Manchester study finds NHS ‘unfairness’ is exacerbating health inequalities among ethnic minorities

The NHS is “failing” people from ethnic minority backgrounds, according to England’s most extensive study of the issue.

The study, from the University of Manchester, found the average health of 60-year-olds from Gypsy or Irish Traveller, Bangladeshi, Pakistani and Arab groups to be similar to that of a white British 80-year-old.

The study found that unfairness in NHS services is exacerbating health inequalities, with people from some ethnic minority groups more likely to report insufficient support from local services to manage health conditions.

Lead author Dr Ruth Watkinson from the University of Manchester said: “This suggests the NHS as an institution is failing people from some ethnic groups.

“Policy action is needed to transform healthcare and wider support services to make sure they meet the needs of all individuals in England’s multi-ethnic population fairly.

“But policymakers also need to address the structural racism that makes it harder for people belonging to ethnic minority groups to access socio-economic opportunities because poverty is a major cause of poor health.”

Approximately 12% of the British adult population is from an ethnic minority background, but these communities have experienced higher rates of infection and mortality during the Covid-19 pandemic.

The study, published in Lancet Public Health, used the England-wide GP Patient Survey to analyse responses from almost 1.4 million adults aged over 55, surveyed between 2015 and 2017.

The sample included 152,710 people who self-identified as belonging to an ethnic minority group — the largest-ever sample.

In 15 out of 17 ethnic minority groups, health-related quality of life was worse on average than for white British people, with inequalities generally wider for women.

Mattey Mitchell who is Romany and a health campaigns officer at Friends, Families and Travellers said: “For the Romany people, these findings reflect a stark and familiar reality.

“We’ve learned to accept this reality as the norm, but this study reminds us it is not. In turn, I hope it will remind others that the sharp edge of inequality has a very real and dangerous impact on peoples’ lives.”

Josie Garrett, from the same charity, said the findings were “not surprising”.

She added: “It is deeply unfair that Gypsies and Travellers experience premature ageing, poorer health, and greater difficulty accessing necessary care and support. Everyone should have the opportunity to live a long and healthy life, and it is vital that more is done to ensure fair access to and experience of healthcare for Gypsy and Traveller people.”

The two ethnic groups who were healthier than white British people were Chinese men and women, and black African men.

But while this applied across all age groups for Chinese men, only specific age groups of Chinese women and black African men in the analysis were healthier than white British people: those aged between 55 and 64 for Black African men, and 55–74 years for Chinese women.

The study found large differences between ethnicities often grouped together in broad categories. For example, Bangladeshi, Pakistani and Chinese ethnicities are often categorised as “Asian”. But the study found that people of Bangladeshi and Pakistani ethnicity often had the worst disadvantage in health whereas people of Chinese ethnicity had a “relative advantage”.

Co-author Dr Alex Turner said: “This emphasises the need for more nuanced research to understand the specific difficulties that older adults from particular minority ethnic groups experience.”

Older people from ethnic minority groups were more likely to report suffering common long-term conditions like diabetes and having two or more conditions.

Dr Turner added: “Researchers haven’t been able to research the health outcomes of people over 55 in ethnic minority groups, because they aren’t included in sufficient numbers in most datasets

“Much official data doesn’t distinguish between groups, which can mask inequalities, but this study allowed us to analyse results for all 18 of the UK census ethnic groups separately, allowing us to see differences between them.

“There needs to be more data collection with much better inclusion of people from ethnic minority groups in longitudinal studies.”

Sam Royston, from charity Marie Curie, said: “We know that these inequalities are frequently crystallised at the end of life – and that, in consequence, too often people from ethnic minority groups miss out on palliative care.

“The pandemic has further exposed the stark scale of health inequalities in our country, particularly for people from minority ethnic backgrounds, many of whom have dealt with the complexities of death and bereavement in lockdown, coupled with the harsh realities of racism.”

An NHS spokesperson said: “While of course the determinants of health and wellbeing stretch far beyond health care itself – and include jobs, housing, income, diet, exercise and wider social inequalities – the health service also has a key role to play in supporting diverse communities to stay healthy and access high quality care.”

A Department of Health and Social Care spokesperson said: “This Government is committed to ensuring everyone has access to high quality healthcare, regardless of where they live or who they are.

“That’s why we are levelling up across this country – so that everyone can have the opportunity to enjoy a long and healthy life.

“Our NHS Long Term Plan, which is backed by an extra £33.9 billion for the NHS by 2023/24, puts tackling health inequalities at its heart and we have established a new NHS Race and Health Observatory to tackle the specific health challenges facing people from ethnic minority backgrounds.”

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