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Since the tragic death of George Floyd, which prompted Black Lives Matter protests all over...
Since the tragic death of George Floyd, which prompted Black Lives Matter protests all over the world, racial history, experiences, and disparities are spoken about more often and openly than ever before – and healthcare is no exception.
When we think about healthcare, over the last 30 years, quality and access have massively improved, but that’s not to say that inequalities in these systems are no longer prevalent. In fact, according to a study by The Lancet, since 1990, the medical divide between the best and worst-performing countries has all but widened.
Not only that, but even in the exact same countries, there remains startling health inequities among different social groups. As you’d probably guess, those on the lower end of the socioeconomic scale generally pose a higher risk of poor health. The World Health Organisation points out that children from the most deficient 20% of households are nearly twice as likely to die before their 5th birthday than children in the wealthiest 20% of households.
If we shift our gaze to the US, African Americans are one of the most economically disadvantaged demographics in the country. Overall, they make up just 13% of the whole population, yet they account for almost half of all new HIV infections. It’s key to point out that there is no biological or genetic reason for these disturbing differences in health, which only begs the question, why do African Americans unjustly bear the brunt of numerous healthcare challenges?
But America isn’t the only country suffering. Looking toward the UK, health disparities are even vast in the same cities. London Health Observatory has noted that if you travel east from Westminster on the tube, each stop represents approximately one year of life expectancy lost. For any Londoners reading this, that means from Westminster to Stratford, life expectancy drops by 19 years!
So why are we only talking about this now? Well, because the Covid-19 pandemic brutally exposed health inequalities all over the world. One study in the US found that Black people were 3.57 times more likely to die from Covid than White people. In the UK, Public Health England found that Covid deaths were higher among Black and Asian people than White people.
With racial discrimination, bias, prejudice, and stereotyping permeating health systems across the globe, today we’re going to focus on the different healthcare systems in the US and the UK to try and understand why those from ethnic minority backgrounds receive lower standards of care and a higher risk of illness, what consequences this has on patients and healthcare providers, and how as an industry we can move past this unfair treatment.
The long and short of it is that health disparities occur in the context of broader inequality and systemic racism. It’s long been known that those from minority ethnic communities experience poorer health than the overall population. What’s more, underlying socioeconomic factors such as education, unemployment, and poverty all contribute to health inequalities.
But, if we really look deep into the systems’ faults, many ongoing – and false – beliefs derive from the 19th century when doctors would use them to justify their treatment of the enslaved. Examples of these beliefs include Black people having thicker skin, stronger immune systems, a higher pain tolerance, and less sensitive nerve endings. Of course, to many of you reading this, these philosophies seem absolutely ludicrous, but as late as 2016, a study found that 73% of White medical students held at least one false belief about biological differences between races.
The UK is one of the world’s most developed countries and yet we are still to reach racial equality.
Looking specifically at healthcare, a review funded by the NHS Race and Health Observatory found that treatment for Black people’s mental health across the UK was particularly poor. Evidence also suggests that ethnic inequalities in adult mental health mirror that in younger generations, with one study showing that Black children are ten times more likely to be referred to Child and Adolescent Mental Health Services through social services rather than their GP.
On the topic of children, the review of maternal healthcare found evidence of negative interactions between healthcare providers and patients, as well as stereotyping, discrimination, and cultural insensitivity. This meant that a proportion of ethnic minority women felt othered, unwelcome, or poorly cared for throughout their pregnancy.
With examples such as the above, it’s no surprise that many ethnic minority patients delay or avoid seeking help for their health issues due to fear of racist treatment from healthcare professionals. Of course, healthcare is a fundamental human right and should be available to everyone without fear, unjust treatment, or biases clouding judgements and diagnoses.
Sadly, these divisions are not only felt by patients in the UK but across the Life Sciences industry as a whole. It’s been noted that racism is present throughout the drug development cycle, from research to assessment to dissemination.
Take clinical trials for example. Despite having poorer rates of ill-health, those from ethnic minority backgrounds still continue to be vastly underrepresented in clinical trials, both as participants and as researchers. In fact, data from National Institute of Health Research found that when applying for funding, researchers from ethnic minority backgrounds had a 16.5% success rate compared to a 21.2% success rate in White applicants.
