Ethnic and racial disparities and patient safety
Safety and equity are fundamental dimensions of the quality of healthcare. According to the World Health Organization (WHO), patient safety is ‘the structure of organized activities that creates cultures, processes, procedures, behaviours, technologies, and environments in health care that consistently and sustainably reduce risks and occurrences of preventable harm, make error less likely, and reduce its impact when it occurs’. Health equity, in turn, ensures that the most vulnerable receive differentiated care so that they are equal to others; that is, equity seeks to provide care that does not vary in quality depending on age, sex, race, ethnicity, geographic location, religion, socioeconomic status, linguistic status, political affiliation or other characteristics.
The WHO defines health equity as ‘the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically, or geographically’. In line with this, the Pan American Health Organization reinforces that the highest level of health equity can be achieved as conditions are created to enable the achievement of a higher level of human dignity for all people, regardless of characteristics.
Evidence indicates that patients from ethnic minority backgrounds may experience disparities in the quality and safety of their health care.
Ethnic and racial disparities in healthcare
People of racial and ethnic minorities are more likely to face worse healthcare outcomes, either due to increased healthcare risk or a lack of access to health systems. Black pregnant women, for example, are 3.2 times more likely to die of pregnancy-related complications than White women. According to COVID-19 death rates, the Centers for Disease Control found that American Indian or Alaska Native Americans were 2.4 times more likely to die, Hispanic or Latino Americans were 2.3 times more likely to die, and Black Americans were two times more likely to die of COVID-19 when compared with White, non-Hispanic Americans.
Evidence suggests that people from ethnic minorities are more vulnerable to adverse events in hospital and community settings than the general population. These people experience a higher incidence of healthcare-associated infections, medication dosing errors, adverse events and complications resulting from the care they receive. Among the factors that motivated these disparities are social indicators (such as economic stability, educational level, and access to a balanced and healthy diet); geographic barriers; habits and behaviours; language difficulties; health literacy; a feeling of alienation and distrust towards professionals, services and health systems; a lack of cultural understanding; and prejudices on the part of care providers.
Factors associated with care providers reinforce the need to provide opportunities for professionalisation in people's health, including members of racial and ethnic minorities.
Ethnic and racial disparities in the training of human resources in health
The health workforce needs to reflect the diversity of the population. There is a need to increase the representation of ethnic and racial minorities in the training of health workers and the composition of health teams. It is critical for multidisciplinary teams to be given the opportunity to be more diverse and equitable.
Evidence shows that assistance is more effective when the patient identifies with the health professional. A study highlighted that Black men seen by Black doctors were more likely to get a flu shot, agree to diabetes screening, and accept cholesterol screening than when seen by White doctors.
In the training of health professionals, strategies to raise awareness regarding ethnic-racial disparities are being developed. Research shows that learning about topics, such as structural racism, ethnic and racial inequalities, and the needs of minority populations, prepares workers for equitable care and the development of cultural competencies.
The representation of minorities promotes benefits for the workgroup. Evidence shows that when there is racial and ethnic diversity in the healthcare workforce, workers tend to have greater professional satisfaction, improved creativity and innovation, advantages in communication, better team engagement, lower employee turnover and, importantly, the development of cultural competence.
Promoting equity and patient safety
Although issues of equity in patient safety have not been extensively studied, principles for promoting health equity align well with safety culture. Quality and patient safety can advance rapidly in ensuring care for racial and ethnic minorities by incorporating the evidence produced regarding reducing health disparities. This enables a real and meaningful change in equitable safety for minorities.
A structure was proposed to promote equity in health, which consists of two aspects:
1. creating a culture of equity in which the entire organisation (leadership, managers, care teams) values and adheres to the mission of promoting equity in healthcare
2. implementing a roadmap to reduce disparities (identifying disparities with stratified health outcomes data and input from healthcare staff and patients; conducting root cause analysis of drivers of disparities; and implementing care interventions that address causes in collaboration with affected patients and populations).
Therefore, creating a culture of equity and implementing concrete actions are essential for change. The bridge between a culture of equity and the principles of the structure for reducing disparities is that everyone in the organisation, from the executive director to frontline staff, must know how to practically operationalise the advancement of health equity in their daily tasks.
Health equity is achieved when everyone can reach their total health and well-being potential, whether as a health service user or a health worker; both can systematically identify and eliminate inequalities resulting from ethnic and racial disparities and other general living conditions.
Authors
Maristela Santini Martins1,2,3, Karina Sichieri1,4, Maiquele Sirlei dos Santos Silva2,3,5.
1. The Brazilian Centre for Evidence-Based Healthcare
2. USP, University of São Paulo, Nursing School
3. Quality and Safety in Nursing and Health Services Research Group
4. Clinical Nursing Division of the USP University Hospital
5. Postgraduate Program in Nursing Management
Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.
