Groundhog day: NHS Race and Health Observatory report shows racism remains a public health crisis

For some time, OBV and other major race equality organisations have underlined the extent to which racial inequities are apparent across various aspects of life in the UK. In fact, it is because of these inequalities that Operation Black Vote and a slew of other race equality organisations exist.

Health outcomes remain one of the most visible areas by which these racial inequalities are seen and a new report from the NHS Race and Health Observatory has once more stressed the need for radical action to address “overwhelming” minority ethnic health inequalities in the healthcare service.

‘There is no excuse for inaction’

Dr. Habib Naqvi, Director of the NHS Race and Health Observatory, concluded his foreword on the report's first page by saying, "There is no excuse for inaction." This brief but succinct remark serves as a prelude to a 166-page report on the impact of "racial inequity" in the healthcare system, including disparities in mental health services, maternal and neonatal care, health-care access, and the composition of the NHS workforce.

According to the report, there are widespread ethnic inequalities in the healthcare system. It outlines what it considers to be a number of ongoing issues. Within the mental health service the comparatively limited access Ethnic minority groups face in Improving Access to Psychological Therapies (IAPT) is highlighted. The programme is meant to support adult anxiety disorders and depression in England, but the report found that ethnic minority groups were less likely to be referred by their GPs, compared with White British people.

The review also highlighted harsher treatment of, and ‘persisting ethnic inequalities’ in the compulsory admission to psychiatric wards of Black, Mixed Black & White groups, and South Asian groups. Crucially, this is a trend also witnessed among within younger age brackets as well.

Evidence from the review affirms that some inequalities present for adult populations were replicated in younger populations. Parents reported their children facing the same barriers to accessing services as reported for adult mental health services.

Within maternal care, the inadequate provision of language interpreters was identified as an issue for women without English language skills. In fact, despite the report recognising the importance of the relationship between women and care-providers to their Antenatal care, ‘poor communication’ between women and providers was deemed a ‘prevalent theme’.

A consistent theme was women’s experiences of negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity. System-level factors, as well as the attitudes, knowledge and behaviours of healthcare staff, contribute to some ethnic minority women feeling ‘othered’, unwelcome, and poorly cared-for. These factors appear to undermine trust and feed fear, which in turn are described as resulting in poorer access to, and engagement with, services.

The notable disparity in pregnancy outcomes continues to be an area that is critical to discourse around racial inequalities in the national health service. You may have previously read some of the words I wrote when reviewing Channel 4’s Dispatches documentary on the Black Maternity Scandal. Campaign groups such as fivexmore have helped to focus national attention on the urgency around the comparatively higher pregnancy risks facing black women, and whilst the past 12 months have seen parliamentary debates take place around the matter, this most recent analysis by the NHS Race and Health Observatory reiterates the scale of the issue. Citing Matthew Limb’s article into the disparity in maternal deaths, the report puts the magnitude of the problem into perspective.

In pregnancy, many ethnic minority women are more at risk from death in childbirth; Black women are four times as likely to die in childbirth, Asian women are twice as likely to die in childbirth, and women living in the most deprived areas (where many ethnic minority people live) are three times as likely to die in childbirth).

'The time for change is now'

Dr. Dharmi Khapadia of the Centre on the Dynamics of Ethnicity (who, you may recall, teamed up with OBV for the EVENS campaign last year) described the evidence as "overwhelming and convincing" in an interview with the Observer. She claims that the report, which also links lower levels of ethnic minority engagement with digital services to scepticism about government data usage, proves that the time for change is now.

The Black Lives Matter protests brought recognition of the impact of systemic racism on public health, but could health officials be accused of paying lip service to the matter?

The majority of people who read the report in the coming days will agree with Dr. Khapadia, but there will still be doubts about what steps will be taken to address these issues. The report made several recommendations to ensure not only better monitoring of these inequalities, but also direct action to address them. In the same Observer exclusive, an NHS spokesperson stated that the pandemic had highlighted these disparities and that the health service was "already taking action to improve patient experiences and access to services."

The Race and Health Observatory report now follows the internal report from the NHS blood and organ transplant unit, public health England’s account on disparities in the risk and outcomes of COVID-19, and the British Medical Association's council survey last month detailing the present day experiences of ethnic minorities within the NHS. For far too many people, that experience is in desperate need of change.

Mayowa Ayodele