14 February 2022

New review calls for radical action on stark ethnic inequalities across healthcare

A major review into ethnic inequalities in healthcare has revealed vast inequalities across a range of health services.

Three nurses walking down a hospital corridor
  • Review of a decades’ worth of research finds ethnic health inequalities across a vast range of areas
  • The review found inequalities experienced by ethnic groups in mental health, maternity care, genomic medicine, digital access to healthcare and within the NHS workforce itself
  • Differences for ethnic groups included access, experiences of, and outcomes in healthcare
  • The review made a series of recommendations for ‘critical actions’ to be taken by NHS organisations for each area where the poorest outcomes were identified

A major review into ethnic inequalities in healthcare has revealed vast inequalities across a range of health services.

The review, a collaboration between the independent health body, the NHS Race and Health Observatory and the Universities of Sheffield, Manchester and Sussex, has found that some of the largest inequalities were found for mental healthcare, where treatment for Black groups was particularly poor.

It also found there was a lack of research into specific areas, including how outcomes may differ for ethnic minority babies in neonatal healthcare settings, where only one relevant study over the past decade was found. 

The much anticipated rapid review from The Observatory undertook a comprehensive stock-take of 10 years’ worth of available UK research, screening over 13,000 research papers, identifying 178 studies into ethnic healthcare inequalities across a range of areas. This included the exploration of key priorities such as; differences in access, experiences of, and outcomes in:

  • mental healthcare 
  • maternal and neonatal healthcare
  • digital access to healthcare 
  • genetic testing and genomic medicine
  • the NHS workforce

Ethnic inequalities were found across each area studied. Whilst there were differences between ethnic minority groups, some communities were found to have particularly poor access, experiences and outcomes.

Professor of Public Health at the University of Sheffield, Sarah Salway and contributor to the study, said: “We know that persistent inequalities in the healthcare and health outcomes between ethnic groups remain, despite past commitments to address the issue. The review recommendations published today provide the clear direction we need to truly make a concerted effort to address inequity, not only in areas such as mental health and maternity care, but also within the NHS workforce itself.

“As a nation we are proud of our NHS. It is one of the few healthcare services worldwide that enjoys a reputation for quality care that is free at the point of access, so it can be difficult to discuss how things may be failing. This report however, gives us the opportunity to identify how we can do things better, for a healthier and fairer society. We can work towards an NHS that provides equitable services for all, where language is not a barrier, medical technologies meet the needs of our diverse population, and everyone feels cared for.”

The review found that ethnic minority groups experienced distinct inequalities in mental health support provision, and in gaining access to mental health ‘talking therapies’. 

GPs were less likely to refer ethnic minority patients to the Improving Access to Psychological Therapies (IAPT) programme compared to White patients, and barriers were also faced by patients who delayed or avoided seeking help for health problems due to their fear of racist treatment from NHS healthcare professionals.

Strikingly, there was evidence that the ethnic inequalities in mental healthcare for adult populations is being reproduced in younger populations, with one study in the review showing that Black children were 10 times more likely to be referred to Child and Adolescent Mental Health Services (CAMHS) via social services rather than their GP service, in comparison to White British children. 

In maternal care, there was evidence that some ethnic minority women have positive relationships with midwives. However, overall, the review found worrying evidence of negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity, leading to some ethnic minority women feeling ‘othered’, unwelcome, and poorly cared-for. 

With respect to the NHS workforce, the impact of racism on careers and professional development was explored in the review, and there was evidence of an ethnic pay gap affecting Black, Asian, Mixed and Other groups, and to a lesser extent, Chinese staff. 

The rapid review now urges further ‘critical action’ to be undertaken by organisations including NHS England, NHS Improvement and NHS Digital, with recommendations outlined by topic area.

Lead investigator, Dr Dharmi Kapadia, Lecturer in Sociology, and member of the Centre on Dynamics of Ethnicity (CoDE), University of Manchester said: “Our team are pleased to have completed this crucial piece of work to address persistent ethnic inequalities in healthcare in the UK. Importantly, this review provides a solid evidence base from which to plan new ways to address these inequalities at both practical and policy levels.

“For too many years, the health of ethnic minority people has been negatively  impacted by a lack of high-quality ethnic monitoring data recorded in NHS systems; lack of appropriate interpreting services for people who do not speak English confidently and delays in, or avoidance of, seeking help for health problems due to fear of racist treatment from NHS healthcare professionals.

“Our review confirmed that all of these issues are still to be tackled by the NHS. The evidence on the poor healthcare outcomes for many ethnic minority groups across a range of services is overwhelming, and convincing. The time for critical action on ethnic inequalities in healthcare is now.”

Dr Habib Naqvi, director of the NHS Race and Health Observatory, said:

“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. This report should be a tool for them; highlighting the best quality evidence and making concrete recommendations for change.” 

Additional Information:

  • Dr Dharmi Kapadia from the University of Manchester led the rapid evidence review. The wider team consisted of Jingwen Zhang, Professor James Nazroo and Professor Aneez Esmail (University of Manchester), Professor Sarah Salway, Professor Andrew Booth and Dr Nazmy Villarroel-Williams (University of Sheffield) and Dr Laia Bécares (University of Sussex).
  • The review incorporates a broad range of academic and ‘grey’ literature from diverse sources across academia, government, the NHS, local communities and academic and clinician stakeholders with expertise on the topic priorities of the review. The review was undertaken for the period between January 1, 2011, and October 25, 2021 and stakeholder discussion groups were also held with people working with diverse communities, facilitated by the Race Equality Foundation and The Ubele Initiative.
  • The academic team scoped the review by drawing together key literature around the main priorities of the NHS Race and Health Observatory.

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