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The Covid death toll in the first months of the pandemic was shocking. But an emerging pattern proved to be an eye-opener – black and Asian patients are more likely to die from the virus.
Similar discrepancies exist in other areas of healthcare too, most notably in surgery and mental health, as well as maternity care, which has prompted an urgent inquiry.
“An uncomfortable conversation needs to be had higher up within the NHS,” says This Morning’s medic, Dr Zoe Williams, of the complex and deep-rooted issues.
“These institutions have been built by white men for white men. Outdated policies and procedures need to be rewritten.”
As top NHS bosses begin new diversity training to tackle the issue of systemic racism, Dr Zoe throws the spotlight on four problematic areas…
Covid: It has highlighted racism and bias
“We’ve seen that people from ethnic minority backgrounds are more likely to get Covid and more likely to have a poorer outcome and essentially die from it.
But Covid doesn’t affect black people or Asian people differently because of genetics. The reasons are multifactorial and complex.
For example, stats have highlighted that people from certain ethnic groups are more likely to have a chronic disease, and are more likely to be living in poverty, putting them at higher risk.
Therefore, they’re more likely to suffer badly after contracting Covid.
It’s important to admit that this is highlighting systemic bias and racism within our institutions. Systemic racism also affects the way people interact with the NHS.
Public Health England’s investigation into the disparities in risk and outcomes discovered what many of us already knew – that some ethnic minority groups had a lack of trust in NHS services and treatment, and this resulted in their reluctance to seek care in good time.
Fear of how they’d be treated in hospital led to late presentation, which led to poorer outcomes.
We’ve also seen that a huge percentage of healthcare professionals who have died of Covid are from ethnic minorities.
Surveys have shown it’s because those doctors are less likely to complain if put at risk. They’re less likely to demand proper PPE or ask to work on non-Covid wards.
Could this be linked to the evidence showing that NHS staff from an ethnic minority are more likely to be subject to a disciplinary process?”
Surgery: White patients get priority
"If you’re a doctor on the surgical team, there may be three or four patients who’ve been admitted recently, as they wait for operations.
They should be ordered by clinical need, but in some cases there isn’t a medical reason to prioritise the patients.
I suspect that without perhaps knowing the reasons why, white patients get prioritised first – that’s an example of institutional systemic racism that impacts on health outcomes for individual patients.”
Maternity: ‘There’s an idea that black women can tolerate pain'
“Black women are four times more likely to die in pregnancy and childbirth than white women in the UK – that’s a very complex and disturbing issue.
There are a number of factors why. Black women are at a higher risk of having physical health issues, mental health problems or social problems such as unemployment, and exploring the reasons for this requires another conversation about systemic racism.
Looking at healthcare specifically, we know there’s this incorrect idea that black people can tolerate pain more than white people.
Studies show that black women are more likely to report being left to experience high levels of pain without any pain relief.
They’re also more likely to report that their symptoms weren’t taken seriously, and I’ve personally heard multiple anecdotal stories where a black woman gave birth without a midwife present because they weren’t believed when they said their baby was imminently arriving.
Years ago someone came to visit the postnatal ward I was working on to help with breastfeeding support.
She used to look at the names on the board and if she spotted an African name she’d ask if they were first or second generation.
If they were first generation and they’d been born in Africa, she wouldn’t offer them support first, assuming they wouldn’t need her.”
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Attitudes: 'They need to change to save lives'
“Changes are happening. Even I’m waking up to things I witnessed years ago that at the time I didn’t see for what they were.
For example, during medical school when we looked at dermatology, the textbooks said the first sign of conditions like psoriasis was red skin, which isn’t the case if you’re a black person.
The government is putting a lot of research into this problem but as individuals we can also start to acknowledge our own bias.
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If you find yourself feeling tense and nervous when a black man is walking on the street towards you, it’s not necessarily your fault – you’ve developed those preconceptions from somewhere – but it’s important to challenge that feeling.
See what happens if you look up and smile rather than put your eyes to the ground and clutch your bag.”
Dr Zoe Williams currently practices as a GP in London and frequently appears on TV, as well as being a director and founding member of the British Society of Lifestyle Medicine.
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