What’s more, White patients are often used as the default group to develop and test new treatment methods because ethnic minorities are largely absent from communities where research participants are recruited. Still, that’s not a worthy excuse considering it only lessens the value of research findings as there’s no guarantee that the results of clinical trials will apply to populations omitted from the research.
Neglecting particular social groups only reinforces existing health inequities which can lead to racially tailored care that perpetuates medical errors and harmful and unscientific ideas about biological differences between ethnicities. To this day, some of these beliefs still exist in medical guidelines that inform decisions on patient treatment. Moreover, because of the lack of representation, racialised minorities are often aggregated into one group, which undermines our understanding and obscures differences among distinct ethnicities.
While all of this happens behind closed doors, there also seems to be widespread ethno-racial bias in academic publishing, which only hinders career progression, research funding, and the dissemination of knowledge and research.
Looking in more depth at imbalances throughout the UK’s healthcare industry has found that employees also feel the repercussions of racial disparity, which usually translates as inequalities in treatment, experiences, and opportunities for professional development.
One study carried out in 2018 by the British Medical Association found that despite the growing number of Black, Asian, and minority ethnic doctors, 45% didn’t feel there was respect for diversity or a culture of inclusion in their primary place of work.
As mentioned at the beginning of this article, the Covid-19 pandemic highlighted inequality in the workplace for minority ethnic doctors. In the UK, those from marginalised backgrounds reported they felt more pressure to work without adequate PPE and were more afraid to speak about their safety concerns for fear of recrimination and the effects it might have on their careers. Even more shockingly, 85% of doctors who died from Covid in the UK happened to be of non-white descent.
Within the Life Sciences space, the outlook is equally bleak, with the Office for National Statistics reporting that in 2019, less than 1% of Life Sciences employees were Black/African/Caribbean/Black British compared with approximately 3% in the wider economy.
This lack of parity only proves that structural inequalities continue to linger in the UK’s healthcare industry, creating unpleasant working environments and an expanding unfair pay gap for ethnic minority workers in comparison to their White colleagues.
Although our healthcare systems are widely dissimilar, like the UK, the US healthcare system is plagued with inequalities that disproportionately impact people of colour, affecting gaps in health insurance coverage, access to services, and poorer health outcomes. In fact, according to the American Medical Association, minority ethnic groups are less likely to receive routine medical care and face higher rates of illness, disease, and mortality.
When looking at illnesses ethnic minority groups are more susceptible to, a report by the US Department of Health and Human Services found that people of colour generally suffer from higher blood pressure and have a lower life expectancy. The same report also found that racism is strongly related to poor mental health, contributing to stress, anxiety, and depression.
Speaking of mental illness, did you know that in the US, Black men are four times as likely to receive a schizophrenia diagnosis than White men? Mental Health America suggests that this is because clinicians often neglect symptoms of depression, instead focusing more on psychotic symptoms when treating Black patients.
Examining in more detail the treatment of Black people in America, evidence suggests that healthcare providers are less likely to admit Black patients to hospitals than they are White patients. In that same 2020 report, it’s noted that Black people are 1.26 times more likely to die in an emergency room or hospital.
And the same kind of treatment goes for children of colour, according to Frontiers in Paediatrics. Their research found that doctors in emergency rooms are less likely to classify Black or Latinx children as requiring emergency care, admit them to hospital, or order blood tests, CT scans or x-rays compared to White children.
Moreover, pregnant women and newborns often receive ill-matched treatment to their white counterparts. Over the last couple of years, many women have been vocal about their treatment during their pregnancies, and a 2019 study supports their claims of mistreatment by reporting that Black women are 3-4 times more likely to die from pregnancy-related causes than White women.
This disparate level of treatment in all areas of care calls for urgent and severe action to protect ethnic minority groups in America. As mentioned above – and likely to be mentioned again – accessible and quality healthcare is a basic human right for all.
Unfortunately, racial inequalities are strewn throughout the US Life Sciences industry, and it has not gone unnoticed.
