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Health inequalities and ethnic minority communities: breaking down the barriers

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Almost from the start of the coronavirus (COVID-19) pandemic, its unequal impact on ethnic minorities has been clear. But the health inequalities experienced by Black, Asian and Minority Ethnic (BAME) communities predate the pandemic. As the Local Government Association has observed:

“…the truth is these inequalities were already having an impact on the health and wellbeing of ethnic minority communities before COVID-19 hit – it is just that the pandemic has shone a light on them like nothing before.”

Recently, the Centre for Ageing Better hosted a webinar titled “Ethnic health inequalities in later life,” based on the report of the same name, published in November 2021.

The report mainly looked at the period from 1993 to 2017, although the webinar was able to offer more recent information regarding the COVID-19 pandemic, which of course greatly affected health inequalities.

Widening inequalities

Dr. Sarah Stopforth, one of the researchers for this study, explained that  ethnic inequalities have been found to widen more after the age of 30, and by the age of 40 have established themselves. One of the study’s main findings was that poor health for White British women in their 80s was the equivalent to the poor health of African and Caribbean women in their 70s, and the equivalent to Pakistani and Bangladeshi women in their 50s.

While there were similar results for men from these same ethnic groups, it is clear that women across all ethnicities have poorer health than their male counterparts. Why is this happening?

The reasons are complex, but Sara suggested that  health inequalities are usually tied to the socio-economic inequalities present in our society. However, she also said that this tends to ignore the underlying causes of these health outcomes.

The role of the NHS

Dr. Habib Naqvi from NHS England talked about the role of the NHS in tackling health inequalities. He asserted that our healthcare system should be well equipped to respond to these inequalities, given the UK’s long history of migration by people from Afro-Caribbean communities. So why has it not been able to?

A lot of this, he explained, was due to the fragmentation of the NHS. The many areas of the sector are not working co-operatively to reach a collective and consistent goal, which then affects the ability to tackle issues such as inequalities in the sector.

In addition, Dr Naqvi pointed to mortality rates for ethnic minority groups – living longer does not always mean living in a healthy way. One of the features of “long Covid,” is its tendency to exacerbate long-standing health complications or to weaken COVID-19 patients’ health even after the illness. Again, ethnic minority communities have been disproportionately affected by this condition.

Another impact of  the COVID-19 pandemic has been a heightened feeling of isolation and fear for many ethnic minority groups, something highlighted in a report from the University of Manchester. Many were unable to communicate with healthcare staff due to language barriers or health conditions affecting their communication skills, and were often having to be admitted alone due to Covid restrictions. The inability of patients from ethnic minority backgrounds  speak for themselves raises concerns about their healthcare. Research has found evidence that ethnic minority patients – especially women – are not having their illnesses taken seriously.  

Vaccine hesitancy

Linked to this is the controversial issue of vaccine hesitancy, which has become a particular concern among ethnic minority groups. One of the reasons that many members of ethnic minorities may feel hesitant or scared to take the vaccination is because of the lack of communication and information, linked with their previous healthcare experiences.

It was suggested during the webinar that even throughout the pandemic, the healthcare sector has not effectively protected ethnic minorities, despite these health inequalities long being known.  Health professionals have attempted to reach out to communities and help them with any fears regarding COVID-19 or the vaccination process, but this can be difficult with social distancing restrictions. As a result, people within BAME communities may have to rely on family and friends to get information regarding vaccination, which may not calm their fears.

Data, care and trust

One of the key points driven home by Dr. Naqvi was the need for better data in order to better understand health inequalities among ethnic minority communities. Birth to end-of-life care was also mentioned, including tackling racial bias that can be found even in antenatal care. Finally, the concept of earning trust was highlighted. Dr. Naqvi said that the NHS must work to earn trust from BAME communities, particularly among the elderly, given the long-standing disparities in treatment and discrimination many have faced over the years.

Final thoughts

The webinar offered useful insights into how deeply healthcare inequalities lie. Our previous blog post on the future of public health offered a reminder that access to efficient, well-supported and high quality healthcare is vital for everyone. This webinar underlined that message, but highlighted its special significance for those experiencing longstanding health inequalities.

