ESSAY COMPETITION WINNER 2021

What relevance does diversity play in healthcare?

By Amara

A healthcare setting should be a place where all who enter feel as though they are safe and are respected by those around them. Thus, it is a requirement most vital that it is an environment filled with people from various backgrounds and identities. Without this, a secure setting suitable for healthcare is not possible.

 

The proverb that a hospital is the safest place in the world is a statement accurate for some more than others. In fact, 14% members of the LGBTQ+ say that they avoid treatment due to fear of harassment. If a place where people come to heal is a place where people feel as though they are at threat of harm, we should all be concerned. Without diversity, it is less likely that caregivers will understand the necessities of their patients, however introducing diversity makes this more plausible as the likelihood of someone understanding the needs of certain minorities, possibly because of their background and history or because of their own identity. It is salient that all people feel as though they can receive endorsed treatment without judgement or discrimination. Otherwise, there is the risk they will seek dangerous care that could worsen their sickness. Additionally, there is the peril that the patient doesn’t seek treatment at all out of fear. For example, black women, who are 4x more likely to die from birth in a hospital, may choose to have a homebirth despite doctor’s advice which could lead to complications that put them and their child at risk.

 

Lack of diversity leads to mistrust between a doctor and their patient which affects the communication between them. It is factual that minorities benefit from minority caregivers however, arguably, caregivers also benefit from a relationship with their patient where both have faith in each other. Although one could contend that this could coax prejudice, this could be advantageous. When patients feel more comfortable and feel as though they can trust the person they are relying to heal them, they will be honest. This is crucial for diagnosis and treatment as the caregiver relies on the patient to be sincere in order to dispense the correct medication, take the correct medical exams and overall, do their job. It would be frustrating for caregiver and patient to have a relationship built on distrust and healthcare is much more efficient when both have confidence in each other.

 

In all workplaces, diversity improves teamwork. In fact, a study by McKinsey & Company found that gender diversity increases the likelihood of outperformance of a company by 48%. The efficiency of healthcare highly relies on members of the team being able to work together and communicate in order to treat patients, so it is pivotal that members come from a variety of backgrounds and identities. The COVID-19 pandemic has highlighted the importance of diversity in the NHS, as workers from marginalised groups have expressed how they felt unable to share their concerns around lack of PPE (personal protective equipment) available for them. If their workplace was more diverse, it is possible they may have felt as though they could be frank about their feelings: for example, to a colleague of similar background to them. Nevertheless, it is also important the workers of colour in healthcare settings feel that it is a safe place for them; this is achieved by increasing diversity. However, in order to benefit from all the advantages of diversity it is essential that workers from marginalised groups feel assured of their safety.

 

To conclude, diversity is highly relevant in healthcare in order to stop prejudice be embedded into a system designed to be equitable. Healthcare in the United Kingdom is for all people despite their background or identity and in order to ensure this, we must create an environment that everyone feels able to enter.

What relevance does diversity play in healthcare?

By Tessa

ESSAY COMPETITION RUNNERS UP 2021

Sir David Nicholson, Chief Executive of NHS England, states that healthcare is about “high quality care for all, now and for future generations.” But can this be accomplished without addressing the racial, gender, sexuality, and socioeconomic inequalities that exist within medicine?

 

In 2020, around 1.3 million people were employed by the NHS. 77.9% of NHS staff were White, 10.7% were Asian, 6.5% were Black and 2.6% were from other ethnic groups. When we look at the countless individuals who enter hospitals and clinics every day, they include people from every race, gender, age and to best communicate with them, it is crucial that they can see themselves  within healthcare. Dr Antonio Webb, an orthopaedic surgeon highlights the importance of this representation as he says, “My parents weren’t physicians, and I didn’t really have any mentors, I kind of carved my own path. ” This lack of diversity in the workforce restricts medicine's capabilities, confining it to a single ethnic lens and set of values. Instead, the medical workforce should be representative of the wide range of patients for whom they care. Furthermore, evidence has shown that implicit bias and lack of anti-racism education has led to unintended disparities that have real consequences in patient care. A Harvard study shows that although doctors self-report no preference, the implicit association test reveals bias favouring white individuals and seeing black patients as less co-operative. This has made an impact: for example, the more implicit bias a doctor has, the less likely they are to thrombolyse black patients with acute coronary syndrome compared to their white counterparts.

 

Furthermore, the LGBT+ community's healthcare disparities demonstrate the need for diversity in healthcare. About 2.2 percent of British people identify as LGBT, and evidence shows that LGBT individuals have disproportionately worse health outcomes and healthcare experiences. LGBT youth receive poor quality care as a result of stigma and a lack of awareness from healthcare providers and insensitivity to unique needs of the community. This is a major issue because LGBT youth have a higher risk of substance abuse, STDs, cancers, obesity, bullying, isolation, rejection, anxiety, depression, and suicide than the general population. According to the 2017 National LGBT survey, at least 16% of respondents who used or attempted to use public health services had a negative experience because of their sexual orientation. TransActual UK’s Trans lives survey 2021 found that 98% of transgender people do not think NHS transition related care is adequate. In addition, almost 45% feel their GP does not have a good understanding of their needs as a trans person, a figure that rises to 55% for non-binary people The concerning issues that we will have to continue facing without an increase of diversity for LGBT youth include stigmatisation, social stress, peer victimisation, and family rejection. This is due to health care providers perhaps lacking adequate training on the specific needs and challenges faced by this community. This lack of training has the potential to perpetuate prejudice and discrimination, resulting in subpar medical care and an increase in the prevalence of diseases and risk factors.

