Wk3 Preparing for multicultural diversity in medicine

Question 1

Why should medical students be at demographically diverse medical schools?

Answer 1

Gain a greater understanding of the experiences of others and their sociocultural backgrounds, which increases their ability to provide healthcare to people with backgrounds different from their own

Question 2

What were the policy drivers before BLM?

Answer 2

• Macpherson (Stephen Lawrence) enquiry
• Race relations amendment act 2000
• disability discrimination act 1995
• sex discrimination act 1975
• human rights act 1998
• equality act 2010 in response to EU directives
• council of Europe recommendation 2006-18
• ECHR and the fundamental rights agency (EU)
• insurance and other ‘customer-led’ pressures?
• chief executive/ government strategic goals - marmot and QOF (Quality outcomes framework) system of payment and now CQC ratings - see their new guidance
• equity and excellence - liberating the NHS (July 2010)
• NHSS equality delivery system + equality & diversity council
• equality & human rights commission inquiries/reports
• lobbying by e.g. eace equality foundation and other charities

Question 3

What is a misleading belief?

Answer 3

• Not all drugs are completely effective across all races e.g. African Americans and valsartan and rosuvastatin
• BME staff 3x risk of COVID death

Question 4

What is Tudor-Hart’s “Inverse Care Law”?

Answer 4

• Non-white patients receive a less good quality of care:
  = less likely to be given advice
  = to have BP checked
  = wait longer for treatment
• People with long-term mental health conditions were more likely to get killer diseases , more likely to get them young, more likely to die of them quickly but less likely to get screened, diagnostic checks and treatments

Question 5

What is the reality of equality in medicine?

Answer 5

• Significant variations in health status
• Significant variations in the experience of receiving health care service
• There is significant variation in the Evidence Base
• There is significant variation in the Knowledge Base

Question 6

What are interlocking influences of intersectionality?

Answer 6

• Location
• Poverty
• Education & Experience
• Access to service
• ETHNICITY

Question 7

What ethnic diseases exist?

Answer 7

- Cystic fibrosis:
white UK/USA = 1/2400 vs. 1/17000
- Phenylketonuria
USA/EU = 1/12000
- Factor 5 Leiden (blood abnormality)
5% of white Americans 
- Tay Sachs
- Sickle Cell Anaemia
4% in West Africa, 0.25% black Americans
- Thalassaemia
16% Cyprus, 3-8% Asia
- G6PD 
in Mediterranean, Black USA and Africa

Question 8

What is culture?

Answer 8

• Religion
• Language
• Art
• Diet (food)
• Music
• Family
• Shared history
• Impact of the experience of racism

Question 9

Stats on inequalities with women

Answer 9

• Designed to be a man’s world
• 50% of women in GB more likely to be misdiagnosed following a heart attack
• Heart failure trials generally use male participants
• Medical books being attached to white people