Frameworks for anti-discriminatory strategies in the health service
There is a long-standing and well-documented pattern of health inequalities in Britain, evident in both health care outcomes and in utilisation of health services, while the gap between health needs and the provision of health services to meet them continues to widen (Baxter, 1997; Department of Health, 2000b). Inequalities in health particularly affect minority ethnic groups because of, among other reasons, disproportionate poverty, discrimination and failure of health service organisations to provide culturally competent care (Ahmad, 1993; Baxter, 1997; Department of Health, 1998a). Lack of competence in handling the needs of culturally diverse users of the health service is a factor in outcomes such as misdiagnosis and inappropriate treatment of Black and Asian people in mental health institutions (Department of Health, 1998d) and in low service utilisation rates among Black and Asian women such as those in uptake of breast and cervical screening. It is also frequently reflected in services providing inappropriate dietary advice and support, inattention to religious requirements, poor interpreting arrangements (Kai, 1999), and poor screening and genetic counselling provisions for sickle cell and thalassaemia (Anionwu, 1996; Department of Health, 1993). This chapter aims to discuss cultural considerations in health care delivery
in relation to countering discrimination in health service. It will describe concepts related to culturally appropriate health care; discuss problems faced in securing a diverse health workforce; consider ways to improve recruitment and retention of people from under-represented groups in the health professions; analyse the role of education and training in promoting culturally competent health care; and identify and discuss approaches to making the NHS a culturally competent organisation. The chapter will not presume to generate a new body of practice strategies and procedures. Rather, it will present a composite of practices and procedures already identified in health care literature and will suggest how they might be adapted to the contemporary NHS environment.