not going to be a change overnight, but what’s important is that we start implementing changes within our healthcare system so we can make improvements because inequality shouldn’t be something that we’re still talking about.”
Dr Ajayi-Sotubo believes starting to have conversations about ethnic inequalities the healthcare system is a start to making change. “Although we’ve known about this [type of] research for years, I feel like it hasn’t really been brought to the forefront,” she says.
“It’s about recognising these inequalities still exist, but actually really getting down to how our healthcare system runs and who it’s run by. When we look at who sits on the top boards of our NHS, it’s predominantly white people. So how can we change a system if the people making the decisions aren’t reflective of the society we’re living in?”
In response to the report, 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.
“The NHS has set out what local health services should be focusing on over the next year so they can make these improvements in their local communities and is already working closely with the Race and Health Observatory to drive forward the recommendations set out in this report.”
Images: Getty
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