Acting on health inequalities and rebuilding trust in the health system

Launching our first project in partnership with Impact on Urban Health

26 Mar 2024
Health inequalities

Impact on Urban Health and NHS South East London Integrated Care Board (SEL ICB) are partnering to fund an ambitious new way to improve the experience and health outcomes of people from Black backgrounds.

At the heart of this project is a new way of working to build trust in the health service. In coordination with Black-led organisations, community-led insights will be used to shape design improvement in health services.

The context

People from Black and other minoritised communities in London experience significant inequalities when it comes to their health – for a combination of social, economic and environmental reasons.

Alongside this is a growing distrust and apathy towards the healthcare system.

The reasons expressed for this distrust are diverse and include experiencing discriminatory practices in healthcare settings, being misdiagnosed, being prescribed the wrong medication and having traumatic experiences.

In 2022, a report commissioned by the Black Equity Organisation found that nearly two thirds of Black respondents had ‘experienced prejudice from doctors and other staff in healthcare settings’, with the proportion being even higher – at 75% – among respondents aged 18 to 34.

Community-led research commissioned by Centric explored this further – and highlighted the disparities experienced by Black people when accessing maternal and mental health care.

Whilst women overall are having healthier and safer pregnancies and childbirth, the maternal mortality rate for Black women in the United Kingdom is nearly four times higher than for white women.

Traumatic experiences during childbirth and reports of inadequate pain relief are also significantly higher for women from Black backgrounds.

These experiences can have a compounding impact on how people from Black backgrounds access healthcare services and treatments.

The 2018 Race Disparity Audit reported that Black men are more than ten times as likely to have experienced a psychotic disorder within the past year as White men. However, Black adults are the least likely to receive treatment for a mental health condition – whether medication, counselling or therapy – and are the most likely to have been detained under the Mental Health Act.

Distrust in the mental health service in Black communities is re-enforced through experiences of greater rates of enforced admission to psychiatric wards and harsher treatment during their detention.

Focusing on Black maternal healthcare

This is why, through our partnership, we have chosen to focus on maternal and mental healthcare. The first part of the project – that we are launching now – focuses specifically on Black maternal healthcare.

In each area of this work, project groups made up of a range of stakeholders including patients, frontline staff delivering services, researchers and advocacy organisations. They will reimagine how healthcare services can be made more relevant, appropriate and accessible to people from Black communities by building on existing work and innovation in maternal care, designing prototype care pathways that are dedicated to improving patient experience and health outcomes.

This work will be overseen by a sponsorship group currently composed of representatives from the South East London Integrated Care System, Impact on Urban Health and Black Thrive. This is part of our commitment to working differently by creating a separate and more agile structure that is close to the work and able to connect it to relevant parts of the healthcare system.

Rooted by Design and BUD have been commissioned to facilitate the delivery of the maternal health stream.

We’re committed to ensuring the governance model and role of the programme’s sponsors is different to historical ways of working that have not accounted for patients’ experiences and health inequalities by keeping equity a central focus and making decisions driven through community research and insights.

Caesar Gordon, portfolio manager at Impact on Urban Health, says, “The partnership with SEL ICB is grounded in our shared commitment and responsibility to achieve health equity for Black people living in Southeast London by working together to leverage our access to power, resources, expertise and connections.”

Andrew Bland, Chief Executive of NHS South East London Integrated Care Board, says, “There is nothing so important to us as addressing inequalities in healthcare and health outcomes for people in south east London. This innovative partnership and community-led approach will, I hope, be a significant step towards doing that, and in building trust and confidence in the service that we want to offer to everyone, without exception, in south east London.”

To find out more about our work on rebuilding trust in the healthcare system, please get in touch with Caesar Gordon and Lilian Latinwo-Olajide at Impact on Urban Health or Jessica Levoir at South East London ICB.

Image © Guy’s & St Thomas’ Foundation