I’ve been asking myself this week if in healthcare we’re failing our Black, Asian and Minority Ethnic (BAME) Children and Young People (CYP).
Data highlights the variation in infant mortality across ethnic groups https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/730917/local_action_on_health_inequalities.pdf
Recently the LeDer report into deaths of people with learning disabilities alerted us to the fact that CYP from BAME backgrounds died 2 years earlier than CYP from white backgrounds, check out chapter 6 https://www.thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf .
The Care Quality Commission in the data from the Children and Young People’s National Inpatient Survey, highlights that CYP from BAME report poorer experiences of care than those from white ethnicity https://www.cqc.org.uk/publications/surveys/children-young-peoples-survey-2016
The National Child Measurement Programme indicates higher levels of obesity at age 10-11 in ethnic minority groups than the white majority.
Racial inequalities are clearly an unjust global challenge that can be avoided, so we must keep challenging ourselves, to do better.
But if I’m honest it’s not an area I feel hugely experienced in. I grew up in South Wales and the diversity in my classroom was provided by a girl whose family came from Wolverhampton, everyone else was born and raised in the town we were being schooled in. Even when I went off to do my general nurse training in Cardiff my closest friends came from Gloucester, Brecon and Abergavenny, my nursing cohort was full of girls who came from across South Wales and the English boarders.
I recall in my 1st staff nurse post caring for more Asian children with renal illness than children of white ethnicity, yet it was really when I came to London to work at Great Ormond Street and then later at the Whittington where I cared for children with Sickle Cell disease and Thalassaemia that I became aware, first hand, of some of the wider challenges faced by BAME children, young people and families.
Now working in East London the challenges are at the forefront of my consciousness, I constantly have a voice whispering in my ear that asks me ‘would this serious case review have had the same outcome if it related to a child of white ethnicity’? These are complex issues playing a huge role in health outcomes.
There are a myriad of reasons why CYP from BAME backgrounds face health challenges, an increased likelihood of experiencing living in poverty, families speaking in different languages (some which aren’t written), along with the complexity of navigating the healthcare system and most concerningly power imbalances.
As a nurse, I’d like to believe myself to egalitarian and unprejudiced BUT the reality is that our lives shape us all, our memories and experiences help our brains to sort stuff, to categorise information so that it’s swiftly analysed, leading us to make automatic conclusions and assumptions. We all have unconscious biases and whilst I can’t and don’t desire to change my family background I am aware of my limited experience regarding race related issues, therefore I need to proactively seek out advice and guidance from colleagues from diverse backgrounds to challenge and inform thinking. A great practical example of doing this is by ensuring we have BAME representation on interview panels, at meetings, along with brave opportunistic conversations with colleagues from different backgrounds to our own. This, in my opinion, will constantly challenge ideas and offer different perspectives which are critical when striving for improvement in BAME healthcare.
In recent years there has rightly been a growing focus on ensuring we’re more aware of these unconscious biases and ensuring the NHS workforce is representative of the community we serve, particularly in ensuring that senior leadership teams are diverse which will help address this. The Workforce Race Equality Standard (WRES) has done so much to prioritise this agenda and it continues to have great impact.
My ‘go to advisors’ and follows on twitter who champion this work include Yvonne Coghill @yvonnecoghill1, Dr Habib Naqvi @DrHNaqvi whose blog for NHS England is worth dipping into https://www.england.nhs.uk/blog/turning-the-dream-into-reality/ Habib shares that he reverse mentors Simon Stevens. And another colleague who has challenged and taught me lots over the years is Scott Durairaj @ScottDurairaj.
It makes sense that if we have a more diverse and representative workforce across all bands of staff, we’ll begin to think differently and become brave enough to challenge some of the unconscious bias that exists in the NHS and across society.
It is a gross injustice that CYP from BAME backgrounds aren’t getting the access they deserve to healthcare whether due to language issues, our lack of ability as healthcare professionals to connect with people from different ethnic cultures or our failure to make services accessible to all.
But in order to ‘change the system’ and ‘mainstream’ these issues we need to be brave enough to speak out, knowing sometimes we might say the wrong thing, not deliberately but naively, yet if we’re authentic in our seeking of understanding people will open up. What is more concerning is us not challenging inequalities and being apathetic in accepting the status quo. This is a slide from @YvonneCoghill1 that challenges us to think and do differently….
So what can we all do about this? There’s possibly no single solution..,
1. We need to recognise that health inequities exist
2. We need to challenge stereotypical thinking, question our assumptions, and constantly seek to be more person centred
3. We need to proactively seek out new perspectives, increase opportunities for others, build trust, champion fairness and constantly raise awareness of these issues.
The Sure start research by @TheIFS @Gabri_EllaConti funded by @NuffieldFound published this week, summarised here https://www.bbc.com/news/education-48498763
https://www.theguardian.com/society/2019/jun/04/sure-start-saved-nhs-millions demonstrates the impact building community capacity can have on improving health outcomes, we need to be doing more of this, not less.
I’d also really recommend this PHE document on local action in health https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/730917/local_action_on_health_inequalities.pdf
This has been a difficult blog to write … I know we can and must do better ….