There are stark differences in health outcomes. Inequalities in power, money and resources, both at local and national levels, can make daily life much more challenging for many, and in turn this can make people more vulnerable to poorer health.
The pandemic has shone a light on inequalities, highlighting an urgent need to strengthen action to prevent and manage ill health, particularly in ethnically diverse communities. Without fully understanding the experiences of those within these groups, however, there’s a danger that discussions about such need is rhetoric only, that ‘inequality’ is just another healthcare buzzword and that the same conversations will still be ongoing in five years’ time.
How to tackle the issues in the healthcare sector and begin making a real difference
As a South Asian woman working in the UK healthcare sector, I have experienced countless examples – both personally and professionally - of a patient’s cultural and geographical background creating a significant barrier to them accessing care and support.
Last year, Connect Health held a webinar on cultural communities and health inequalities, as part of their Change event series, hearing from several patients and carers about their own experiences of navigating the health care system. Sandeep Saib had been diagnosed with anorexia nervosa, body dysmorphic disorder and OCD, and had tried to take her own life.
Like others in a similar position, Sandeep is incredibly brave to have shared her story, and to have sought professional help. In our South Asian culture, there is a huge stigma around mental health. Although the situation is changing, slowly, the stigma remains. If you have a problem, you don’t want to be seen to be trying to get help. You hide away, you pretend it’s not there.
Overcoming the stigma is difficult enough. When a patient manages to summon the courage to seek help and access care, they may not find the right support. Sandeep said she struggled to feel understood by healthcare professionals. “I saw three therapists who tried their best to understand from my perspective as much as they could. None were of an Asian background. I’m a woman, I’m British, I’m Asian, I’m Indian - I have all these different identities…You're dealing with very complex needs for each individual. You’ve got to unpick each issue and find out what the core issue is in that person,” she said.
Sandeep explained that if she’d had someone who was on her wavelength, who understood her and understood her background, her recovery would have been quicker. She would have had more of a chance.
Unfortunately, Sandeep’s experiences aren’t uncommon, and I believe more needs to be done to improve patient communication in general. I’ve been to hospital appointments with my mum, who doesn’t speak English, where we’ve been provided with an interpreter who spoke a similar language to ours – but not the same. It became apparent that the interpreter wasn’t relaying information properly. I remember a response to a question taking 90 seconds, and the interpreter giving us one word back. That’s very concerning. A patient puts huge trust in the interpreter, particularly if there’s no-one else there in the room. I’ve sometimes felt that if I wasn’t with my mum, things could go wrong. If we can’t ensure that the correct information is relayed, what are the chances of understanding cultural factors?
Cultural competence needs addressing in healthcare, especially for mental health patients
Language and the terminology we use around these issues is so important too. I dislike the phrase ‘hard to reach’ because it’s untrue. No-one is hard to reach, it’s the healthcare provision that is hard to reach. We should instead describe these groups as ‘seldom heard’, and we’ve got to ensure we’re knocking on the right doors to hear their voices. It’s about talking to people where they are, not asking them to come to us; it’s going to the people, into communities and gaining trust. ‘Value added initiatives’, as I describe them, are key – we’re adding value, we’re not expecting anything of anyone.
A project I worked on in the north of England provided exercise and massage to patients in a Gujarati temple. We learnt so much by going directly to that community and talking to them about what they wanted. The women wanted a female physiotherapist, which we expected. They also said they were very worried we’d be using massage oils containing animal fats. Who would know to consider that, without talking directly to the community? We set up the clinic with a couple of Gujarati physiotherapists – we struggled to find them, which is another issue in itself. For a while, we were completely inundated with patients wanting to use the service, which, in a way, was a good problem to have. The sessions made an enormous difference to those who attended, helping them to manage pain and feel better about themselves.
Communities know much more than we do about what’s best for them. We therefore need to ask them - what do they need? They become the solution to their own problem, which is empowering. Healthcare services are on the outside, they’re there when needed to help look at solutions together – that’s how it should be. ‘Shared decision making’ is another buzz phrase that has long been bandied about; it's so encouraging to see it in practice, and as healthcare professionals we need to push for it to be at the heart of all operational planning.
Of course, there are entrenched problems that cannot be fixed quickly through community exercise classes. Our challenge in finding Gujarati physiotherapists with lived experience of understanding that particular culture is just one small example of imbalance; there are deep-rooted cultural and structural issues at play that mean that the majority of senior healthcare executives are still disproportionately white males.
Part of the diversity strategy I’ve written for Connect Health is focused on recruiting more senior management from different backgrounds – but before we even look at recruitment, we need to go further back. What are we doing in the careers and education space, how are we motivating people from diverse communities to enter the profession, specifically within the musculoskeletal (MSK) discipline, and in mental health care? Do we need to go down the community route, showing what a difference health professionals can make to their own neighbours, as well as the wider community?
I don’t have all the answers, but I know we need to keep moving forward to create change. Opening the dialogue with the people we’re here to help is something we can do today; we can give people what they need, we can pledge our commitment to getting it right. We’re definitely not there yet, but I’m confident that when we do begin to get these things right, care provision itself will improve, and we’ll see much better health outcomes as a result.
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