Photo by Hush Naidoo Jade Photography on Unsplash

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Diversity and inclusion in the workplace: more than just demographics

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The experts are in agreement: having a diverse workforce can drive innovation, improve performance and attract top talent.  As such, diversity and inclusion (D&I) is a ‘hot topic’, with many top organisations identifying it as a key element of their corporate strategy.

But what does effective D&I look like in practice?  In this blog, we will look at how to implement effective D&I initiatives in the workplace.

 

Progress still needed

While organisational diversity has improved in recent years, there is still a long way to go.

Action has been most visible in regards to gender.  However, although female employment rates have increased, male and female experiences of progression within the workplace are still vastly different.  For example, in 2018, FTSE 100 CEOs were still more likely to be called Dave or Steve than to be female.

Progress has been less tangible in regards to race and ethnicity.  A recent study by the Chartered Management Institute (CMI) found that while 75% of FTSE 100 companies set progression targets for gender, only 21% did the same for BAME. Indeed, only 6% of top management jobs are held by Black, Asian and minority ethnic (BAME) leaders, whereas BAME groups make up 12% of the working population.

There is a similar lack of representation among disabled and LGBT employees.  This only increases when considering intersectionality – that is, employees who identify with more than one protected status.

 

Diversity and inclusion are separate concepts

Many organisational diversity initiatives have proved unsuccessful.  Where have they gone wrong?

Firstly, being a truly inclusive organisation is about more than just hiring a diverse workforce.  Diversity alone does not guarantee that every employee will have the same experience within the organisation.

A first step towards implementing an effective D&I strategy is to understand that diversity and inclusion are related, but distinct, concepts.

As the recent CIPD report on ‘Building inclusive workplaces’ explains:

  • Diversity refers to the demographic differences of a group. It usually references protected characteristics in UK law: age, disability, gender, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.
  • Inclusion, on the other hand, is often defined as the extent to which everyone at work, regardless of their background, identity or circumstance, feels valued, accepted and supported to succeed at work.

Thus, effective organisational D&I is more than just demographics.  Put simply ‘Diversity is the mix. Inclusion is making the mix work’.

 

Copy and paste mistakes

Another key mistake that many organisations make is ‘copying and pasting’ initiatives from another organisation into their own situation.

Just because a D&I initiative has been successful elsewhere does not mean that it will be effective in a different organisational context.  It is essential that D&I initiatives are tailored to suit individual organisational contexts.  Much will depend on the unique structural and individual barriers to inclusion that are faced in an organisation.

 

Addressing the barriers

Thus, it is crucial that organisations identify and tackle these specific barriers to inclusion.

Structural barriers may include a lack of flexible working opportunities, or a lack of BAME representation on recruitment selection panels or within senior management and HR.

Individual barriers may include prejudice and bias (both conscious and unconscious).  For example, the TUC Racism at Work survey found that 65% of BAME workers have suffered harassment at work within the last five years, while 49% had been treated unfairly.  Similarly, an NIESR study found that 23% of LGBT employees had experienced a negative or mixed reaction from others in the workplace due to being LGBT or being thought to be LGBT.

 

Tackling prejudice and bias

Addressing employees’ unconscious bias is one way to help tackle this.  Unconscious bias training involves teaching people about the psychological processes behind prejudice and techniques that can be used to reduce it. Research has found that unconscious bias training can be effective in increasing people’s awareness and knowledge of diversity issues.

However, evidence of its impact on attitudes and behaviours is less conclusive, so it is not a panacea.

 

Making the mix work

So what else can organisations do to help foster inclusion?

Research has found that there are several key aspects that contribute to individual feelings of inclusion.  In particular, individuals must feel valued for their uniqueness, and they must feel able to  be their authentic selves at work, regardless of any differences between them and other team members. This, in turn, leads to a sense of belonging, without the need to conform to ‘group norms’.

