Ethnic Health Inequalities

This is Article 3 in a series on health inequalities. Next article: Addressing health equalities (coming soon). Previous article: Socioeconomic health equalities.

Welcome to the third article in a series of articles about health inequalities. This article will look more in detail at what ethnic health inequalities are.

Introduction

Ethnic health inequalities are persistent disparities in health outcomes, experiences of healthcare, and even employment within the healthcare sector itself, for ethnic minority groups. Individuals from minority ethnicities frequently face an increased risk of poor health compared to their White counterparts. These inequalities are often rooted in structural racism and the racialisation of socioeconomic factors, rather than biological or cultural differences, suggesting that racism itself is a primary determinant of health. They are exacerbated by differences in socioeconomic status and deprivation. These inequalities manifest in different ways for different minority groups, and can be measured by specific health outcomes in different conditions.

How ethnic health inequalities manifest

A joint report by the Health Foundation and Runnymede Trust explained that Bangladeshi and Pakistani individuals have higher mortality rates for circulatory diseases. They also have significantly higher rates of metabolic conditions compared to their White counterparts. This predominantly includes diabetes, which is three to five times more common in Bangladeshi and Pakistani individuals. This is a result of both genetic factors and lifestyle and diet factors, the latter of which can be influenced by socioeconomic status; the report explains that Bangladeshi and Pakistani individuals are much more likely to be in poverty or deep poverty, impacting their ability to afford health-improving goods, such as nutritious food. As they are also more likely to live in deprived areas compared to their White counterparts, Bangladeshi and Pakistani individuals often face the dual challenge of food deserts and food swamps. This means they lack access to affordably priced, high-quality groceries while being surrounded by an overabundance of cheap junk food. 

In addition, research collated by the King’s Fund shows that Black Caribbean and Black African individuals experience higher rates of hypertension and stroke, and have higher rates of admission to psychiatric hospitals with psychotic illness diagnoses. This is also driven by an array of factors, including lifestyle and diet, but also socioeconomic status and deprivation. 

Maternal mortality for Black women is almost three times higher than for White women, partly due to socioeconomic factors, as well as underlying health conditions.

Furthermore, Office for National Statistics data from 2022 shows that infant mortality is tragically twice as high for Black infants and nearly twice as high for Asian infants compared with White infants, as seen in Figure 1. Again, this is partly due to higher socioeconomic deprivation, among other factors.

Experiences of ethnic health inequalities and the role of structural and institutional racism

Even though the NHS generally provides free universal access to primary care, access to and experience of healthcare services for ethnic minority groups often differ compared to their White counterparts. The NHS Race and Health Observatory has conducted research on racism and has found that there are disparities in areas like hospital and dental services: for example, there aren’t enough interpreting services for those whose first language is not English, which limits effective communication between patients and healthcare professionals. This also makes it harder for patients to stick to their treatments.

Repeated negative experiences have led to a lack of trust in the health system among some ethnic minority communities. Patients from these groups consistently report less favourable experiences across various services, as seen in Figure 2. A review by the UCL Institute of Health Equity reported that some indicators of this are longer waits for GP appointments, needing multiple visits before cancer referral, and overall lower satisfaction with hospital and mental health care. This poor experience is often characterised by stereotyping, disrespect, cultural insensitivity, and discriminatory treatment from healthcare staff, leading to delayed diagnoses, inappropriate interventions, and poorer health outcomes. The review also explained that these systemic issues can manifest in the NHS workforce, where ethnic minority staff face discrimination and harassment, impacting morale, retention, and ultimately the quality of care provided to patients.

Conclusion

Ethnic health inequalities, like all other types of health inequalities, are avoidable, unfair, and systematic failures. They have persistent impacts across different ethnic groups, leading to poorer health outcomes. Beyond clinical outcomes, ethnic minority patients also encounter systemic barriers such as a lack of interpreting services and discriminatory treatment, including stereotyping and cultural insensitivity, leading to a breakdown of trust in the healthcare system. These issues impact everything from GP wait times to the morale of the NHS workforce, where ethnic minority staff face discrimination that can ultimately impact the quality of care provided. It’s important to note that other factors like lifestyle, diet, genetics, and socioeconomic backgrounds have a part to play; however, the examples in this article are strongly influenced by systemic disadvantage due to bias and racism, as well as the above factors. Therefore, a comprehensive strategy which considers the impacts of all these factors is needed to remove these barriers and provide equitable care for everyone. The next article will be the final article in the series, and will look more in detail at how to address health inequalities, so watch out for that!

Written by Naoshin Haque

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