The covid-19 pandemic has exposed the differential health outcomes for people from ethnic minorities who have been disproportionately affected by the virus. The Black Lives Matter campaign across the world in response to the murder of George Floyd has simultaneously shone a light on inequalities faced by people from ethnic minorities. The reasons for the disproportionate impact of covid-19 on ethnic minority communities are complex and a number of explanations have been put forward varying from poverty, overcrowded living conditions, and pre-existing chronic co-morbid conditions.

Aside from the covid-19 pandemic, other inequalities exist. We know that rates of incarceration and subsequent mental and physical illnesses in prisons are high in ethnic minorities. Access to social housing, employment, and rehabilitation from prison can be limited for ethnic minority groups. [1] Rates of physical and psychiatric illness also vary across different ethnic groups, along with behaviours which increase the risk of poorer health outcomes (e.g. obesity, tobacco use, and alcohol use). [2-4]

Various social and cultural factors affect differential rates of illnesses, access to services, and response to treatment and outcomes. Social determinants play a major role. Educational attainment, poverty, and overcrowding affect health differentially across ethnic minorities along with social inequalities and generational inequalities. Racism, discrimination, and prejudice play a major role as people from ethnic minorities may choose not to seek help or access healthcare services. These delays contribute to the severity  of illness, often resulting in chronic conditions and poorer outcomes. Healthcare services are often not culturally sensitive or competent adding another layer to the complex nature of help-seeking. In order to deliver equity there must be joined-up thinking and planning between health, education, employment, justice and other ministerial departments.

In our view, the government should establish an Office for Minority Health to help tackle these issues. It needs to be set up as a public body and act as a public authority to deliver better health outcomes for all.  A public body such as this could be responsible for policy development, oversight of clinical services and research, and improving the health of ethnic minority groups through the development of culturally relevant and appropriate policies. This could help guide more culturally sensitive services, which would be more likely to be used by ethnic minority groups. The purpose would be to keep under constant review the elimination of ethnic inequalities across statutory organisations and other bodies. We need to develop evidence-based health and social care policies that promote health equity between mental and physical health across ethnic groups. A start to achieving this would be to monitor the life outcomes and experiences of the ethnic minority groups and use these data to provide guidance on how to best to improve life chances and attainment across all sectors  e.g. health, education, employment. 

Improving access to healthcare and health outcomes in ethnic minority communities is critical as good health outcomes can lead to improved opportunities in education, employment, housing, and social support. It is crucial to take cultural and ethnic variations into account in order to have healthcare services which are accessible and provide better therapeutic engagement and improved outcomes. 

We do not need any more inquiries, the evidence is there. What is needed is action. Improving the inequalities currently faced by ethnic minority communities will require dedicated consistent work for a long time. This will only be possible if we learn and understand why and how the UK is changing, and have the data and evidence needed to inform our actions. 

Dinesh Bhugra, Professor Emeritus, Mental Health and Cultural Diversity, King’s College London

Albert Persaud, Founder, Care-If, London

Competing interests: None declared

References:

1. Coid J, Petruckevitch V, Bebbington P, Brugha T, Bhugra D, Jenkins R, Farrell M, Lewis G, Singleton N: Ethnic difference in prisoners: criminality and psychiatric morbidity. Br J Psych, 181, 473-480
2. Pinto R, Ashworth M, Jones R : Schizophrenia in black Caribbeans living in the UK: an exploration of underlying causes of high incidence rates. BJGP,2008, 58, 429-434 
3. NHS Digital: Statistics on Smoking, England 2019 https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2019/part-3-smoking-patterns-in-adults-copy  accessed June 20, 2020
4. ONS: Overweight adults. 2020  https://www.ethnicity-facts-figures.service.gov.uk/health/diet-and-exercise/overweight-adults/latest#:~:text=73.6%25%20of%20Black%20adults%20were,out%20of%20all%20ethnic%20groups  accesses June 20,2020