The Inadequacy of Ethnic Consideration in Healthcare Policies
January 2025
A recurring point hashed out in debates on medicine, ethnicity, and the increasingly divisive field of modern politics is the ethnic disparities within healthcare. Trying to find reliable information on this topic is marginally easier than walking in a patch of landmines, so here I have tried to pull together a very broad, general overview of the current state of ethnic disparities in the United Kingdom’s current healthcare system. Each and every single one of these points, plus much more, I could and at some point will write much more in depth on. But for the time being, as a very wide look at a very wide topic, I hope to show in this short piece that there is a concerning gap in satisfactory healthcare attainment by ethnicity, and that the UK government in its current state is, at least seemingly, ignoring this issue.
To get a grounding before the article, some basic statistics to set out the current issue.
Research has shown, time and time again over recent studies into the experience and outcomes of healthcare and medical treatment, that there are ethnic disparities in the quality of the healthcare. For an example, of all mental health detentions as measured by ethnicity in the 2023-24 period, African, Caribbean, and other Black patients made 970, to only 1,203 among all other ethnic groups recorded, a total of 12 others, combined. This, despite the fact that the population of the UK is only 4% Black. More importantly however are the actual, practical applications of these numbers, namely what has been done already in the field of compensatory policies and public awareness on this topic, as the evidence to show these attainment gaps will be able to come up much more naturally in context. And that deserves the bulk of this article, so what has been done?
Well, due to such a discrepancy in healthcare results by ethnicity, and that this data is accessible by the government, it would be natural to assume that there would be an amount of compensatory policies released to handle this difference, especially as, in 2022, the Health and Care Act (In future, the “2022 Act”) was released, aiming to introduce new, COVID era provisions within the healthcare field. The government itself has also launched inquiries under the Commission on Race and Ethnic Disparities (CRED), as well as having been advised by an NHS report in conjunction with the King’s Fund on the same topic. As a result, the government is very aware of this problem, and is actively attempting to develop the NHS as recently as 2022 in a major fashion, while also reading some healthcare bills in parliament currently. Therefore, an amount of effort taken to account for this problem would make sense.
However, in the 2022 Act, and the bills currently in reading within parliament which I will address later, ethnic health disparities are not mentioned at all. The only evaluation of the impact on ethnic disparities in healthcare regarding this act is a small section in a gov.uk assessment article which stated on page 47 that an amendment to the Human Tissues Act which criminalises certain receipts of organs overseas “May cause concern among people who legitimately receive organs overseas, who are also more likely to be from ethnic minority backgrounds, that they will be treated as a criminal suspect”, and that this may make their receipt of organs within the UK harder due to longer waiting times. However, this is a statistically insignificant issue when compared with the real and present problems that the government has been made aware of.
So it seems clear then, that in the largest mass amendment to pre-existing policies within the last seven years, the official gov.uk report couldn’t find anything more substantial that the government have done to affect ethnic disparities in healthcare than a slight mention of making organ transplants harder to achieve overseas. Needless to say, this an underwhelming finding for a policy as vast and encompassing as the 2022 Act. Although it is easy to say that this is still only one act making small amendments to many others past, and as such to actually judge its effects properly would be quite hard due to the sheer amount of tiny changes, the fact that the government has been warned of these issues repeatedly suggests that this lack of direct, targeted change is not a result of the data being hard to find, but rather just ignorance and indecision.
As an example to prove that the government is aware of these inequalities, and some further details upon the attainment gap itself, the CRED was formed to investigate ethnic disparities in healthcare in July 2020, launching a call for evidence on the 26th of October that year, concluding on the 30th of November the same. The CRED stated that a “considerable” number of participants cited systemic racism as the cause of their experience of ethnic disparities, and that they especially believe that the field of healthcare harbours “negative preconceptions and unfavourable attitudes to ethnic groups.” This was evaluated however with some believing they receive better treatment from Black and Asian professionals. The report did state that it believed the core cause of these ethnic disparities though was not ethnic prejudices, but actually the typically lower economic status of ethnic minorities, who are more likely to experience material deprivation, and as a result suffer from more health problems, as well as experience societal judgement for being working class. This though fails to account for the fact that a lot of ethnic minorities are not materially deprived, and such blanket statements cannot apply to all cases, when the problem applies to all minorities.
Even further, the NHS itself is aware of these issues acutely, and is aiming to counter them with their own independent actions. In the independent King’s Fund report commissioned by the NHS, the organisation sets out its past actions, current plans, and relevant data for ethnic inequalities in healthcare. This report is, in a field of underwhelming data and vastly lacking policy, a ray of sunlight as it sets out clear, attainable goals and lessons learnt from measurable progress in the past, while still acknowledging the vast distance left to go as yet. However, all these glowing and wonderful ideas that could work to level the field of healthcare are of barely any value if the government cannot back them up, as the NHS is already working to hold itself together in an underfunded, post-COVID world. Beyond that, the NHS as a government organisation should inform the decisions of government, and if, with the weight of evidence against them there are still no bills working to raise the quality of minority healthcare being fielded, then the future of their aspirational report seems fairly bleak. .
