Race, Racism and Discrimination in minority health -where next
According to the census in 2011, of the total 56.1 million population of England and Wales, 86% are white and of the remaining Black, Asian and Minority Ethnic (BAME) population 7.5% are of Asian heritage and 3.3% are black, 2.2 % mixed ethnicity and 1% are other minorities.
In the decade since 2001, the percentage of the population of England and Wales that was White British decreased from 87.4% to 80.5%, while the Other White group saw the largest increase in their share of the population, from 2.6% to 4.4%. In the same period, among the specific ethnic groups, people from the White British ethnic group made up the largest percentage of the population (at 80.5%), followed by Other White (4.4%) and Indian (2.5%). The number of black Africans doubled over the same period from 0.9% to 1.8%.
The variations in population reflect changes in political and social scenarios. Increase from Eastern European communities reflects xenophobic racism. However, what is clear is that health needs vary and a short-term solution has to be setting up of an Office which looks after health of minorities in a joined up manner.
The current COVID-19 pandemic and tragedy of the murder of George Floyd in Minneapolis and Black Lives Matter campaign have further highlighted the differences among ethnic and racial groups on a number of parameters and for a number of reasons. There is considerable evidence that ethnic minorities continue to experience tremendous discrimination in a number of fields including education, employment and health in particular. Death rates among BAME populations in general and in NHS frontline staff in particular are strikingly high. A number of explanations have been put forward varying from poverty, overcrowding, high ethnic density, pre-existing chronic co-morbid conditions to other less known factors.
I have always believed that services need to be integrated but the COVID-19 pandemic has shown that integrated effort is needed. As we have argued recently, a joined up approach is critical.
Disproportionate rates of infection and deaths in ethnic minorities highlight the urgent need for us to change our thinking.
Research in health including mental health over the past five decades in the UK has shown conclusively that high rates of various physical and mental illnesses in minority ethnic groups from schizophrenia to depression, from hypertension to diabetes and other chronic diseases. There are also clear gender differences in the incidence and prevalence of physical and psychiatric disorders.
To complicate matters further, not surprisingly there are cultural differences in behaviours. For example, smoking rates remain high in some black, Asian and other minority ethnic groups. Pakistani and Bangladeshi groups report low levels of physical activity. Dietary factors also play a major role in developing obesity which has also been associated with increased mortality with COVID-19. Furthermore, there are clear social and cultural factors in differential rates, access to services, response to treatment and outcomes in both physical and psychiatric disorders.
Reduced longevity and poor health are also associated with differential attainment in education and also difficulties in obtaining employment in black and minority ethnic groups. Some of these factors may be attributable to ethnic variations but social inequalities, generational inequalities and social determinants appear to contribute a large part to this.
Racism, discrimination and prejudice tend to play a major role in creating double and triple jeopardy where people from ethnic minorities choose not to seek help with delays contributing to chronicity of their conditions and resulting in poorer outcomes. Services in general are not culturally sensitive or competent, adding another layer to the complex nature of help-seeking.
Another significant finding is over-representation of black and minority ethnic groups in prisons. The effects of incarceration are felt far beyond prison and jail walls and impact health not only of prisoners but also that of their families and dependents. It is well known that the rates of incarceration among certain ethnic groups such as blacks are higher as are rates of psychiatric and physical disorders as compared with the general population and majority groups. In addition, their needs for housing, employment, and educational opportunities after release are very often ignored.
Thus, in order to deliver equity. there must be a joined up thinking, policy and planning between health, education, employment, justice and other ministerial departments.
The solution is establishment of an Office of Minority Health (OMH) as a matter of urgency. We know the problems and there have been many enquiries in the past looking at the issues related to health of BAME groups. OMH needs to be set up as a public body within the Cabinet Office so that it gets the status it deserves. This needs to be established by an Act of Parliament to act as ‘public authority’ to deliver public duty.
The aim of such an OMH will be to improve the health of racial and ethnic minority groups through the development of culturally relevant and culturally appropriate health policies across the lifespan of individual, leading to culturally appropriate services which are more likely to be used by the BAME groups. The OMH will also focus on health promotion, illness prevention and health improvement at population, community and individual levels and also through healthcare systems thereby helping eliminate health disparities.
Its main role is to keep under review elimination or otherwise of ethnic inequalities across government, statutory organisations and bodies, social institutions and others.
The OMH will be a repository of data on health discrepancies of the BAME populations as well as examples of good practice. It will develop evidence-based health and social care policies and to promote these to achieve health equity between mental and physical health and across ethnic groups in one generation and work with stakeholders and research funders to ensure that studies have a true representation of BAME participants and all studies include these groups.
The main functions of the OMH will be to monitor the life outcomes and experiences of the BAME groups in addition to providing guidance on how to best advance life chances and achievements with suitable data framework and oversight. It must have a series of clearly defined , identified and agreed outcomes to provide direction for research, capacity building and setting standards for hospitals, primary care settings and regulatory bodies among others in delivery of services.
The OMH has the potential to bring everything under one roof, cut bureaucratic costs and integrate research and joined up delivery of healthcare across life span for BAME individuals who need help in different settings.
Profession and individuals need to highlight the discrepancies and influence local parliamentarians and as individuals advocate for establishing the Office. Making progress against these major problems of inequalities will require dedicated work for a long time, perhaps over a generation.
This progress is certainly possible if we are able to learn and understand why and how the UK is changing.
NOTE FROM THE EDITORS: We would like to once again say a big thank you to Professor Dinesh Bhugra, CBE, for sharing another wonderful blog with our InSPIre the Mind readers!