Individual feelings of inclusion are influenced both by the behaviours of others at work, as well as informal and formal organisational practices.

Some good practice examples of organisational inclusion include:

  • Fair policies and practices
  • Ensuring the availability of specific practices, such as flexible working, that can support inclusion
  • Involving employees in decision making processes and networks
  • Actively taking feedback on board
  • Ensuring that leaders are role models for inclusion
  • Genuinely valuing individual difference, not just hiring for representation

Other practices that may help promote inclusive working environments include mentorship, sponsorship and the creation of inclusive employee networks.

 

Learning from good practice

The good news is that an increasing number of organisations are working towards becoming truly diverse and inclusive.  Awards and certifications such as Business in the Community’s Race Equality Award, EDGE certification for gender equality, and Stonewall’s Workplace Equality Index for LGBT inclusion, all highlight the positive work that is being done.

For example, Pinsent Masons – currently the number 1 employer in the Workplace Equality Index – have worked to remove barriers to employment for trans individuals, provided support for LGBT women to overcome the ‘double glazed glass ceiling’ and facilitated the creation of an LGBT and allies employee network.

 

Inclusion leads to better, fairer workplaces 

Successful D&I cannot be measured by demographics – it is not enough to just have the right numbers on paper.  Every employee must feel valued as an individual and have equal access to opportunities.  In order to achieve this, organisations must look at their own contexts and develop initiatives that tackle the individual and structural barriers to inclusion that have been identified.  Listening to feedback from employees, and genuinely valuing and acting upon their input, is essential.

Becoming more inclusive is not only a moral obligation, it also has profound business implications – a recent study found that the potential benefit to the UK economy from full representation of BAME individuals across the labour market through improved participation and progression is estimated to be £24 billion per annum.  Thus, inclusive organisations are not only better and fairer places to work, but can also achieve better performance and innovation.

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Closing the race attainment gap: a new report aims to help universities move forward

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Image: Universities UK

On the face of it, the UK’s university sector is an international success story. UK universities attract global talent, valuable income and investment, produce world-leading research, generate hundreds of thousands of jobs, and improve people’s everyday lives in countless ways. Britain’s universities are also more racially and culturally diverse than ever before.

But a recent report has shone a spotlight on fundamental barriers to racial equality at UK universities, indicating that a student’s race and ethnicity can significantly affect their degree outcomes. The Universities UK (UUK) / National Union of Students (NUS) report highlights significant gaps in attainment between white students and their black, Asian and minority ethnic (BAME) peers, finding that 81% of white students graduated with first and upper second class honours in 2017/18, compared to just 68% of BAME students. That’s an attainment gap of 13%.

The report echoes findings from the Office for Students (OfS), the independent regulator for higher education in England. Earlier this year, the OfS reported stark gaps in achievement for black students, and also found that higher numbers of BAME students were dropping out of university before completing their courses.

Why are BAME students not doing as well at university compared with their white counterparts?

The UUK/NUS research identified four factors that are contributing to the attainment gap:

  1. Varying degrees of satisfaction among different student groups with the higher education curricula, and with the user-friendliness of learning, teaching and assessment practices.
  2. Relationships between staff and students and among students: a sense of ‘belonging’ emerged as a key determinant of student outcomes.
  3. Recurring differences in how students experience higher education, how they network and how they draw on external support were noted. Students’ financial situations also affect their student experience and their engagement with learning.
  4. The extent to which students feel supported and encouraged in their daily interactions within their institutions and with staff members was found to be a key variable.

 How universities can improve outcomes

As part of its research, UUK and NUS engaged with students, the higher education sector and external organisations to identify the most significant steps needed for success in reducing attainment differentials:

  1. Strong leadership – university leaders and senior managers need to demonstrate a commitment to removing the BAME attainment gap and lead by example.
  2. Having conversations about race and changing the culture – universities and students need more opportunities to have open, meaningful and constructive conversations about race, racism and what is causing the attainment gap.
  3. Developing racially diverse and inclusive environments – A greater focus is needed from across the sector, working with their students, on ensuring that BAME students have a good sense of belonging at their university, and an understanding of how a poor sense of belonging might be contributing to low levels of engagement and progression to postgraduate study.
  4. Assess the existing mix of data and evidence used to understand the causes of the attainment gap – The sector needs to take a more scientific approach to tackling the attainment gap, gathering and scrutinising data in a far more comprehensive way than currently, in order to inform discussions among university leaders, academics, practitioners and students.

