Gov. Policy and WOC: Healthcare – Pooja Patel
It’s widely recognised that systemic racism and sexism exists but what’s harder for ethnic and religious minority (ERM) women in 2020, is being able to understand the pressure points of an inherently convoluted system well enough, to fight back and be able to claim our rights and access to the same spaces and services as our white and/or male counterparts.
So what are those points? Is it the policy that is discriminatory or the system? Do the policies deliver on what they promise through our current systems? This blog sheds a light on things that not only matter to us WOC now, but things that will affect the health of those we love and our future families.
Mental Health
One of the biggest disparities in healthcare can be found in mental healthcare treatment and diagnosis. The UK’s Mental Health Foundation studied and broke down the stats for different cohorts of ERM communities.
For the Asian/Asian British cohort:
● Those identifying as Asian or Asian British are one-third less likely to be in contact with mental health or learning disability services.
● Within the South Asian community in England and Wales, research has indicated that older South Asian women seem to be an at-risk group for suicide.
● One 2018 review found that non-European immigrant women, including young South Asian women, were a high-risk group for suicide attempts.
Historically, public mental health services have had funding slashed for years under austerity. Its access also doesn’t reach the most vulnerable groups such as the 14-25 cohort, pregnant women/new mothers and ERM communities. The alternative is private mental health care and therapy which is often inaccessible to our communities due to socio-economic background and lack of ERM therapists who can understand triggers specific to our communities.
Another rising concern for ERM women particularly is maternal mental health, specifically postpartum depression (PPD). A 2019 systematic review found that cultural expectations, lack of awareness about mental ill health, ongoing stigma, culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers all impact on women’s ability to receive adequate support, and women are left isolated and suffering in silence.
Another huge contributing factor to the above statistics is the way mental issues are viewed in our communities. Typically, they are viewed as weaknesses, overly-privileged whining, or just the plain old ‘only crazy people go to therapists/psychiatrists’. It is heavily stigmatised and not seen for what it truly is: an illness that needs to be treated by a medical professional.We need to first be able to normalise speaking about mental ill-health the same way we do about diabetes, high blood pressure or a stubbed toe – say ‘I’m not feeling good and I need help’ and support our families and communities in finding that help.
Maternal Health
Maternal health is probably one of the most shocking statistics for this country. A country that is leading with the lowest maternal deaths in the world, still sees black women being 5 times more likely to die from childbirth than white women, with women of mixed ethnicity being 3 times more likely, and Asian women being twice as likely. So, despite being the world leader in maternal and infant mortality rates, how do we find it acceptable that WOC are dying at a much higher rate than their white counterparts?
Many studies show some of the differences such as linguistic barriers and inadequate translation services meaning that ERM women are not as informed of their antenatal choices as their white counterparts. Time and again, studies have shown inadequate translation and interpretation services to be a factor in maternal death rate disparities.
If the services were to continue as they are and are not implemented properly, then not only would more ERM women be dying from childbirth, it would be a direct breach of the requirements of the Race Relations (Amendment) Act 2000 which means the NHS is not working to the standards that it should be.
For those people who will immediately jump on the ‘You’re in England, so it’s your fault for giving birth in a country that speaks English when you can’t speak the language’ bandwagon, I’m about to fire a science and research-sized hole in that racist theory. A 2018 MBRACE report showed that out of the cohort which they studied, 96% spoke English and 63% were born in the UK. So, how is it that there is such a big disparity in maternal death rates?
Two words: “unconscious bias” (read racism).
Numerous accounts from many different women (including Queen Serena Williams) have shown that ERM women often have their pain levels mismanaged or not believed when they are in labour wards, which leads to mismanagement of their deliveries and ultimately, death. They also have assumptions made about their English-speaking ability and their health conditions, even when the expectant mother herself gives her full health information! In short, our system does not believe us when we say we hurt – and that’s not only wrong, it’s life-threatening.
Covid
One of the biggest things to come and shake up life and society as we know it, was Sars-CoV2, otherwise known as COVID-19. It saw economies crumble, societies come to a standstill, and inequalities in an already unequal system deepen. Public Health England (PHE) published a review on 2nd June which collated and analysed data to understand why there was such a large disparity in the rate of infections and deaths from COVID-19 in ERM communities. The review found:
The highest age standardised diagnosis rates of COVID-19 per 100,000 population were in people of Black ethnic groups (486 in females and 649 in males) and the lowest were in people of White ethnic groups (220 in females and 224 in males).
…people of Bangladeshi ethnicity had around twice the risk of death when compared to people of White British ethnicity. People of Chinese, Indian, Pakistani, Other Asian, Black Caribbean and Other Black ethnicity had between 10 and 50% higher risk of death when compared to White British.
The report highlighted some reasons to explain the disparities as follows:
Firstly, people of BAME communities are likely to be at increased risk of acquiring the infection.This is because BAME people are more likely to live in urban areas (18), in overcrowded households (19), in deprived areas (20), and have jobs that expose them to higher risk (21).
In short, the above tells the same thing that ERM communities have been subject to for years. Whilst the statement is relying heavily on ‘correlation doesn’t equate to causation’, points 18-21 are all characteristics of the results of decades of systemic racism and inequality.
Immigrants from South Asian, Caribbean and African countries that arrived post WWII to help with British recovery efforts, were then not compensated fairly and were subjected to abhorrent racial abuse. To find solace, they were driven to the most deprived areas in different cities where they established their own communities. Most of these immigrants took any odd job they could get, continuously putting themselves at risk in labour-intensive jobs to provide for their families.
The report itself has been heavily criticised by independent journals, such as the British Medical Journal , for the review’s recommendations being ‘whitewashed’ , in that whilst the review was commissioned out of rising concerns over increased risks and deaths in ERM communities and the terms of reference (the document stating what the review will set out to do) stating that there will be recommendations on actions to be taken, there was none.
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What is seen from the three areas I chose to explore is that we suffer at the hands of not only a racist system where it seems to be our responsibility to fight against people’s preconceived biases, we also have to deal with judgement within our own communities due to traumas faced by those elder to us.
Under austerity and bias, our communities have suffered and as a result, we put much more pressure on ourselves and future generations to be ‘tough’ and not talk about their struggles, for it to be a sign of weakness.
By Pooja Patel
