LONDON – 21-year-old Evan Nathaniel Smith from Walthamstow was admitted to North Middlesex Hospital on April 18, 2019 with a diagnosis of a bile duct infection. Within days, he developed the extremely painful symptoms of a sickle cell crisis. His doctors did not recognise the symptoms, however, and at one point Smith became so desperate for help that he used his mobile phone to call 999 from his hospital bed.
Smith died 2 days later.
Dr Khadija Owusu of East Kent Hospitals University described this tragic case in an opening keynote at the Royal College of Physicians Annual Conference in London as an example of how ethnic minorities can receive inadequate healthcare.
“He passed away in the hospital I was born in,” said Owusu. “Are our hospitals safe for people who experience conditions that not all of us are prone to?”
The coroner concluded that the cause of Smith’s death was a delay in treating him with a timely exchange transfusion. This was made more difficult, he said, because Smith’s medical and nursing staff lacked an understanding of sickle cell disease, despite the hospital serving a large African-Caribbean community.
Other Factors Impacting Healthcare Equality
Racial stereotyping is also an issue in healthcare settings, explained Owusu. This can lead to false beliefs about biological differences between Blacks and Whites, which in turn influence patient treatment. For example, there is a widely held belief that Black people are less sensitive to pain, leading to racial bias in pain assessment and management.
It is also now well established that minority ethnic groups were disproportionately affected by the COVID-19 pandemic. And a 2023 report by the Women and Equalities Committee concluded that Black African women are nearly four times more likely to die during childbirth than White women.
Recent research also shows that skin pigmentation influences pulse oximetry, such that readings are less accurate in darker-skinned people. These differences contribute to other known ethnic disparities in healthcare. Because Asian, Black, and Hispanic patients have higher average readings than White patients for a given blood haemoglobin oxygen saturation, they receive less supplemental oxygen.
More Diversity in Management and Research
Owusu noted that although much of the NHS is highly diverse, just 7% of executive directors in NHS trusts are of a minority ethnic background, and she suggested that one way to tackle healthcare disparities is to have better representation of ethnic groups at all levels of the healthcare system.
“Without diverse leadership, there's a lack of shared lived experiences at the top and a lack of perception,” she said. “This leads to inattention and inaction, which is why we continue to hear about these health inequalities.”
According to Professor Ramesh Arasaradnam, academic vice president of the Royal College of Physicians, who chaired the session, awareness of these issues is growing.
“Research is the gateway to the tools we use in everyday clinical practice,” Arasaradnam told Medscape News UK. “A good example is the use of antihypertensives, some of which don’t work in non-Caucasian populations because of specific genetic polymorphisms.”
“The National Institute for Health and Care Research now understands [these issues], and asks us to ensure that all sectors are represented in population-based studies. Then they can say it works well in one group and not so well in another, which in itself is very important information.”
Arasaradnam added that improving engagement with the public is key to overcoming these challenges. “You really have to understand the population so that you can actively reach out and ask them to participate,” he told Medscape News UK. “Unless you do that, the conventional model of sitting in the hospital and expecting them to come to you isn’t going to change.”
Moheb Costandi is a freelance science writer based in London.