By Vihansa Samarakkody CONTACT: 19vsamarakkody
In 2010, the Equality Act(1) was passed by UK Parliament in response to evolving societal views and the advancement of jurisprudence for human rights issues. It introduced 9 ‘Protected Characteristics’, which include Age, Disability, Race, Sex, Sexual Orientation, Gender Re-assignment, Marriage and Civil Partnership, Pregnancy and Maternity, and Religion or Belief. Under the umbrella of Healthcare(2), it protects those receiving care and the workers that provide it from discrimination stemming from characteristics protected by the legislation.
A recent investigation into online consumer reviews(3) found that out of 2,986 flagged reviews, a disparaging 48.9% mentioned acts of discrimination that occurred in clinical spaces as consumers were waiting for or actively receiving care; with 29.1% being coded as examples of institutional racism.
In addition to individual medical practitioners, racism and discrimination are deeply ingrained in the social, political, and economic structures of our society. For minorities, such differences result in unequal access to quality education, healthy food, humane wages, and affordable housing(4). In recent years, in the wake of multiple highly publicised events, the Black Lives Matter movement has gained momentum, and with it have come more strident calls to address this intrenched, or structural racism, as well as implicit bias.
“The loss of dignity and care that is experienced among diverse populations indicate that not all healthcare workers recognise the inherent and equal dignity of all human beings, nor do they value their diversity,”(5 )writes chair of clinical nursing practice, Leslie Baillie, Milton Keynes. She argues that behaviours such as indifference and dismissal are dignity-violating. One example is the substantial number of older people who have struggled with unnecessary pain and distress(6) under the care of the NHS due to unwarranted discriminatory attitudes and neglect towards the older generation, ageism, (7) in the UK.
The inception of the Equality Act has induced updated approaches to healthcare, a notable example being the NHS, who collate protected characteristics data of patients(8) to recognise the distinct modes of care and consideration needed for each individual. This includes language interpreters for non-English-speaking and deaf patients, culturally appropriate counselling, and non-degrading questionnaires for homosexual patients on sexual health(9)
Cultural differences and communication gaps frequently contribute to erroneous character assessments, exemplified by instances where medical professionals misinterpret foreign speech and colloquial language as offensive, leading to biased treatment. The recognition of marginalised traits is paramount for preserving the health and emotional integrity of patients; awareness and ‘seeing the person in the patient’ prevent prejudiced actions that may compromise the well-being of patients. Thus, with continually improving empathy and understanding, patients’ autonomy, concerns, and values can be articulated effectively, and patient safety and satisfaction are led to the forefront of treatment.
To summarise, legal frameworks, such as Protected Characteristics, can safeguard against inequity, ensuring equal access and medical treatment. They play a role in disarming systemic disparities by recognising and dismantling the effects of long-standing discriminatory practices. Culturally competent care and sensitivity to diverse backgrounds are essential elements in fostering trust and effective communication between patients and providers. Ultimately, these characteristics will become pivotal in tailoring a personalised, patient-centred healthcare landscape for years to come.
Bibliography
1- “The Equality Act and Protected Characteristics”. Local Government Association (last accessed 3rd Jan. 2023) ( http://www.local.gov.uk/our-support/workforce-and-hr-support/equality-diversity-and-inclusion-workforce/equality-act-and )
2-“Key Adult Social Care Legislation: Overview for Social Care”- SCIE (last accessed 3rd Jan. 2023) https://www.scie.org.uk/key-social-care-legislation/equality-act#:~:text=Anti%2Ddiscriminatory%20practice%20is%20fundamental,are%20protected%20under%20the%20legislation.
3- Jason K.C. Tong, MD1,2,3,4,5; Eda Akpek, MPH6; Anusha Naik, BS2,3; et al. June 2022. “Reporting of Discrimination by Health Care Consumers Through Online Consumer Reviews” (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789443 )
4 Elias, A., Paradies, Y. “The Costs of Institutional Racism and its Ethical Implications for Healthcare.” Bioethical Inquiry 18, pages 52–56 (2021). https://doi.org/10.1007/s11673-020-10073-0
5 Baillie, Lesley. Matiti, Milika “Dignity, equality and diversity: an exploration of how discriminatory behaviour of healthcare workers affects patient dignity’ (2013) Vol 10, Iss.1 (https://www.proquest.com/openview/cb998c0684ee8ad8a9183cbb3b751653/1.pdf?pq-origsite=gscholar&cbl=2033334 )
6 Grace Gottlieb “Is the NHS Ageist?” The Bulletin of the Royal College of Surgeons of England (2015) Volume 97, Number 9 https://doi.org/10.1308/rcsbull.2015.405
7 Dobrowolska B, Jędrzejkiewicz B, Pilewska-Kozak A, et al. “Age discrimination in healthcare institutions perceived by seniors and students”. Nursing Ethics. 2019;26(2):443-459. doi:10.1177/096973301771839
8 “The importance of collecting protected characteristics data”-NHS South East (https://youtu.be/Xzhvs2pr7VI?si=Vfuffj3iOCWM52bB ) -June 2023 9 “The importance of collecting protected characteristics data”-NHS South East (https://youtu.be/Xzhvs2pr7VI?si=Vfuffj3iOCWM52bB ) -June 2023
