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Black babies are less likely to die when cared for by black doctors, US study finds

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3315 (Published 21 August 2020) Cite this as: BMJ 2020;370:m3315

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Re: Black babies are less likely to die when cared for by black doctors, US study finds - Revolutionise Medical Education or see Trans-Atlantic Problem

Dear Editor,

If the recent wave of anti-racism protests have taught us anything, it is that race and the fabric of inequality due to differences in race, are rife and consistent in a variety of our most distinguished establishments. From black babies dying in the USA, BAME medical students in the UK being ostracised and stories of discrimination in care homes for the elderly, it is evident that there is rampant injustice throughout every part of the health system.
The USA has long shown evidence of inequality, and the findings highlighted when black new-borns are treated by a black physician are stark. (1) Similar data is not currently available in the UK, however, there is a worryingly similar theme with the differences seen by ethnicity in the infant mortality rate in England and Wales. Even when accounting for congenital abnormalities, which are known to be higher in the Bangladeshi and Pakistani community, BAME babies have a higher mortality rate compared to their white ‘equivalents’. This is not a recent development. In 2009, the data was similar, with BAME babies dying at an evidently higher rate. (2) From this, and owing to the lack of available data, we call for inquiries into why this is the case and why, despite knowledge of the disparity, little seems to have been done to address it.

The data also suggests that the inequality continues far beyond babies. As these babies grow up, they will be expected to live shorter, more painful and more difficult lives than their white counterparts. (3) As we enter our final year of medical school, it is incredibly apparent that more must be done. Looking back, the only specific teaching about treatment of BAME patients that we can recall is in the treatment of hypertension. This is a trend that has been echoed across medical schools, and the disdain for this lack of diversity in teaching has been voiced with the outcry for specific medical education of ethnic minority presentations.(4) Variations in dermatological presentations across ethnicities are severe, as seen in Kawasaki disease, and yet students are being trained without seeing enough of these differences. With already limited paediatric and neonatal undergraduate teaching, this trend of dying babies in the USA could theoretically be seen in the UK and potentially exacerbated with further changes in teaching due to the COVID-19 pandemic.
The fact that these differences in race with physical health are being noticed raises questions over discrepancies in mental health which is known to be neglected. Black people are more than four times likely than white people to be detained under the Mental Health Act. (5) We cannot allow lack of understanding across ethnicities to be driver in health inequality and this must addressed within the medical school curriculum.

Therefore, as medical students, it seems very clear that we now, more than ever before, have a responsibility to address this issue. We must help to implement these changes to our medical education system, so that as we start our clinical careers, we will be more vigilant and better educated in our own practice, and ensure that all patients receive adequate care, regardless of the colour of their skin.

References

1. BMJ 2020;370:m3315

2. Toleikyte L, Salway S. Local action on health inequalities: understanding and reducing ethnic inequalities in health. Public Health England. 2018.

3. Sauaia A, Dellavalle RP. Health care inequities: an introduction for dermatology providers. Dermatol Clin. 2009;27(2):103-v. doi:10.1016/j.det.2008.12.001

4. BMJ 2020;370:m2746

5. https://www.ethnicity-facts-figures.service.gov.uk/health/mental-health/...

Competing interests: No competing interests

01 September 2020
Edward J Towning
Medical Student
Akul Purohit
King's College London
London