Since the early 2000s, the FDA has advised that clinical trial groups be reflective of the overall population, but even though ethnic minorities carry a disproportionate burden for certain diseases, US-based trials continue to underrepresent those from ethnic minority backgrounds. In fact, a recent report found that White people accounted for 77.9% of clinical trial participants while Black people only represented 10.6%, Latinx represented 11.6%, and Asians 5.7%.
To put that into perspective, in 2020, the American Association for Cancer Research found that African Americans have 1.5 times the incidence and twice the death rates from prostate cancer compared to any other race or ethnicity. In comparison to White people specifically, African Americans suffer an 111% higher risk of dying from prostate cancer!
During that same year (2020), only 1% of cancer-focused clinical trials were directed toward racial and ethnic minority groups and only one third reported race and ethnicity in trial results… so you see the problem?
The whole point of conducting clinical trials is to provide evidence that a medical product or treatment is safe and effective. It’s known that biological differences exist in how people respond to therapies, so if a trial group lacks diversity in people who are eventually going to use the treatment, how can those results be entirely reliable?
Still, that’s not to say that the lack of ethnic minority groups in trials is all down to the researchers. Of course, there are many more barriers that could affect enrolment and participation, such as mistrust in the clinical research system due to historical abuse, time and resource constraints, transportation and participation conflict, health literacy, language and cultural differences, and limited access within the healthcare system. The difference here is that these limitations correspond with disparity that’s existed for years within the system. In order to beat them, we must address them and reduce them.
Fortunately, since Covid, decentralised and hybrid trials have become a much more popular way of conducting clinical trials. These models provide flexibility which means they reach populations who would have been harder to recruit in the past – essentially, removing some of the barriers listed above.
On top of that small win, corporations have got involved in advancing more diverse participation too. In February 2021, The National Institutes of Health (NIH) established the UNITE initiative, which aims to end systemic racism in biomedical research within the NIH and in the universities and research institutions it funds. It’s worthy to note that although the NIH has longstanding policies that focus on increasing diversity in research teams and participants, this is the first time the agency has employed money from its $45 billion fortune to tackle systemic racism head on.
Additionally, the American Medical Association (AMA) is working to increase the number of minority physicians to reflect the diversity of the US population through its policies and advocacy work. The AMA has also enacted other policies to increase awareness of racial and ethnic disparities in healthcare and strengthen patient-provider relationships in publicly funded health plans.
By and large, the Life Sciences workforce lacks diversity as pointed out in a study by Nature Biotechnology. They found that NIH have just 4% of Hispanic and less than 2% of Black senior investigators. What’s more, in biotech companies in general, Black employees make up just 7% of the workforce and 3% in management roles – significantly less than their overall 13% share of the US population.
Pivoting our attention to those dealing with patients, like in the UK, American healthcare professionals are no strangers to racism when it comes to their jobs. However, research on this area in the US is few and far between.
One study, in particular, found that 23% of US patients directly refused care due to the race of their physician. The same study also found that the majority of participants experienced significant racism from their patients, colleagues, and institutions, which also correlated with symptoms of secondary traumatic stress.
If we look back toward the height of Covid-19, similarly to those in the UK working without adequate PPE, The Lancet reports that throughout the pandemic, US-based Black and Asian healthcare providers were less likely to receive Covid testing than White healthcare providers.
From the few studies outlined above, none of us can deny that ethnic minority groups suffer from disparities in healthcare, both as patients and as professionals. But, with UK and US Life Sciences industry having immense influence on global health, there is a responsibility as well as mass opportunity to transform our systems. To do so, urgent work is needed in each healthcare system to truly understand the precise reasons behind these disparities so we can develop and implement multi-level strategies to improve health equity in both the UK and the US.
So, instead of reinforcing systemic ethno-racial inequities, we must reduce them to reflect the diversity of the population, optimise innovation and inform inclusive decision making. This begins with diversifying teams and improving research to reach better outcomes. By doing so, not only will internal structures thrive, but patients and diseases that have previously garnered less attention will have the platform, access and care they so rightly deserve.
Although the industry suffers from a lack of diversity, there are also some phenomenal Black talents making huge strides in the world of Life Sciences. To find out who they are, keep your eyes peeled for our next blog post!