Frontline staff and managers' skills in engaging with and using evidence are essential to promoting race equality in health services. Britain prides itself on its open access to healthcare and the quality of its prevention and treatment of illness.
In this, the 60th anniversary year of the NHS, there is much to be proud of, but still much to be done to improve the life chances of many of its citizens from minority ethnic groups.
Britain prides itself on its open access to healthcare and the quality of its prevention and treatment of illness. In this, the 60th anniversary year of the NHS, there is much to be proud of, but still much to be done to improve the life chances of many of its citizens from minority ethnic groups.
A positive example is the affirmative action taken by the Department of Health and UK Transplant after data clearly highlighted that some minority ethnic groups are disproportionately more greatly represented than others on organ transplant waiting lists in the UK, especially for kidney transplants. They established specific organ donor campaigns targeting South Asian and African Caribbean communities.
This is, however, a short-term solution. The long-term one is to take preventive measures to address the problem of poor access to services and reduce the number of South Asian and African Caribbean people requiring kidney transplants.
This example of the poorer health status of black and minority ethnic communities compared to the overall UK population is just one of many that are highlighted in study after study. Others include the higher rates of doctor-diagnosed diabetes, cardiovascular disease and mental illness among certain minority ethnic groups.
These health inequalities exist between and within minority ethnic groups, and also vary by social class. The dominance of the "medical" or "individual" model of health has also meant that services have not always considered the effects of social, economic and environmental circumstances – the "wider determinants" of a person’s health.
There is evidence, too, of poorer access to healthcare and unequal treatment in services.
For too long, there has been a "one size fits all" approach that has in effect excluded some ethnic groups. For example, people who do not speak the dominant language face significant difficulties in communicating with professionals.
Poor levels of communication have a negative effect on access to services and on relationships between service users and professionals. There is evidence of a lack of confidence or willingness on the part of both service users and providers to discuss cultural issues that may be relevant to the way services are provided.
Community engagement is an essential part of appropriate service provision, and there needs to be greater involvement of black and minority ethnic service users in shaping and running services. Yet there continue to be barriers to participation for black and minority ethnic groups. Individualised, person-centred services cannot succeed without listening to what users want, and being open to change.
This situation is compounded by racism. The evidence of the negative affects of racism on health is robust. For example, experience of racist verbal abuse or physical violence is related to a greater risk of premature death; high blood pressure; respiratory illness; lower self-esteem and life satisfaction; psychological distress, depression and anxiety; suicidal tendencies; stress and anger; psychosis; and more work-limiting long-term illness and disability.
However, despite the stark realities outlined above, reform is underway that can make a difference. Just two examples are local strategic partnerships that bring together the public, private, community and voluntary sector at a local level to tackle health inequalities, and practice-based commissioning that enables a consortium of local general practices (supported by their PCT) to identify the health needs of, and appropriate services for, their local population.
Crucial to implementing these reforms is the role of the workforce. It is essential to develop a confident, competent and diverse workforce, that is reflective of the communities served at all grades and levels. If achieved, it should improve the quality of healthcare for all.
Evidence on health inequalities is now stronger and clearer than before, but there are still gaps (for example, in the collection of data relating to ethnic monitoring) and the quality of evidence can vary.
As important, is the ability and willingness of policy makers and practitioners to use the evidence to bring about change. However, if we want to achieve sustainable improvements in the quality of healthcare for black and minority ethnic communities, then using the evidence is essential.
With a programme of Better Health briefing papers and associated training events, staff at the Race Equality Foundation are working to assist practitioners and managers to understand the evidence on race equality and health, and be better placed to make changes to practice.
Ronny Flynn is director of health and housing at the Race Equality Foundation.
To explore some of the issues raised in this article, the Race Equality Foundation is organising a conference on March 10 in London. The evidence used in this article draws on material from six papers in the Better Health briefing series, which can all be viewed and downloaded from the websitewww.raceequalityfoundation.org.uk