Why don't we give marginalised communities the resources to narrow inequality?
Here Dr Alom, a medical doctor working in East London, considers his own journey to medical school and how COVID-19 has laid bare the many inequities facing underserved communities in the UK.
When I was a young teenager, and the elected Deputy Young Mayor of Tower Hamlets, I was privileged to sit on the borough’s Health and Wellbeing Board. There, I learnt about the stark inequalities that my community faced compared to those a few tube stops away. I also learned that children receiving free school meals were unlikely to achieve even five GSCE’s. Nonetheless, I managed to gain a place at the University of Southampton to study medicine on a widening participation course, with the hope that I’d be able to return to Tower Hamlets and narrow these inequalities.
Traditionally, medicine has been an elite subject to study and the opportunities to progress as a doctor have many social and economic barriers which are beyond the scope of this article. Eighty percent of medical school applications come from 20% of schools in the UK. Over the last 20 years, many medical schools have tried to address this issue by establishing widening participation courses that allow students from non-traditional backgrounds to train as doctors based on contextual admissions processes. This meant a working-class, British Bangladeshi boy, like me, could go back to the NHS Trust where he was born and serve his community; a community that has largely had a poor experience of healthcare and health outcomes. Research shows that patients are more likely to adhere to medical advice and treatment if they can relate to the healthcare professional. It is also vital that patients have health advocates who understand them holistically and not just the pathophysiology of their health condition.
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COVID-19 has laid bare inequities that lie at the heart of some of our most marginalised communities.
The COVID-19 pandemic has highlighted the impact of health inequalities, especially ethnic disparities. A report by Public Health England stated that British Bangladeshis and Pakistanis were amongst some of the most at-risk groups with respect to COVID-19 mortality, and that Black people were more likely to require intensive care support. It also became apparent that these groups had some of the lowest COVID-19 vaccination rates. Due to the relentless work of grassroot initiatives led by faith leaders, community activists and trusted individuals in those communities, we saw a sharp increase in vaccine uptake. The British Bangladeshi community’s uptake rates alone changed from 15% to 75% between February and March 2021. This result emphasizes the importance of targeting resources to the populations most at need and empowering them to improve health outcomes of their own communities.
Similar to an undergraduate medical degree, postgraduate degrees have not been traditionally accessible for ethnic and working-class communities. This leads me to wonder: is a career in public health accessible for the marginalised communities that actually suffer at the hands of ineffective public policy? Professor David Williams of the Harvard T.H. Chan School of Public Health describes the ‘empathy gap’ as a racial empathy gap that influences public policy. It describes the failure to subconsciously feel empathy for people who differ from you and, therefore, has implications on policy preferences. In my opinion, no amount of unconscious bias training can change this. What can change, however, is empowering marginalised communities to become public health practitioners and policy makers.
To achieve this, we need to establish more contextual admissions and financial aid options for degree applicants of non-traditional backgrounds aspiring to improve the health and wellbeing of their communities. Not only would this provide them with valuable learning opportunities, but it would undoubtedly enrich the experiences of their fellow classmates. An alternative approach is an apprenticeship-style model that recruits local people into the public health directorate, thereby giving them the requisite training, including flexible higher education and support to influence health policy in their communities.
If we want to take health inequalities seriously, we need to change who makes the decisions impacting marginalised communities. Let the people advocate for themselves, for their lived experience is invaluable in policy making.