THE SPECTRUM
GLOBAL HEALTH
Why do the health inequalities in ethnic minority populations still exist?
Siobhan McShane, Rupali Lav, Nadia Dohadwala, Enya Khan, Benjamin Zuckerman and Pedra Rabiee by
The issue of Black, Asian and minority ethnic (BAME) inequalities in the healthcare sector has existed within the policy agenda for a number of years, both globally and within the UK. On paper, policy activity within this arena in the UK has been evident for a while with directives such as the Equality and Health Inequalities Hub.1 However, the COVID-19 pandemic has been instrumental in pushing the issue of these inequalities to the forefront of the national agenda with key players contributing to research on the issue in light of the pandemic. Public Health England’s report2 highlighted the scope of the problem with reference to key stakeholder concerns, while the Office of National Statistics provided key figures on increased death rates of ethnic minorities compared to the white population (see Figure 1). Further calls from prominent voices in health policy such as The King’s Fund have also called for action.3 Ongoing research has uncovered the underlying drivers behind these inequalities in the UK. The second quarterly report from the Racial Disparity Unit in the UK4 explicitly acknowledges inequalities are driven by risk of infection. More specifically, structural and occupational factors as well as considerations such as denser households in terms of individuals living under the same roof, and not ethnicity itself,
are at fault for disparities. Overall, there are a number of key themes which emerge from the research done on inequalities in health among BAME populations during the pandemic, which broadly correlate to the social determinants in health. These are drivers that conceptualise the wider socio-economic and environmental factors dictating people’s educational status, employment, housing and living conditions, among others. Such factors then feed into an individual’s health. Within the UK, a promising vehicle for change has emerged in the form of the NHS Race and Health Observatory5 which was created in May 2020 in response to the emerging evidence on BAME inequalities in health both within the pandemic and more widely. Constituting an impressive body of experts in health and health inequalities and directed by Dr Habib Naqvi, the aim is to provide evidence-based actionable policy recommendations. We present this policy paper within the framework of problem-based policy development to align with the aim of the Observatory and recognition of their role as a focal point for policy change. The multifactorial nature driving inequalities warrants the ethos behind this framework, which is to focus on key areas to solve based on a clear diagnosis of current challenges with separate means and ends. To this end, this paper focuses on four key areas that relate to structural elements of inequality identified in the research thus far. These are: tackling the discrepancies in engagement and health communication within BAME communities, the gap in health data collection, underrepresentation of BAME populations in UK health research, and finally, migrants’ experiences of healthcare in the UK.
Figure 1. Comparison of death rates for COVID-19 among ethnic minorities in UK relative to white population 2 March to 28th July 2020.
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