In this series of public health articles, you will be able to learn about the fundamentals of public health which will serve you well for your medical school interviews. These principles will help you to understand how medicine and public health are intertwined especially as a result of the Coronavirus pandemic.
The UK is a multi-ethnic country with diversity steadily increasing
Ethnicity is a protected characteristic within the four dimensions for assessing inequalities, therefore, it is essential to investigate health inequalities among different ethnic groups in the UK, as it has implications on health and healthcare of the population. With the current COVID-19 pandemic and injustices towards Black people shining light on key disparities between ethnic groups, ever existing racial health inequalities have yet again manifested across our society and are at the forefront of public health.
It is long and well acknowledged that people from Black and Minority Ethnic (BAME) communities face the poorest health and healthcare, compared to the general population
Health literacy is lower among migrant and minority ethnic groups. This means vital health information lack the requirements and needs for ethnic minority groups to understand and be responsive towards. This can be in the form of language, accessibility or acknowledgement of unique needs. Poor health literacy leads to health inequalities in the use of preventative health services. An example of this is uptake of the national breast screening programme which saw the lowest rates of uptake among Bangladeshi and Black African women. Similar trends are seen within immunisation, smoking cessation and many more preventative health services.
When it comes to satisfaction with primary care services, 45% of Pakistani and 37% of Bangladeshi respondents replied “no” when asked if they were able to book advance appointments with their GP. This compared to 24% of White people. Within hospital mental health services, minority ethnic groups face excessive restraint and medication leading to lower rates of recovery, particularly in Black groups. Black people with serious mental illnesses are more likely than other groups to come into contact with secondary care services through non-health agencies, in particular, the police. These clear disparities between different ethnic groups make it difficult to achieve health equity and access to healthcare for all.
The COVID-19 pandemic has highlighted key disparities, many of which appear within most diseases
Men and women of Black ethnicity are four times as likely to die from COVID-19 compared to people of White ethnicity, this is after adjusting for age. Further, 34% of COVID-19-related admissions to intensive care were for ethnic minority people, while they only account for 13% of the population of England and Wales. There are a wide range of factors that play a role within these inequalities ranging from social and economic down biological factors. Furthermore, these factors do not act independently, and we can see complex interlinked relationships between them which make it difficult to tease out single factors.
An overarching issue we see is racism which can explain a lot of the fundamental concerns surrounding racial inequalities in health. Racial discrimination can reduce opportunities for people within education and employment, leading to people from BAME communities having limited options for employment and education.
This correlates with poor socioeconomic conditions such as low income, low grade employment and densely populated poor neighbourhood environments leading to poor health opportunities and behaviours such as unhealthy cheaper diets, low physical activity and lower health literacy which consequently lead to poorer health outcomes.
Systematic and structural changes are required to tackle these inequalities
The vast amount of evidence does not seem to manifest into adequate levels of action to tackle these inequalities, hence, widening inequalities further. BAME communities require better representation within senior leadership and policy roles. There should be specific roles for individuals that understand the unique needs of BAME groups to form policies and interventions that directly address these needs. Without this representation, health services will always be tailored towards the White majority, when in fact, many of the times the needs are greater in BAME communities.
Religion plays a huge role in many BAME communities. Therefore, involving religious leaders into the formation of health services will make for more appropriate programmes. It will also increase the confidence within BAME groups to be able to approach and utilise these services as faith can be a big source of comfort for many individuals.
Primary and secondary care facilities must undergo more strict monitoring by, for example, clinical care groups in how they enable equitable access and treatment for BAME individuals. Public should be involved in monitoring the effectiveness of these services making sure each ethnic group is represented equally. Services should be held accountable for their performance.
Medical and healthcare students should be educated with the needs and characteristics of each ethnic group in mind
Education and research within the healthcare field demands improvement. . Diseases and conditions are often taught within a very narrow ethnic lens, for example Kawasaki disease which presents differently on darker skin but is taught on predominantly lighter skin. This creates an environment where people of colour are not represented and do not receive the healthcare they need. This must be changed, and the curriculum has to incorporate these changes. In academia, research on BAME groups needs to, only increase, but be widely disseminated, with proper recommendations for healthcare and policy incorporated. We tend to see less articles get accepted if they are about minority ethnic groups and this discrimination in academia must stop. Data collected must be representative of the population we live in and be analysed and presented accordingly. Health is a basic human right, and every single human regardless of race has the right to access effective, cheap, timely and fair healthcare.