Treatments optimised towards white patients may be costing lives

Our health workers need knowledge and tools to reduce health inequality

Have you heard the one about the one-size-fits-all condoms?

In 2018, an African Health Minister complained condoms were too small. Black Americans and Europeans joined the call for larger condoms, while White Americans and Indians in South Asia called for the opposite. Given the important role that condoms play in sexual and reproductive health and the fight against HIV/AIDS, this was no laughing matter. It highlighted that health interventions must cater for the diversity of the population who use them. Yet, we don’t seem to have learnt our lesson.

The COVID-19 pandemic has reminded us of the price we pay when our healthcare system only serves one sub-group; oximeters (for determining the levels of blood oxygen) are prone to overestimate the amount of oxygen in dark-skinned individuals, and spirometers (used to assess lung function) do not work as well in Black and Asian patients because their normal lung function measurements remain poorly described. These tools used to fight COVID-19, which are optimised for white patients, may have cost the lives of ethnic minorities.

Beyond COVID-19, the differences in health outcomes between races and ethnicities for the same conditions include non-infectious conditions. For example, Black and Asian women in the UK are at least four times more likely to die in pregnancy and childbirth than White women.

Addressing these health inequalities is an urgent issue. Apart from our ethical duty, correct healthcare for all would improve the health service by treating diseases early, appropriately and effectively, reducing wasted prescriptions, preventable hospitalisations and facilitating antibiotic stewardship. To reverse these, we must focus on equipping our health workers with the right knowledge and tools.

First, our health workers must be trained in providing all aspects of clinical care for all ethnicities and races. In the UK today – with a diversity of medical staff, as well as patients – there is no reason why taking blood from different colour skin should not be mandatory training for all nurses.

Secondly, our clinical tools, treatments and vaccines must be evaluated and optimised for all ethnicities and races. Among people of Black African descent, the severity and outcome of autoimmune diseases is worse, yet with early diagnosis, we can significantly reduce this. My own research has shown that the diagnosis criteria for lupus and systemic sclerosis is based on the symptoms of caucasian patients, and means the symptoms of black patients, especially those frequently displayed early in the course of the diseases, are overlooked.

Finally, we must invest in inclusive biomedical research and clinical trials. Without insight into the scientific basis for the differing health outcomes and symptoms experienced by ethnic minorities, we have no basis for reversing them.

Tackling these medical issues is an important step towards greater health equity, but without addressing deeper problems, not least deprivation and racism, health inequalities will remain. If we are serious about health equality we must; think big and act faster and just, get on with it.