Today is World Cancer Day, and this year marks the beginning of a new 3 year campaign to ‘Close The Care Gap’. Anyone can get cancer, but sadly Black and Brown people face multiple and unique barriers to screening, public health information, are more likely to have a late diagnosis and to experience poor care.
As reported by Macmillan ‘uptake of cancer screening in people in BME groups’ as well as ‘cancer awareness and help seeking behaviours’ are low across ‘all minority ethnic groups’, especially in comparison to White demographics (The Rich Picture Report, Macmillan).
This inequality when it comes to cancer has been acknowledged by many major cancer and racial health inequality charities as well as public health research. The ultimate question asked by all is why?
– Why is it that there is a noticeable drop in screening rates when it comes to Black, Brown and minoritised groups?
– Why is there less cancer awareness in these communities?
– Why aren’t people from these groups accessing services and presenting help seeking behaviours in the same way as the White population?
The answer is complicated and multifaceted, but undeniably the ‘why’ is largely influenced by the failure of public health and NHS services to cater to communities and individuals who exist outside of the assumed patient, who is White, cisgender, ablebodied and hetrosexual.
When it comes to care in appointments medical professionals are simply not being given the training to serve Black and Brown communities. Shockingly, a recent research paper investigating the engagement barriers faced by British Pakistani women when it comes to cervical screening found that healthcare professionals in 95 UK Breast Screening sites rated their ‘ability to communicate with South Asian women as difficult and poor’.
With so many medical professionals essentially feeling ill-equipped to cater to the differing needs and contexts which might exist when seeing a South Asian patient it is not surprising that ‘South Asian women are often diagnosed at a more progressive stage, resulting in a poorer prognosis and invasive treatments’ (Victoria G. Woof et. al).
And it’s not just South Asian communities who are experiencing this. As the report goes on, individuals across Black, Brown and minoritised cancer patients ‘described themselves as unable to effectively access healthcare services due to a lack of confidence in healthcare professionals, as well as significant knowledge and communication barriers’.
The knowledge and communication barriers are extensive and all highlight the way in which Black and Brown patients sit outside the patient model assumed by public health policy, information and practice.
For example, one communication barrier is language. Some first generation citizens in Black and Brown communities don’t have English as a second spoken or written language. If language is a barrier, receiving and understanding a leaflet about cancer, or an invitation to a screening becomes impossible. As the report on engagement and barriers faced by British Pakistani women explains, many rely on family members – daughters, partners, siblings – to translate medical correspondence or attend appointments with them. This can inevitably lead to difficulties with the translating person themselves not always comfortable with what is being asked of them. An example of this can be seen from one focus group participant when translating for her mum, is quoted as admitting:
“Like we go to the doctor with her and she’ll say, ask him this, and sometimes we won’t. We’ll be like, no, I don’t want to ask that” – Fareeda (a daughter who had been acting as translator for her mum)
The same situation can be true in reverse. If a parent is relying on their children to interpret, more intimate health may simply feel too embarrassing to share.
Many are not aware and not made aware by health professionals that they do have a right to a NHS interpreter.
The legacy left by the hostile environment policy introduced by Theresa May in 2012 and continued by stealth under the current government with their constant immigrant scaremongering and scapegoating has led to a culture of fear in many Black and Brown communities when it comes to accessing care. There is a genuine widespread fear of deportation created by the hostile environment. This flies in the face of the oft-repeated argument that so-called immigrants are burning through NHS resources. The opposite is true – refugees as well as many from Black, Brown and minoritised groups are not accessing care, missing diagnosis and quite literally dying.
Health statistics are always a snapshot of factors; living in poverty makes a huge difference to someone’s overall health. Black and Brown people are statistically more likely to be living in poverty. Beyond the compounded impact this has on health, it can also make access to appointments an issue. People may be less able to pay for travel or get time off work to attend. Black and Brown people often also experience or have experienced racism at the GP/hospital and don’t want to return. There can be further barriers for female patients who may want to be seen by a female practitioner for reasons of faith.
None of this is news to the health care providers. The Race Equality Foundation reports a lack of focus and data in the first instance, resulting in poor understanding of the needs of Black, Asian and minoritised ethnic communities. There was an underlying lack of priority and urgency of the cancer needs of Black, Asian and minoritised ethnic populations in NHS policy documents and in NHS cancer data collection exercises.
In recent years an example in London showed big differences in South East and North London where Bangladeshi women had low levels of breast screening uptake compared to White British and other groups of women. Over in Central and East London however, (which has a high Bangladeshi population), a targeted project to encourage uptake in the Bangladeshi community contributed to the results being similar to other groups, rather than significantly lower. What this shows is that it matters not what the geographic spread is, when our Black and Brown communities are targeted in a safe and supportive way, uptake can improve, as trust and understanding of what is being asked of them and why begins to build.
This time to question the status quo and embrace anti-racist practices in healthcare is NOW.
Sources:
https://www.trec.org.uk/events/world-cancer-day
https://raceequalityfoundation.org.uk/wp-content/uploads/2018/07/REF-Better-Health-471-1.pdf
Trenchard et al., (2014; 2016) report variation by ethnicity of patients’ ratings of communication and information. Asian and Chinese patients were less likely to receive understandable written information about side effects and were less likely to receive understandable answers to important questions directed at the doctor compared to white patients. In a breakdown of the “Asian” category, Bangladeshi patients were the least likely to receive answers to important questions