The report also provides a checklist to help university senior leaders to move forward with their own strategies. Among the actions on the checklist are:

  • consider whether coaching, development opportunities or programmes are needed to give leaders the confidence to talk about race and take a leading role in opening conversations.
  • consider mechanisms for recognising (and perhaps rewarding) staff and students who press for the removal of racial inequalities.
  • take responsibility for ensuring that appropriate resources are dedicated to removing the attainment gap, including for any appropriate tailored interventions, research and expertise in data analysis.

Learning from what works

Another important recommendation in the report is that universities should share and learn from evidence of what works and what does not. Case studies throughout the report demonstrate that higher education institutions across the country are trying to close the attainment gap:

The University of Manchester and the university’s students’ union have been working in partnership with Manchester Metropolitan University and the University of Birmingham to deliver a Diversity and Inclusion Student Ambassador Programme to tackle the causes of differential outcomes for BAME undergraduate students and those from low socio-economic groups. Key features include creation of safe spaces, where students and staff can engage in open dialogue on inclusive learning and teaching environments, academic support and well-being; and training student ambassadors to safely challenge racism, microaggressions and discrimination.

Intercultural awareness workshops have helped students at Glasgow Caledonian University to develop a better understanding of different cultural norms and values. The programme provides a baseline for first-year students to develop their understanding and recognise the unconscious bias that exists within global academic, social and working environments. It has already won a Student Engagement Award and been shortlisted for an NUS Scotland 2019 diversity award.

The University of Arts London has developed a data dashboard – the academic enhancement model (AEM) – which gives accessible information to course teams about all aspects of the student experience and differentials. The AEM is a cross-university approach to removing attainment differentials, based on agreed data thresholds for attainment and student satisfaction scores. Courses that fall below these thresholds work with AEM leads to create co-designed AEM support packages. The approach has contributed to UAL’s success in tackling attainment issues: in 2018, the university saw a 4.9% reduction in its BAME attainment gap.

Closing the gap, reaping the rewards

The report has united universities and students in highlighting the race attainment gap, understanding the reasons behind it and tackling the problem.

Baroness Amos, director of the School of Oriental and African Studies (SOAS), who co-led the report, said: “Our universities are racially and culturally diverse, compared to many other sectors, but we are failing a generation of students if we don’t act now to reduce the BAME attainment gap. Amatey Doku, NUS vice-president for higher education, added that for far too long universities had presided over significant gaps in attainment between BAME students and white students. “From decolonising the curriculum to more culturally competent support services, many students and students’ unions have been fighting and campaigning for action in this area for years.

Now that the issue has been raised, it’s up to universities to take action so that all students – whatever their background – are given every opportunity to reap the many rewards that higher education can bring.

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University challenges: excellence, inclusion and the race to win more funding

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In May last year, Manchester University announced plans to make 171 staff redundant. Cost savings were among the reasons for the staff cutbacks, but the university also highlighted other factors, including the need for improvements in the quality of its research and student experience to ensure financial sustainability, and to achieve its ambition to be a world leading institution.

Although Manchester was able to achieve its staff reductions through voluntary severance, other universities have also had to announce staff cutbacks,  including Portsmouth, Liverpool, Heriot-Watt and Southampton. And these institutions are not alone in facing such demanding challenges.

Higher education institutions across the UK are competing against each other and against international rivals to attract funding and students. At the same time, universities, particularly among the prestigious Russell Group institutions, are under pressure to increase participation by more black, Asian and minority ethnic (BAME) students, and those from disadvantaged backgrounds. All of this is set against a background of debates about value for money in higher education, and concerns about Brexit. It’s no surprise that many universities are worried about their future.

