Why is progress on race equality so slow in the UK?

Why is progress on race equality so slow in the UK? 

By Sara Hodgkinson & Sarah Salway

A new report from the Equality and Human Rights Commission highlights widespread racial inequality and warns that failure to tackle this deep-rooted disadvantage will exacerbate societal divisions. EHRC Chair, David Isaac, noted that the report exposes a ‘very worrying combination’ of a post-Brexit rise in hate crime and long-term systemic unfairness and race inequality.

Along with ethnic inequalities in employment, education, criminal justice and living standards, the EHRC report also highlights health and healthcare inequalities. The report confirms that, despite an apparently strong legal and policy framework, barriers to high quality healthcare persist for people of minority ethnic identity.  This apparent inconsistency between national policy and local reality was the motivation for our recent research project that looked into the role of healthcare commissioning organisations in delivering equal access to health services for minority ethnic groups in England.  We wanted to find out why progress towards race equality is so slow in the UK.

Healthcare commissioning is the process of planning, procuring and monitoring health services to effectively meet the health needs of the population. Between 2010 and 2013, we carried out a large-scale study to examine healthcare commissioning in England which was, at that time, predominantly carried out by Primary Care Trusts. The study included case studies, stakeholder workshops, and interviews with professionals.  We spent a large amount of time talking to people as they went about their jobs, observing the work of the organisations and reviewing the documents produced.  We wanted to find out whether and how ethnic diversity and inequality is considered within health commissioning in the UK.

We found that minimal attention was being given to ethnic diversity and inequality within healthcare commissioning.  Three key themes emerged from the research, suggesting why this might be.  First, minority ethnic health inequality is not a high policy concern.  Despite racial inequality in England remaining a hot topic both within the media and in academia, there appears to be a lack of discussion and action at policy level to effectively address the matter.  Few national resources include any consideration of ethnic diversity or equal access to services for minority groups and there is no performance monitoring related to this agenda.  Marginalisation of minority ethnic health was found to be consistent at national and regional level and, while some areas of good practice were identified at local level, the work tended to be piece-meal and without broader impact.

Second, we found widespread uncertainty among policy makers as to whether inequality is even really an issue.  Some senior leaders were unconvinced of the existence of inequalities between ethnic groups, despite a growing body of evidence to the contrary, others did not view such inequalities as a priority.  Without acknowledgement of the issue and its importance, ethnic inequalities in healthcare will continue to be overlooked at all levels.

Finally, interviews and case studies pointed to a lack of clarity at policy level as to how ethnic diversity and inequality should be addressed within the national health system.  Limited data on patterns of ethnic health inequalities, together with a lack of understanding of the subject among senior leaders and the tendency of some managers to blame minority groups themselves for poor access to services, were also important barriers.  Minimal understanding – both of the issue and of how to address it – undermines people’s confidence to act, resulting in the problem being downplayed and overlooked.

Our study primarily highlights obstacles to ethnic equality in healthcare in England, though we did find some factors promoting positive work.  Importantly, we found that action on ethnic diversity and inequality was rarely prompted by national directives but was rather driven by committed individuals who championed the issue locally.  Such individuals did, however, struggle to maintain momentum without clear leadership on the issue from local managers or central government.  Good work remained siloed and was often short-lived.

How, then, can equality in healthcare access be improved?  Our study suggests the need to enhance the skills, confidence and competence of individual managers and commissioning teams and to improve organizational structures and processes that support attention to ethnic inequality. However, it is also clear that greater political will and clearer national direction is required to produce the widespread system change needed. Our conclusions therefore mirror those of the recent EHRC report which calls for a ‘comprehensive race equality strategy’ that goes beyond the current ‘patchwork of initiatives’, is underpinned by good data, and monitors progress against clear targets.

The full report of our study can be found here and our recent paper in Social Science & Medicine can be found here.

New Migrants in Primary Healthcare Summary Findings and Mini Casebook


NM picMigration is a perceived pressing issue for healthcare in the UK but there are few studies that record how different parts of the NHS are responding to the needs of new migrants. A project funded by Sheffield Clinical Commissioning Group examined how primary healthcare is meeting the needs of new arrivals. Survey, interview, documentary and focus group data were used to examine what are the issues for primary care, who is adapting their services and how they are doing it. A case study approach was used to identify examples of practices adapted to need across different parts of the UK: Sheffield, London, Bradford and Glasgow.

Download the Summary and Mini Casebook

Image courtesy of Tanakwho under Creative Commons licence.

Tailoring physical activity interventions to meet the needs of minority ethnic groups in England

This project is supported by CLAHRC YH

Aims of this project

  1. To establish the characteristics of physical activity interventions/programmes that prioritise minority ethnic community participation in England
  2. To identify the characteristics of ‘tailoring’ of interventions that account for minority ethnic population needs

Why is this important?

Adapted public health interventions have widespread support as a means of challenging health inequity. Minority ethnic populations in the UK and across the Global North continue to display disadvantage in several health domains such as cardio-vascular disease and diabetes (Bhopal 2009). Physical activity interventions can play a positive role in reducing the risk of such conditions. Rates of participation in physical activity among minority ethnic populations are, however, low relative to the White British population in the UK. This research uses an existing national database to examine the characteristics of physical activity interventions intended for diverse populations. It is an opportunity to assess the current ‘state of the field’ and areas of emergent practice.

How will the research be carried out?

Analysis of an English database of physical activity interventions has been used to identify and analyse adaptations for minority ethnic participation. From this, case studies have been built to demonstrate good practice.

Timeframe: November 2014-December 2015

Who is undertaking the research?

Liz Such

How are stakeholders being engaged?

Stakeholders are being consulted in the identification and exploration of case studies and in ‘sense checking’ of the findings on adaptation.

What will be the outputs from the study?

A case study summary will be produced for consultation with community based organisations and other local partners. A peer reviewed journal paper.

Image: Riccardo Romano, The Blue Dress, Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0), https://www.flickr.com/photos/pixx0ne/4270662379