As a firm, we have had many discussions about Black Lives Matter and how we can make a difference to the movement. In the third blog in our series, Simran looks at the higher percentage of BAME patients who are more likely to die as a result of contracting COVID-19 than patients from a white British background. She explores the poorer experience BAME people have within the healthcare system where inequality is due to long-standing issues around unconscious bias and the clinical care provided to BAME patients more generally.
Recent events around the globe have made the reality of racial inequality in society feature at the forefront of media coverage, political discussion and social consciousness, but the effect of this inequality has been felt by those in the Black, Asian and Minority Ethnic (BAME) community long before this. It has become clear that there is a lot of work to be done to address these inequalities in every aspect of society and Covid-19 has demonstrated that significant progress must be made in the healthcare sector to protect patients and healthcare workers from a BAME background.
A report published by Public Health England in June 2020 found that BAME patients were between 10% and 50% more likely to die as a result of contracting Covid-19 than patients from a white British background. This is an alarmingly high rate and has attracted (some) media attention as a result.
Part of this disparity could be impacted -by other socioeconomic factors relevant to Covid-19 such as the larger average household size of BAME families compared with white families. However, those socioeconomic factors do not in themselves explain the significantly higher fatality rate for BAME patients. One must therefore question whether the material issue again falls back to the poorer experience BAME people have within the healthcare system. It appears that much of this inequality is due to other long-standing issues around unconscious bias and the clinical care provided to BAME patients more generally.
For example, it has been clear for some time that there are stark racial inequalities in the statistics around BAME women suffering fatal complications during childbirth when compared with their white counterparts. Reports produced by MBRRACE-UK since 2014 have found that black women are five times more likely to die during childbirth than white women. Asian women and women of mixed ethnicity are two and three times more likely respectively to suffer fatal complications during childbirth than white women.
Crucially, a report produced by Nuffield Department of Population Health and the University of Oxford suggest that the quality of maternity care provided to BAME mothers could have contributed to these statistics. The report found that BAME mothers experienced longer hospital stays, were less likely to receive pain relief during labour and received fewer home visits from midwives than white women.
Further, accounts provided by midwives and nursing staff have reported incidents of unconscious bias. This includes occasions where white medical staff have commented on a BAME patient’s pain threshold being relative to their ethnicity or assumed that BAME patients lack English skills and as such, cannot make informed decisions in relation to their medical care. One must question whether an ability to speak English, if that is indeed a factor rather than a presumption, is a pre-requisite to being able to communicate pain or make assisted decisions about healthcare.
The issue around the perception of BAME patients and how this impacts the medical care they receive is also reflected in the story of Serena Williams’ experience during childbirth when she suffered serious complications as a result of a pulmonary embolism (a potentially life-threatening condition which involves a blocked blood vessel in a patient’s lungs). Serena Williams has stated that after delivering her child, she raised concerns regarding experiencing shortness of breath, which she knew was a symptom of a pulmonary embolism as she had experienced this condition as part of her medical history. However, she was perceived as being ‘confused’ due to her pain medication even though she had clearly stated that she knew she required a CT scan with contrast and a blood thinner. It was only after Serena Williams repeated this a number of times that a CT scan with contrast was completed, confirming that she had several blood clots in her lungs, and she was subsequently provided with blood thinners.
There is no question that Serena Williams is one of the most accomplished athletes in the world and a global icon. Yet, she was forced to advocate for herself repeatedly before her concerns were viewed as legitimate and acted on by her medical team. Despite her status, Serena Williams almost fell victim to the same issues that black women face within the healthcare sector and which lead to dangerous or life-threatening pregnancy-related complications.
This raises two questions. Firstly, how likely are other patients of a BAME background to have their concerns listened to and acted on appropriately? And secondly, how far does this issue contribute to the disproportionately high fatality rate of BAME patients?
Listening to a patient is one of the fundamental requirements of adequately diagnosing, treating and caring for them. The lessons learned from Covid-19 must therefore also include a wider discussion around the issue of racial inequalities in the healthcare setting and unconscious bias in diagnosis and treatment to ensure that the disproportionate risk to patients from a BAME background is addressed and rectified.
Our black lives matter / BAME Blog series
As a firm, we have had many discussions about Black Lives Matter and how we can make a difference to the movement. We wanted to do more than just put out a statement of support, we wanted to take substantive action to address the inequalities faced by Black people and other ethnic minorities. Over the coming weeks, we will be publishing a series of blogs from our varying practice areas highlighting what we are doing, how you can make a difference and shining a light on the issues.
Our Diversity and Inclusion group is working hard with Human Resources and the Management Team to effect change through methods such as training and reviewing recruitment practices. We have implemented a lot of change but we recognise we have more to do and we are always looking to make improvements as a firm. We all have respective roles to play in advocating for issues of inequality and we hope our blogs give you some inspiration as to how you can make a change.
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