Competition: national…

Recent changes to the higher education sector, such as the removal of the cap on student numbers, the entry of private sector providers, and the introduction of a teaching excellence framework have driven universities to become more competitive. Some have built new facilities, or joined forces with business to create technology parks, while others have closed departments that are expensive to run, such as modern languages. A growing number are also turning to financial markets to fund their expansion plans.

…and international

While UK universities have a world-class reputation, they face strong competition from overseas institutions. This year’s world university rankings reported that of the 76 UK universities in the worldwide top 1000, 41 improved their position since last year, while 14 remained in the same position. But while this was the best ever UK performance the compilers of the rankings warned that rising class sizes and the UK’s ability to attract overseas students post-Brexit could have a negative impact on future placings. It’s also becoming clear that global league tables themselves are having an impact on universities.

Added to this, the uncertainty over Brexit is already having an impact on university research funding. Official figures published at the end of 2017 showed that there had been a downturn in both UK participation in, and funding from, the flagship Horizon 2020 project. The need to find alternative sources of funding is pressing, as can be seen in the success of RESEARCHconnect, a tool to help universities identify and manage funding opportunities.

The struggle to widen participation

The proportion of people going to university has risen dramatically in the past fifty years. In the 1960s, five per cent of young people went into higher education; today, around half of young people do. Universities have committed themselves to widen participation, but the statistics suggest they are struggling to achieve this, particularly concerning students from BAME and disadvantaged communities.

Figures published earlier this year recorded a 0.1 percentage point increase in the proportion of state-educated students who started full-time undergraduate courses in the autumn of 2016, compared with the previous year. The statistics showed a slight rise in the proportion of students from disadvantaged areas, but critics have argued that this was cancelled out by the fall in part-time students (who are more likely to be from disadvantaged backgrounds). In nine out of the 24 Russell Group of universities, the proportion of state school pupils fell.

Further evidence of the country’s leading universities’ difficulties in widening participation has been brought to light by David Lammy MP. His enquiries on the number of ethnic minority students offered a place at Oxford and Cambridge Universities have found that more than a third of Oxford’s colleges admitted three or fewer black applicants between 2015 and 2017. For each of the six years between 2010 and 2015, on average, a quarter of Cambridge University colleges failed to make any offers to black British applicants.

Moving away from “one size fits all”

The government says it is determined to ensure that everyone, no matter what their background, has a fulfilling experience of higher education. In 2018, the new Office for Students (OfS) was launched, merging the Higher Education Funding Council for England and the Office for Fair Access. The OfS aims to regulate higher education in the same way that bodies such as Ofwat and Ofcom regulate the water and telecoms sectors. Its Director of Fair Access and Participation has a particular remit to ensure that higher education institutions are doing all they can to support under-represented groups.

A 2018 report has suggested that the OfS “has the potential to be an agent of profound change, particularly with regard to widening participation.” Among the reports contributors, there was a consensus that widening participation needs to be thought of with a broader scope:

“…‘one size fits all’ solutions will not work if we wish to make higher education representative of the diverse society it serves. Different groups such as care leavers, refugees or those with physical disabilities or mental health problems have different needs, and support should be tailored accordingly.”

Changing the face of higher education

Clearly higher education is facing enormous challenges. But for staff and students of universities, there are concerns about the forces of change that are transforming universities from communities of learners and scholars into businesses.  Alison Wolf, professor of public sector management at King’s College London, has commented:

“If the driving ethos, the thing which directs your behaviour day on day is maximising your income, maximising your position in the league tables in order to maximise your reputation and your fees, that means that you behave in a way that is very different from a traditional university where that wasn’t the driving force. You do get the sense that if that is 90 per cent of what is being thought about by central management, you are fundamentally changing the institution.”

Time will tell whether those changes are for better or for worse.

RESEARCHconnect supports universities, research institutions and research-intensive companies across Europe in identifying and disseminating R&D funding. In the current economic climate, there is increasing pressure to exploit alternative funding sources and RESEARCHconnect ensures that global funding opportunities will not be missed. Find out more.

