Why It Matters
"Racial inequalities in health permeate every facet of the health care journey, from maternal and neonatal health care to end-of-life care and all critical points in between."
Health care systems worldwide are grappling with health inequities. In the United Kingdom, the NHS Race & Health Observatory was established to confront and alleviate racial disparities in health care. In the following interview, Professor Habib Naqvi, Chief Executive of the NHS Race & Health Observatory, discusses the organization's purpose, its journey, and the vital role of data in achieving its goals. The organization, in partnership with the Institute for Healthcare Improvement (IHI) and supported by the Health Foundation, has launched a Learning and Action Network to address the gaps in severe maternal morbidity, perinatal mortality and neonatal morbidity between women of different ethnic groups in England. This interview was conducted before the launch of this initiative.
What is the UK’s NHS Race & Health Observatory and why was it created?
The NHS Race & Health Observatory was established with the aim of identifying and addressing racial and ethnic inequalities in health. These disparities exist in access, experience, and outcomes in areas as diverse as genetic counseling, artificial intelligence, mental health, and maternal care. For example, it cannot be right that today, in 2023, Black women in the UK were up to five times more likely to die during pregnancy or childbirth, compared to their White counterparts. Our approach revolves around a three-fold strategy. Firstly, we gather and consolidate evidence and insights. Secondly, we translate this evidence into actionable policy recommendations. Thirdly, we support health care organizations and systems in implementing these recommendations on the ground.
What was the catalyst that led to the establishment of the NHS Race & Health Observatory?
The idea of creating an Observatory dedicated to addressing racial disparities had been circulating for some time in the UK. However, the turning point came with the publication of a special edition of the British Medical Journal in 2020, titled “Racism in Medicine.” This publication made the compelling case for the urgent need to establish an Observatory that would examine racial inequality within the UK health care system and recommend concrete actions to address it.
How would you describe the significance of the NHS Race & Health Observatory's work within the broader context of the NHS and the UK health care system?
Racial inequalities in health permeate every facet of the health care journey, from maternal and neonatal health care to end-of-life care and all critical points in between. The COVID-19 pandemic highlighted the disproportionate impact on ethnic and racial communities, adding an extra layer of urgency. The UK has a rich history of migration, diverse ethnic communities, legal frameworks for equity, and substantial investments in health care research. Still, the response to these challenges, historically, has been somewhat fragmented and costly. Prior efforts often addressed surface-level issues without delving into the root causes of racial disparities.
With the observatory being a part of the NHS, do you see your work as challenging the status quo?
To achieve different outcomes, we must do things differently. The COVID-19 pandemic amplified long-standing inequalities, but we need to address the root causes. This involves aligning our moral compass to focus on social determinants of health — including racism — in its structural, interpersonal, and organizational dimensions. This is crucial to rectify disparities in access, experiences, and outcomes. The Observatory’s independence ensures objectivity in the data and evidence collected, in the recommendations made, and in the actions and support provided. We are driven by data and focus on evidence-based solutions. There’s a moral and financial case for addressing these issues, and different narratives need to be communicated to different audiences. For leaders, it's a matter of leadership and moral responsibility, as well as improving patient outcomes and saving resources.
Could you expand on the financial aspect of this work and how addressing racial disparities can lead to cost savings?
Addressing racial disparities not only saves lives but also reduces costs. For instance, we conducted a study on racial bias in pulse oximetry, which revealed that pulse oximeters are less accurate on darker skin. By addressing such issues, we not only save lives but also reduce the strain on health care resources. This leads to fewer emergency care visits, reduced repeat appointments, and better equitable care for all.
For individuals or organizations who find addressing racism and inequities daunting, what advice or encouragement can you offer?
Focusing on racial equity is a matter of leadership and moral responsibility. It's essential to align our efforts with “the right thing to do” and work towards a more equitable health care system that is there for everyone. This is a shared responsibility, and everyone has a role to play in reducing disparities and bridging the gap between our aspirations and the realities we face.
Editor’s note: This interview has been edited for length and clarity.
You may also be interested in:
More about the Learning and Action Network