That then mostly concludes what has been done, which is worryingly little. The general conclusion here seems to be that there is a problem much larger than many would want to admit, and despite repeated attempts to get something to happen that would narrow the ever-present gap in healthcare by ethnicity, so far the government has said a lot and offered little.
But that is still only what has been done, the really important part is what will be done in the future. Specifically, is the government currently planning anything, fielding any bills, developing any policies, that would try and ease this problem? For bills currently in parliament, is there anything which could offer a touch of progress?
As it is, it seems not really. There are currently, the time of writing being 12/Jan/25, two bills which could affect ethnic disparities in healthcare.
The first of these is the Public Body Ethnicity Data (Inclusion of Jewish and Sikh Categories) Bill, which aims to add the two listed ethnic groups to national surveys, as both are currently vacant. This bill, if enacted, could see a small raise in the catching of ethnicity specific health problems, such as the current British standard set to provide genetic screening for breast cancer in Jewish people, who experience higher rates than the majority. To have these ethnic groups listed on surveys rather than having to fit into wider, less accurate ethnic categories would offer a small but tangible effect to national record keeping. This though is a very small change.
The other is more hopeful, but is quite open to multiple interpretations. This bill, currently in 2nd reading in the House of Commons, is the Care and Care Workers Bill, which seeks to create an independent “National Care Workers Council” to set a system of “professional qualification and accreditation” for care workers, and general “professional standards” in the said field. While this definition is currently quite vague, it is very easy to see that, were this bill to receive royal assent and become reality, the “professional standards” discussed could well contain metrics for equal treatment, consideration, and care provided to ethnic minorities, and having an independent council to enforce this would allow them to be enforced more equally. A potential example of this would affect the aforementioned CRED report, as a stricter, more professional stance on systemic racism could positively change the perception of this as a “considerable” cause of ethnic disparities.
These both however are only bills, neither of which have passed second reading, both of which are only tangentially related to the field of ethnic disparities, and both of which are only treating the symptoms of the disease, such as lack of efficient labelling in surveys or the less enforced standards for care workers, rather than the cause. This cause being, the widespread and systemic racism within British healthcare that sees the government informed, repeatedly and in depth, of the problems staring them in the face, and still not leading them to any substantial focused development. So what is being done remains only general, untargeted policies that seem to have nearly as little bearing upon ethnic healthcare disparities as what has been done, evaluated earlier in the 2022 Act.
And while obviously yes, it does make sense for general improvement to the field of health to take place, such as the 2022 Act, if there is a measurable, sharp difference in healthcare by ethnic group, it is the most basic of logical choices to say that there should be a measurable, sharp change to that region specifically, as the standards being raised for all does not close the gap, only move the whole problem up slightly.
In conclusion, the most policy analysis that can take place in the current field of British ethnic healthcare is that the policy is not there to analyse. In much over 48 hours of research combined, picking through every new act released in the UK since 2017, every healthcare year in policy reviewed by the King’s Fund since 2019, multiple NHS reports, government reports, and every bill currently before parliament, absolutely nothing that treats on the ever-reinforced issue of ethnic disparities seems to exist, and if it does exist it evidently has not cured the problem, which is still pressingly present especially under the recent banner of COVID, which saw ethnic minorities face a significantly higher death toll than the majority. Unless some specific new policy is introduced, or independently of this general overview I can find some gleam of hope in the records of British legislation that suggests action is currently being taken and having an appreciable suite of effects, then all analysis will eventually have to boil down to the fact that the UK government cannot currently take any action to support its ethnic minorities in the most important of fields, healthcare, unless it vastly shifts direction and releases some kind of large scale development to the NHS. However, viewing the bills we currently seem to be receiving, this scale of change seems unlikely.
For those interested in seeing where the data for this overview has come from, below are the collected references that were linked throughout the article, and the bulk of what I read to form the opinions put forward here. I would like to put special credit to The King’s Fund for their Healthcare Policy Year in Reviews and Year in Graphs, which led to many of the other sources used and were a wonderful way to turn a large set of concepts into manageable pieces.
I will always encourage more reading around topics of interest, especially those with some substantial importance to them such as this. Furthermore, the most valuable of any information is first hand, and this by nature is a second hand, quantitative analysis of the matter. So to truly learn about this, we have to continue to study, campaign and develop in the face of a complex and hard to grapple with topic. Hopefully, these links can form a good stepping off point for that individual learning.
All references used and read independently. Further reading around the topic through legislation.gov.uk and gov.uk for lists of Acts and current bills, as well as the NHS website for current standards and reports.
ICB Report on Crude Rates of Mental Health Detention by Ethnicity and Year
Population of England and Wales’. 2022. Gov.uk
Preet Kaur Gill, Labour-Birmingham Edgbaston. 2024. Public Body Ethnicity Data
Raleigh, Veena. 2023. ‘The Health of People from Ethnic Minority Groups in England’, The King’s Fund
Shropshire, Morgan Helen Liberal. 2024. Care and Care Workers Bill 2024
The Commission on Race and Ethnic Disparities.
Why Have Black and South Asian People Been Hit Hardest by COVID-19?