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Equal to the task? Addressing racial inequality in public services

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Throughout October, a series of events to promote diversity and equality will take place as part of Black History Month. Although there are many achievements to celebrate, it is an unfortunate fact that many people in the UK today still experience disadvantage due to the colour of their skin.

Over the summer, reports by the Equality and Human Rights Commission (EHRC) and the UN Committee on the Elimination of Racial Discrimination (CERD), found that racial inequality in the UK was ‘worryingly high’.

In its biggest ever review of race inequality in the UK, the EHRC concluded that:

“while for certain people life has become fairer over the past five years, for others progress has stalled and for some– in particular young Black people – life on many fronts has got worse.”

Audit of racial disparities announced

The government responded quickly by announcing an audit of racial disparities in public services. It promises to ‘shine a light on injustices as never before’.

From summer 2017, Whitehall departments will be required to identify and publish information annually on outcomes for people of different backgrounds in areas such as health, education, childcare, welfare, employment, skills and criminal justice.

As well as enabling the public to check how their race affects the way they are treated by public services, the data is also intended to help force services to improve.

The audit is being called ‘unprecedented’ – and it certainly is – up until now, public services in the UK have not systematically gathered data for the purposes of racial comparison. Indeed, according to the FT, very few countries, if any at all, currently produce racial impact audits.

‘Worryingly high’ levels of racial inequality

The audit will have its work cut out.  The review by the EHRC found that, compared to their White counterparts, people from ethnic minorities were more likely to be:

  • unemployed
  • on low wages and/or in insecure employment
  • excluded from school
  • less qualified
  • living in poverty
  • living in substandard and/or overcrowded accommodation
  • experiencing mental and physical health problems
  • in the criminal justice system
  • stopped and searched by police
  • a victim of hate crime
  • a victim of homicide

Institutional racism

Similarly, the CERD findings into how well the UK is meeting its obligations under the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) raised serious concerns about the level of institutional racism in UK public services. Omar Khan, of the Runnymede Trust, suggested that the findings would ‘embarrass the UK on the world stage’.

Longstanding inequalities in access to services, the quality of care received and patients’ health outcomes were criticised, as was the over-representation of persons belonging to ethnic minorities in psychiatric institutions.

The committee echoed the EHRC’s concerns regarding higher unemployment rates and the concentration of persons belonging to ethnic minorities in insecure and low-paid work.  They also criticised the use of discriminatory recruitment practices by employers.

In education, there were concerns regarding reports of racist bullying and harassment in schools, and the lack of balanced teaching about the history of the British Empire and colonialism, particularly with regard to slavery.

The committee also concluded that there had been an outbreak of xenophobia and discrimination against ethnic minorities, particularly since the EU referendum campaign.  Indeed, the rise in post-Brexit racial tensions has been widely acknowledged.

Equal to the task?

Although the audit has been welcomed by many, including the EHRC, others have raised concern about the extent to which it will tackle the root of the problem.  Danny Dorling, of Oxford University, remains sceptical, stating that “within two or three years every single one of these audits is forgotten”.

Some have noted that in order to be effective, the audit will also have to capture outcomes for migrant families, and for poorer White people, who also suffer from discrimination and disadvantage.  Others, including Labour’s Angela Rayner, shadow equalities minister, have noted that there is a ‘huge gap’ in the review as it would not include the private sector.

The EHRC have called upon the government to create “a comprehensive, coordinated and long-term strategy to achieve race equality, with stretching new targets to improve opportunities and deliver clear and measurable outcomes.”

Certainly, the data produced by the racial equality audit may well provide some basis for the establishment of such targets.

So while this October there is cause for celebrating the progress made so far, the findings of the EHRC and the CERD underline just how entrenched and far-reaching race inequality remains.  As the EHRC states:

“We must tackle this with the utmost urgency if we are to heal the divisions in our society and prevent an escalation of tensions between our communities.”

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