Ensuring the diverse needs of our communities are met

It’s nearly a year since the NHS Race and Health Observatory got up and running, and this is an opportune moment to look both back at what we have done in the first 10 months, and ahead to our plans to deliver even more.

In our first year, we focused on building the Observatory’s architecture. As well as a core team, we have established a board, an academic reference group, a stakeholder engagement group and several specialist advisory groups. Based on consultation with these groups, we published a strategy for the first three years, making explicit our values and laying out our priorities.

These priorities, taken together, enable us to focus on long-standing health inequalities; be responsive to emerging issues; keep this agenda at the forefront of leaders’ minds, and work in a way that is evidence-driven and informed by meaningful engagement.

The Observatory has been designed to add value by proactively investigating the ‘causes of the causes’ that underpin health inequalities. We commission research that enables practical and meaningful policy recommendations for positive change in access, experience and outcomes for our diverse patients, communities and the health and care workforce.

Although a wide range of ethnic inequalities exist across our health system, our initial work is focussed on specific high need areas such as maternal and mental health, where we know experience and outcomes vary according to ethnic background. For example, Black women’s hugely increased risk of dying during childbirth is well-known, but there are also more subtle ways in which race can impact on care: the APGAR score, for example, is almost universally used to assess a newborns health at birth but relies in part on the ‘pinkness’ of their skin colour.

Looking ahead, genomics, personalised medicine and digital health are areas where we need to ensure that technical advancement doesn’t inadvertently embed inequalities for future generations, and that the opportunities granted by this progress are available to all. Digital apps are already changing healthcare, but they cannot deliver equitable care if they are fed by incomplete and biased data sets.

Beyond care delivery, it is also important to ensure research is diversified – not just in terms of who is carrying out the research, but also in who its participants are.

Our work examining potential racial bias in pulse oximeters shows the risks of testing potential life saving devices on homogenous research cohorts. As it stands, we cannot be confident that these devices give accurate information about oxygen saturation levels when used on people with darker skin. Our ground-breaking work on this has led both to updated guidance on how results are interpreted, and to a wider independent review of racial bias in medical devices, launched by health and social care secretary Sajid Javid.

And we’re doing a lot more besides. We’ve recently initiated a three-year research programme, REACH-OUT, to examine the impact of long Covid on ethnic minority healthcare workers. We’ve appointed a medical adviser to work specifically on variations in care for sickle cell disease patients. We’ve launched a project to examine the extent to which ‘trust’ can be considered a social determinant of ethnic health inequalities.

We’ve celebrated the success of others by sponsoring the HSJs top 50 Black, Asian and minority ethnic leaders Powerlist and the HSJ ‘Race Equality’ award. And, as the nation’s pandemic response moves to its recovery phase, we’re also exploring inequities in elective recovery and the clearing of historically long waiting lists.

Of course, if any of this is to have lasting impact, we cannot work in a silo; one thing Covid has shown us is that pandemics don’t respect borders, and so we must also think on a global scale. We have already signed a memorandum of understanding with the Centres for Disease Control and Prevention in the US, and have established an international race and health advisory group to share learning and expertise across a growing number of nations.

As our first year draws to a close, we look forward to our international conference on “Race, Racism and Health” – planned for July – which will offer a unique opportunity to share good practice from across the globe. We are also developing an interactive digital platform which will pull together insight and case studies in the area of race and health, on a single site – making it the “go to” place for anyone interested in ethnic health inequalities. And there will be much more.

This is the first organisation of its kind – one that exists solely to ensure our health and care system truly meets the diverse needs of our diverse communities. We are ready for the challenges ahead and invite others to join us in achieving this ambition.

Habib Naqvi is director of the NHS Race and Health Observatory

Owen Chinembiri is senior implementation lead at the NHS Race and Health Observatory