Addressing Ethnic-Based Inequalities in UK Healthcare

Abstract

The paper provides a systematic review of research literature on the issues of cancer inequalities facing Black Africans and Black Caribbean in the UK. The methodology constituted of a cross –sectional analysis of five peer-reviewed journals on the issues relating health inequality among the Black community in the UK. The findings of the study reported an alarming pervasiveness of awareness, screening, diagnosis and patient experience inequalities among the Black community patients when compared with the White majority. It is the recommendation of the study that the government redress issues relating to public health awareness and implement culture sensitive campaign programs aimed at improving identification of cancer symptoms among the Black community. The government should further implement policies promoting timely and quality screening of patients in an effort to improve on the survival rate of the Black African community.

Introduction

The healthcare system of the UK has increasingly been criticized for what has been termed as ethnic-based inequality in the provision of services. Members of the Black and minority ethnic (BME) has been found to report more cases of ill health compared to the White majority (Morris, 2015). WHO (2017, p2) defined health inequality as “as the differences in health status or in the distribution of health determinants between different population groups” Of particular concern has been inequality in accessing timely and relevant information pertaining to the prevention, screening, diagnosis, and management of cancer (Martins et al., 2013). The rapid diffusion of cancer-based studies has further raised alarm over the pervasiveness of cancer inequality among the Black community. Cancer inequality in most cases takes the form of inequality in the level care provided based on one's race, socio-economic status or the type of cancer (Miller, 2013).

Of particular concern has been the extent of cancer awareness inequality among the Black population. Studies by The Prostate Cancer Charity (2017) indicated that over 46% of the Black community members were not aware of the symptoms of cancer and on how to reduce the risk factors. Similarly, a report by Elk and Landrine (2012) showed that male members of the Black community were at three times greater risks of being diagnosed with cancer compared to the White men in the UK (bme1). However, studies by The Prostate Cancer Charity (2017) indicated that despite the alarming figures of risks facing Black men, only 37% of Black men had heard of prostate cancer compared to 64 % of the White men. Inequality in cancer patient diagnosis has also been termed as health issues facing the Black minority (Great Britain, 2008). While empirical evidence has indicated that timely diagnosis of cancer highly improves survival of patients, cases of delayed diagnosis for cancer among Black Africans was higher compared to White patients (Martins et al., 2013). Ethnic-based cancer inequality has additionally been compounded by evidence of disparity in the quality patient experience. Based on a study by Pinder et al., (2016) the proportion of White patients who term their experience as excellent was 57.4 % while only 37.7 % of the Black African reported an excellent care. Consequently, the findings of these studies have far-reaching implication on the quality of healthcare services that the Black communities are exposed to. It is clear that members of the Black community are faced with significant health inequality issues relating to risks and awareness, screening, palliative and end of care for cancer patients. The paper will provide a systemic review of 5-research literature on issues relating health inequality concerning the Black community in the UK. The following peer-reviewed researched papers will be central to the discussion:

Morris et al (2015): Ethnicity, deprivation, and screening: survival from breast cancer among screening-eligible women in the West Midlands diagnosed from 1989 to 2011
Forbes et al (2011): Breast cancer awareness and barriers to symptomatic presentation among women from different ethnic groups in East London
Davies et al (2013): Socioeconomic and ethnic inequalities in screen-detected breast cancer in London
Niksic et al (2016): Ethnic differences in cancer symptom awareness and barriers to seeking Medical help in England
Saunders et al (2015): Inequalities in reported cancer patient experience by socio-demographic characteristic and cancer site: evidence from respondents to the English Cancer Patient Experience Survey

Aim

To critically review research literature on health inequality in cancer patients among the Black Community in the UK

Objectives

a) To assess forms of ethnic based cancer inequalities facing the Black Community
b) To make recommendations aimed at addressing issues of cancer inequality among the Black Community.

Methodology

The research papers under review were obtained from two electronic journal databases namely ProQuest and EBSCO. The inclusion criteria consisted of primary research studies; studies published from 2010 onwards, studies focusing on cancer health inequalities and the Black African community in the UK, studies on UK government policy on health inequality. The exclusion criteria included studies focusing in Africa, America, Asia, and Australia, studies relating to genetic cancer and secondary research based studies. Consequently, the retrieved articles were further subjected to appraisal review and only those classified as satisfactory were included in the systematic review. The review concentrated on five research papers that critically examined cancer inequalities facing the Black Africans in form of awareness, experience and diagnosis inequalities.

Findings

A systematic review of the research journals on health inequality among the Black community in the UK highlighted on the pervasiveness of awareness, screening, diagnosis and patients experience in equalities. An overriding concern among the research community was the increasing disparities in the treatment and survival of Black cancer patients and the majority White (Banning, 2011). Admittedly selective, the three studies under review majorly concentrated on breast cancer, while the other three examined cancer patients in general. When compounded, the studies indicated that cancer patients from the Black African community were more likely to experience health inequality due to deprivation (Kronenfeld, 2008). In an attempt to deconstruct the consequences of ethnicity on the cancer patients from the Black community, the findings concentrated on the prevailing disparity on patient experience, awareness, and diagnosis.

In their examination of ethnicity and level of awareness for breast cancer, Forbes et al., (2011) findings indicated that the awareness of breast cancer was low among women from the Black community compared to the White population. The study showed that only 17% of the Black Caribbean women and 14 % of the Black African women were able to recognize five or more non-lump symptoms for breast cancer correctly (Forbes et al., 2011). In relation to breast cancer, the study noted that 22% of the Black Caribbean and 15 % of Black African conducted breast checking at least once a month. Similarly, Niksic et al., (2016) conducted an exploratory analysis of the cancer awareness and barriers to seeking medical aid. The findings indicated that the Black minority reported lower awareness of cancer symptoms coupled with widespread barriers to seeking medical help compared to the White participants.