 

Moreover, socioeconomic discrimination heavily affects healthcare as well. The COVID-19 situation exposed the inequalities that working-class families faced and the devastating effects that it could have on their lives. Low- paid individuals are more likely to have to go to work, more likely to be furloughed and less likely to receive a good level of sick play. This not only puts them at a higher risk of contracting the virus, but also increases their chances of taking a financial hit and falling into debt and poverty even if they do not get ill. Throughout the pandemic, key workers have stayed at work and kept essential industries going. Despite the vital work they do, many are also not getting paid enough. Four out of ten key workers earn less than £10 per hour. This has a huge impact in household finances as many of these workers support multiple members of their family. Research by Citizens Advice found that over 13 million people had already been unable to pay at least one bill (or expect to be unable to do so) at the start of the pandemic. The type of job you do during this pandemic doesn’t only affect your finances – it may also increase your risk of dying from the virus. The mortality rate is also much higher in the most deprived areas of the country . Data covering March to mid-April shows that the mortality rate in the most deprived areas of England is double that of the least dep Low-paid workers are much more likely to be going out to work as normal right now, and much less likely to get decent sick pay if they fall ill, and so are less likely to get treated.

 

In conclusion, diversity is undeniably relevant in healthcare today, as without it the healthcare sector will continue to avoid addressing the inequalities faced by marginalised groups. In order to provide a more comprehensive, scientific, and humane care for these minority communities, healthcare providers must be educated through proper training, and guidelines must be developed and implemented to avoid the ignorance, stereotypes and prejudice that is being perpetuated at the moment.

What relevance does diversity play in healthcare?

By Raiannur

When we look at Diversity in healthcare, first we must look to what diversity is exactly. Verna Myers describes “Diversity” is being invited to the party while “Inclusion” is being asked to dance. In ethical stance, many disagree with this perspective, because they believe it is an unmitigated oversimplification. When we look at the realms of healthcare we look at: race, ethnicity, gender, sexual orientation, and other minority groups and whether they make an effect in a health care setting.

 

In the UK, the vision of the National Health Service when it was established was to create a comprehensive service, available to all, no matter what, and the envision of equality is enshrined in the Equalities Act (2010). While many believe that institutionalised bias is primarily saturated in the United States, the United Kingdom does not stand innocent. After the murder of Stephen Laurence, the Government aimed to increase diversity in the civil service. Evidence shows that the NHS failed to commission services that catered to the black and ethnic minority groups, causing distrust between patients and healthcare service providers.; and that the NHS disproportionately favoured white applicants and alarms were raised when there was a large absence of black and ethnic minorities in senior NHS roles. In 2013, following the Francis Report, people agreed that the NHS needed a radical change of culture and leadership style.

 

The NHS, under large criticism was labelled as unable to tackle inequalities, healthcare access and do the part and parcel of their job. Low diversity and lack of cultural competence were the main factors in compromising the effectiveness and safety of care. In a study, when researching the provision of care for people of Bangladeshi origin, research showed that the provision to overcome communication problems have been minimal and that general practitioners largely relied on informal interpreters, as a result, British Bangladeshi’s continue to experience poorer health and poorer healthcare than any other minority (diabetics) in the UK; however these obvious problems remain untouched by clinical commissioners; a lack of BME staff has been linked to this problem. A 2013 study showed that a white British candidate was 1.74 times likely to get a position then a BME candidate, even though the job specifications were the same.

 

Diversity also plays a key role in British Healthcare by bringing new innovation, a larger pool of talent and increases their capacity to organise; in turn this led to a better rate of satisfaction for patients; and studies found out that high performing healthcare organisations were more likely than low performing organisations to have a board with 50% female membership. This directly shows how women, at a high proportion were able to work more effectively, making better decisions, sensitivity to perspectives and a better governance process. Furthermore, in 2013, when the NHS was facing budget cuts, the knowledge of the members of ethnic minorities have played a key role in minimising costs an example of this acquired diversity is the use of Indian expatriates improving information & communication technology in the NHS. While research is inconclusive, it supports the fact that NHS Trusts should work to compose a workforce with acquired diversity. With all these factors in mind, it has been proven that a better workforce that is diverse, and knowledgeable about cultural competence leads to positive work outcomes, and improved performance, decreased absenteeism and greater patient outcomes.

 

Trust Boards should make a continued effort to make a diverse NHS because diverse teams informed and safe decisions. In many areas, board members do not reflect the general population and continually fail to provide to BME population; because they have more difficulty ensuring that care is genuinely patient centred.  An example of this is the resultant failings in quality of services which Ministers acknowledged in 2006 where they stated “Black and minority ethnic users were being discriminated in ways that were unethical and unlawful”. Dr Frank Keating, in his book, Breaking the Circles of Fear, stated that Black people have a strongly grounded mistrust and fear of NHS service, which they think are inhumane, and constantly resist seeking help. One of the reasons he states why is because “[there should be a] leadership of black staff, services should adopt a culture that says it is ok to talk about race” and says that BME communities should have a key role in setting a service agenda.

 

In conclusion, diversity plays a big role in running the NHS, from trusts to hospital work. The British Healthcare system should look to mobilise culture change and to resist staying still. Now, we must go back to what was read at the start; The National Health Service, a comprehensive service, available to all, with a wider social duty to promote equality through the services it provides. (NHS Constitution). The NHS must work interchangeably for a better world leading class healthcare system: there should be better outcomes for BME employees in the NHS; the removal of workplace bullying, harassment based on minority factors; and in turn this will lead to better patient outcomes, better morale, less absenteeism and a better NHS.

1. Salway (2013)

2. Kline (2013)

3. https://blogs.lse.ac.uk/politicsandpolicy/a-very-long-and-slow-walk-ending-race-discrimination-in-the-nhs/

4. Chambers (2011)

5. King, E.B. (2011)

6. Jan Sobieraj (2012)