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Action on patient safety can reduce health inequalities

BMJ 2022; 376 doi: (Published 29 March 2022) Cite this as: BMJ 2022;376:e067090
  1. Cian Wade, national medical director’s clinical, fellow12,
  2. Akanksha Mimi Malhotra, national medical director’s clinical, fellow3,
  3. Priscilla McGuire, patient safety partner1,
  4. Charles Vincent, professor of clinical safety research4,
  5. Aidan Fowler, national director of patient safety1
  1. 1NHS England and NHS Improvement, London, UK
  2. 2Harvard T H Chan School of Public Health, Boston, MA, USA
  3. 3Health Foundation, London, UK
  4. 4Department of Experimental Psychology, University of Oxford, UK
  1. Correspondence to: C Wade cianwade{at}

Providers and health systems should use ethnic differences in risk of harm from healthcare to reimagine their role in reducing health inequalities, write Cian Wade and colleagues

Health inequalities are widening in many high income countries and have been thrown into focus by the covid-19 pandemic.1234 Not only have black, Hispanic, Asian, and other marginalised ethnic groups in many high income countries had disproportionate death rates from covid-19, but non-covid health outcomes have also worsened.567 These unfair and avoidable differences in health between population groups are driven by a range of social determinants such as education, poor housing, and unemployment that contribute to social exclusion and disadvantage.1

When people already negatively affected by unfavourable social determinants of health seek care, healthcare itself may exacerbate health inequalities rather than mitigate them.8 One way in which this occurs is when patients experience disproportionate levels of harm from the healthcare they receive. For example, a 2022 review in the UK found that ethnic minority women’s experiences of poor communication and discrimination during interactions with healthcare staff may explain some of the stark inequalities observed in maternal health outcomes.9 Healthcare may therefore be less safe for some patients than others.

Patient safety is the science and practice of minimising harm and error experienced by patients while receiving healthcare.10 Harm typically centres on a “patient safety incident” in which a failure in healthcare causes physical or psychological injury to a patient.1112 Most clinicians would recognise patient safety incidents such as administering a drug to the wrong patient as potentially extremely harmful and preventable (box 1), but it is less clear whether the concept of harm should encompass population level health inequities such as more severe diabetic complications in one group compared with …

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