New reporting from the Guardian has shed further light on what experts call the 'ethnicity pain gap,' revealing that a patient's skin colour significantly affects the quality of medical care they receive. The evidence is overwhelming: race and ethnicity are associated with differences in care quality and health outcomes, regardless of whether individual providers are consciously racist.
Maternal Care Disparities
Women from Black and Asian backgrounds are less likely than their white counterparts to receive an epidural while giving birth, even when they ask for one. New research finds that Black women are stereotyped as having 'thick skin' and being able to tolerate pain, while Asian women are seen as 'princesses' who are over-demanding and judged for not tolerating even a small amount of pain.
Cancer Treatment Inequalities
Patients from Black, south Asian and mixed ethnic backgrounds received fewer and lower doses of pain-relieving medications than people from white backgrounds, even after controlling for patient age, cancer type, health condition, deprivation and other variables.
Interventions That Work
According to Prof Devi Sridhar, chair of global public health at the University of Edinburgh, acknowledging the problem is only a first step. She outlines four evidence-based interventions:
- Data collection: Healthcare organisations should routinely collect and transparently share racial and ethnic disparity data on waiting times, infection rates, mortality outcomes and more, with accountability for what the data shows.
- Bias training: Awareness-raising for all staff about unconscious biases can help dispel myths such as that Black patients have a higher pain tolerance, or that Asian people have a lower one.
- Standardised pathways: Checklists, protocols and objective criteria on care (e.g., when a woman can access an epidural during birth) reduce individual bias at key decision points.
- Leadership: Leaders must recognise the ethnicity pain gap and make it a priority across the organisation to change the culture.
Sridhar emphasises that this is not about accusing individual staff of racism. 'Most people working in healthcare genuinely want to provide the best care possible, but we can see that within delivery and care individuals are being treated differently, and the data points to a clear pattern of racial and ethnic differences.'
She concludes that patients should receive the same high-quality care regardless of skin colour, calling it 'simply good healthcare and good practice.'