The study further examined traditional barriers to seeking medical help among the UK women. It emerged that both Black and White women were no more than likely to report both emotional and embarrassment barriers to seeking medical assistance (Niksic et al., 2016, Teng et al., 2016). The study asserted that the observed low breast cancer awareness among Black women was a risks factor for the delayed presentation of breast cancer. Consequently, the late presentation of breast cancer was identified as a key factor contributing to the survival disparity among Black and White women in the UK (Bansal et al., 2012). However, while Niksic et al., (2016) findings on cancer awareness were consistent with Forbes et al., (2011) it offered contradictory findings on barriers to seeking medical aid. Niksic et al., (2016) noted that Black patients had the lowest barriers to seeking medical help compared to White British.

In their examination of ethnic inequalities in screen-detected breast cancer in London, Davies et al., (2013) noted that Black women reported the lower proportion of breast cancer detection compared to White women. Both Black Caribbean women and Black African were significantly less likely to undergo screen detection of breast cancer compared to White women (Davies et al., (2013). Interestingly, Saunders et al., (2014) identified lack of knowledge, limited awareness of breast cancer and disparity in breast screening as the cause of barriers for screen detecting of breast cancer among the Black community.

Not sufficiently in itself, Morris (2015) further correlated ethnic based health inequalities and the prevailing socio-economic status of the identified ethnic groups. The research indicated low incidences rates of screen-detected cancer among women living in the deprived areas in contrast to a higher proportion of screen detection for women from the affluent social status (Morris, 2015). Largely, Black African women and Black Caribbean women were more likely to come from the less affluent community compared to the majority White (Niksic et al., 2016).

Morris et al, (2015) reported the same findings on ethnicity and deprivation. Based on their research, White women were more likely to be affluent than Black or Asian women (Morris, 2015). Consequently, the screening of cancer among women varied with the deprivation and ethnicity. Women who were most deprived and from the Black community had the least incidences of cancer screening. Analysis of the survival rate by ethnicity further indicated that Black women had an alarmingly lower survival chances than any of the ethnic groups. On the other hand, analysis of the survival trends showed that Asian and White ethnic groups had experienced improved survival rates while the Black had not (Morris, 2015). On the contrary, studies by (Saunders et al., 2014) downplayed the role of socio-economic status, education, and deprivation on the disparity in the uptake of breast screening among Blacks. As opposed to deprivation, the study identified cultural factors as the primary contributing element for the observed difference in the uptake of the screening (Saunders et al., 2014).

Discussion

The current evidence provided by the research literature on cancer inequality facing the Black community in the UK is overwhelming. Although the majority of the reviewed literature focused on breast cancer and women, it encompassed the prevailing conditions facing Black African and Black Caribbean cancer patients in the UK. The findings noted the forms of cancer inequality that are rampant in the country (Parliamentary Office of Science and Technology, 2007). These included health inequality in form of low awareness to cancer knowledge and risks factor, the disparity in incidence of screening and differences in patients experience based on race. By all accounts of the research literature, cancer patients who were from the Black community reported higher cases of lower awareness on breast cancer symptoms and risks factors, lower incidences of screening and unsatisfactory patients experience. The studies provided serious consideration to the state of low cancer awareness among the minority groups. Studies by Forbes et al., (2011) and Niksic et al., (2016) highlighted the need for culturally sensitive and minority focused health campaign to address the identified health inequality issues. A critical review of the issues of health inequality and Black community demonstrated the interplay of the forms cancer inequalities among the subject group. At the onset, the Black community is characterized by low awareness of the symptoms and diagnosis of cancer that is further compounded by the extent of medical help barriers (Larkin, 2011).

Consequently, the resulting lack of cancer awareness and numerous barriers to medical help negatively deter Black patients from undertaking screening of cancer incidences (Marshall, 2010). The net effect of the delayed screening, lack of awareness and the presence of significant barriers to medical help subsequently result to the observed low survival rate for the Black patients. While Forbes et al., (2011), Davies et al., (2013) and Morris, (2015) identified socio-economic factors as contributing elements to the widespread disparity in health care delivery among the Black African and White in the UK, Niksic et al., (2016) disagreed. Niksic et al., (2016) noted that neither the deprivation nor education influenced the low uptake of screening but instead cultural factors played a significant role, which is consistent with Mulugeta, (2014) studies.

Conclusion

The government of UK should undertake public health reform and further strategize on how to address the health inequalities facing the Black African community. The findings from the systematic review of the research literature call us to question the nature and quality of healthcare service delivery to Black African cancer patients in the UK. An overriding concern constitutes the pervasiveness of health inequality that patients from the Black community continue to face in form of cancer inequality (Ingleby, 2012). Vis a vis, these alarming findings call to restructure health awareness campaigns that target the minority so that they meet the identified needs of the communities without hindering the timely and quality provisions of service care.

Recommendations

Based on the findings of this report the following recommendations are aimed at redressing the issues of health inequality with particularly focusing on the issues affecting Black African and Black Caribbean communities in the UK.

The government and stakeholders should formulate and implement public health policies aimed at advancing patient experience of the members of the Black community (Askari, 2017)
Health information systems and requisite support system should target the Black African and Black Caribbean community based on their survival rates and cancer incidence.
Life course interventions should be implemented to prevent the onset of deprivation related inequalities among the Black community (Peate, 2007)

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