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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
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
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
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
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
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.
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
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
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
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
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
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
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
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
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!