Cultural beliefs and Diversity in Medicine Flashcards
when can prejudice occur in healthcare?
As a doctor you aim should be to deliver fair treatment to everyone, with social inclusion at heart of healthcare service
Sometimes pharmaceutical companies discriminate by creating drugs which have a greater effect on a certain ethnic group and sometimes cause harm to another ethnic group. E.g. Valsartan – ace inhibitor was found to be significantly less effective in black Americans than white Americans.
Sometime diseases can be discriminating e.g. black and Asian individuals are more likely to die from COVID.
Also, age is discriminated – older people are more likely to die form COVID
why is their a lack of evidence on BAME pts?
There is significantly less evidence for how conditions specifically affect BAME patients (lack of research in this area)
There is also less evidence available for diseases which are common amongst BAME people but significantly less common amongst white people.
There is also significant variation in the knowledge base of doctors for conditions specific/more common to BAME patients e.g. Keloid scars, which are more common in dark skin patients.
what is “The Tudor Hart’s Inverse Care Law”?
“Those with the greatest need and the greatest propensity to benefit are likely to get the least”
Bangladeshis in the UK have particularly low levels of benefit claims even though they have some of the the highest levels of poverty.
There is also low-take up of benefits among Roma/Gypsies and Irish Travellers (A group twice as likely as the general population to have ‘Bad or Very Bad’ health –DCLG 2012).
There are significant variations in the experience of receiving health care service -Non-whites more dissatisfied with treatment by GPs:
usually receive lower quality of care
less likely to be given advice
less likely to have their BP checked
Usually have to wait longer for treatment
what are the factors affecting access to and outcomes of health care
Provider
Competence of practitioner - knowledge of e.g. disease that disproportionally effect BAME individuals or disease BAME are more predisposed to.
Suitability of treatment - is the medicine that is available only effective in white individuals
Can an interpreter be provided?
Referral Patterns - A lot of people didn’t get referred into hospices as they were seen as Christian services.
Structural
Resources e.g. brown prostheses not available
Legal/insurance entitlement of migrants to healthcare
Geography and timing e.g. ethnic minority common job taxi driver so working hours don’t match up with GP opening time
what are interlocking influences or intersectionality?
Intersectionality is the interaction of interlocking influences (in this case on health outcomes). The point is that they do not simply ‘add up’ but also influence each other, e.g. people living in a deprived location will have less access to health services, green spaces or good schools which all impact on health.
E.g. Location (where they live) - what is the quality of healthcare in your area
what does this table show?
The health of ethnic minorities is shown to be a lot worse when compared to white brits (=1) - more likely to see GP
This could be due to the reasons below.
Angina – artefact as people may not know what Angina is
what are ethnic diseases?
These are all genetic diseases which you have higher chance of getting if you are a certain ethnic group:
what are predispositions?
example?
These ethnic groups are not more predisposed to diseases such as T2DM just due to their genes but also due to lifestyle choices/education e.g. diet (cultural foods) and lack of exercise
In 2004, the WHO introduced a differential risk threshold for South Asians
Cut-offs were reduced to BMI>23 kg/m2 for overweight and BMI > 25 kg/m2 for obese.
If professionals are unaware of risk threshold differences, they may under-estimate the risk associated with a particular BMI in South Asian patients.
It is now strongly encouraged that Asian-specific BMI and waist circumference (WC) cut-offs should be used to evaluate diabetes risk.
what do migrants mainly get affected by?
Most migrants are healthy when they arrive in the EU, but they can be affected by conditions and factors before their travel and during their journey.
E.g. physical exhaustion, extreme distress, dehydration. This combined with other issues such as non-adequate living conditions or unhealthy lifestyles can result in detreating health.
explain income as a factor of health outcomes
Income is unevenly distributed! In the UK, over 50% of Bangladeshi, Pakistani and Black children live in households earning less than 70% of the median’ income – i.e. they live in Poverty’.
what is the difference in the way ethnic minorities view CAMs?
Many ethnic minorities place higher emphasis on complementary and alternative therapies
This is another form of risk - alternative herbal medicine can be harmful as its unresearched.
what is culture?
set of shared attitudes, values & practices that characterises a group of people
determined by:
religion
language
art
diet
music
family
shared history
impact of racism
not only about ethnicity e.g. deaf, sexual orientation, LGBTIQ
Recognising people’s culture in a social setting can solve problems by giving people their identity.
