Using evidence to achieve equality in healthcare

The UK prides itself on its open access to healthcare and on the quality of the services it provides. In this, the 60th anniversary year of the NHS, there is a lot to be proud of, but much remains to be done, particularly when it comes to improving the life chances of many citizens from minority ethnic groups.

To achieve this, healthcare leaders must be well versed in interpreting evidence on health inequalities and using it to bring about positive changes.

One example of this is the Department of Health and UK Transplant's publication of data on the ethnic make-up of organ transplant waiting lists in the UK, which showed that some minority ethnic groups are disproportionately represented, especially for kidney transplants. In response, they established specific organ donor campaigns targeting South Asian and African Caribbean communities.

Big picture

But this is a short-term solution. In the long term, the UK must 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.

There are many more examples of the poorer health status of black and minority ethnic communities compared to the overall UK population. Others include higher rates of doctor-diagnosed diabetes, cardiovascular disease and mental illness among certain minority ethnic groups.

These inequalities exist both between and within minority ethnic groups, and also vary by social class. The dominance of the "medical" or "individual" model of health has 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 also evidence 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 health professionals.

Working together

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 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 problems, suicidal tendencies, stress and anger, psychosis, and work-limiting long-term illness and disability.

What is being done?

However, despite the stark realities outlined above, there is reform under way that can make a difference. Just two examples are local strategic partnerships that bring together the public, private, community and voluntary sector to tackle health inequalities, and practice-based commissioning, which enables a consortium of local practices 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 ever before, but there are still gaps and the quality of evidence can vary.

Policy makers and practitioners must use available evidence to achieve sustainable improvements in the quality of healthcare for black and minority ethnic communities.

To explore some of the issues raised in this article, the Race Equality Foundation is organising a conference on 10 March 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 at www.raceequalityfoundation.org.uk