Equality in Healthcare

Unfortunately, healthcare is still far from true equality. This page outlines the racial and gender inequality in healthcare and some current initiatives used to improve this.

Definitions

Socioeconomic Status: A way of describing a person based on their education, income, and type of job.

Gender Health Gap: The unequal distribution of health outcomes between different genders.

Racism and Healthcare

This can be viewed from two perspectives: racism against staff and racism against patients.

Racism against NHS Staff

In 2022 The BMA surveyed over two thousand doctors and medical students about racism in the NHS. It found:

  • 90% of Black and Asian respondents believed racism in the medical profession was an issue.

  • 76% of those surveyed experienced a racist event in the last 2 years.

  • 14% had considered leaving their jobs due to racism.

  • 6% left their position in the last 2 years due to discrimination.

However, this racism isn't just between patients and doctors, it is also integrated within the NHS:

  • GMC “Fair to Refer?” report found black and minority ethnic staff were 1.22 times more likely to enter a formal disciplinary process than white staff.

  • The report found they were less likely to have the adequate support and feedback with their managers after the complaint - especially when they were of different ethnicities.

  • BMA found that 71% of those who experienced racism chose not to report it as they feared being labelled as a “trouble maker” or didn’t believe the appropriate action would be taken.

  • Black and minority ethnic staff comprise of 20% of the NHS but only 8.4% of board members. They were also found less likely to get a promotion than their white counterparts.

Schemes to Overcome Racism

  • NHS Confederation released a strategy known as “Commit, Understand, Act 2022”. This was aimed to encourage NHS organisations to acknowledge racism and tackle it in the work force.

  • NHS Confederation also released an “Advancing Equality, Diversity and Inclusion Programme” which details objectives to improve diversity in NHS leadership.

  • Interim NHS People Plan has set targets to increase diversity in NHS leadership.

Racism Against Patients

The Marmot Report found:

  • The presence of a social gradient within society: the lower a person’s socioeconomic status, the poorer their health.

  • The annual cost of health inequalities to the NHS and government (through lost taxes) is £40bn.

Other studies into healthcare found:

  • Black people are 3-4 times more likely to die during childbirth than white people.

  • 73% of doctors believe at least one false biological difference between races (e.g black people have a higher pain tolerance and stronger immune systems than white people).

  • Racism has been strongly linked with mental health issues.

  • Lower proportion of the black population are vaccinated than the white population.

  • In the US, a study estimated black people were 3.6 times more likely to die from Covid-19.

  • In the US, black patients living in counties with black physicians have longer lifespans than those without.

We can see that healthcare inequalities are still prevalent and can only be partly explained by the socioeconomic factors (as discussed in the Marmot Report) and underlying health conditions. This indicates institutionalised racism within society and healthcare.

Gender and Healthcare

For the UK the gender health gap is the 12th largest globally.

  • UCL found women with dementia receive worse care than men with dementia.

  • UCL also found women visit the GP less than men.

  • A study in US found that women were less likely to receive opioid painkillers than men and had to wait longer to receive pain medication.

  • 26% of young women experience a mental health disorder whereas only 9% of young men do.

We can clearly see there are disparities in the health of women and men. This is mainly caused by hundreds of years of institutionalised sexism:

  • Clinical research was often conducted on men as they don’t have monthly hormone changes that could effect results. Therefore, most symptom presentations and interventions are based on the male body. This problematic because:

    • The medical literature which is teaching medical students now is biased towards males.

    • Modern day research often involves comparing new findings with past experiments (most of which are on men) so modern day trials are still mainly conducted on men.

    • This makes some interventions for women under-researched and thus causes issues with informed consent, as all the risks may not be known.

  • By basing the presentation of symptoms, such as a heart-attack, on the male body, this has caused many issues for women. For example, medical textbooks describe the symptoms of a heart-attack with “squeezing chest pressure or pain” which isn’t always present in women. This has lead to some heart attacks in women going unnoticed.

  • Women weren’t considered able to understand their own healthcare in the past so would often get oversimplified explanations leading to more health complications and less autonomy.

Transvaginal Mesh Implants

This was a major issue surrounding informed consent in the 2010s, resulting in problems that still affect women today. Transvaginal mesh implants are offered for two main conditions:

  • Stress Incontinence: After having a baby or the menopause, roughly 20% of women have a condition where their bladder leaks during stress activities such as running, jumping and coughing.

  • Pelvic Organ Prolapse: For roughly 50% of women after childbirth, one of their pelvic organs (uterus, bladder, rectum, bowel etc.) sags and moves out of place. This occurs when pelvic floor muscles are damaged.

Without treatment these conditions can lead to incontinence, pain during sex or painful urination. The vaginal mesh is a plastic net-like implant used to support a pelvic organs. It is implanted into the wall of the damaged organ and is used to encourage growth of tissues.

In the early 2010s, each year there were roughly 17,000 pelvic mesh implants for women suffering stress incontinence and 2000 for organ prolapses. However, it is now estimated that:

  • 1 in 11 women experienced problems after the procedure including: mesh exposure and erosion (when the edges of the mesh are exposed/rub against surrounding tissues and cause damage), bleeding, nerve damage, urinary complications, and pain during sexual intercourse.

  • 1 in 15 women require surgery to extract it.

This failure of healthcare occurred for two reasons:

  • Inadequate clinical trials which failed to investigate the long term effects of transvaginal mesh implants before it was offered to women.

  • A lack of “informed consent”. Many surgeons did not inform women that the procedure was new and the risks it involved.

This resulted in over 100,000 transvaginal mesh lawsuits in the US, most of which were directed at Johnson & Johnson, the manufacturer of the most common transvaginal mesh.

Unfortunately, this is just one example where healthcare has failed women. Other examples are:

  • The Primodos Scandal: an oral hormone pregnancy test used in 1960-1980 which has been linked to miscarriages and birth defects.

  • Sodium Valproate: a drug taken to treat epilepsy and bipolar disorder but has been linked to birth defects and learning difficulties if taken during pregnancy.