The report, led by J.S. Bamrah, MD, of the University of Greater Manchester, and colleagues, synthesizes extensive evidence that racism, sexism, and gender bias are deeply embedded in NHS policies, clinical practices, and workplace culture.

These systemic inequities are linked to worse health outcomes, reduced access to care, and deteriorating conditions for patients and staff.“An investment in equality and inclusion is a strategic investment that pays dividends in the form of better patient care, a more inclusive work environment that supports retention of valued staff, and the eradication of health disparities,” the researchers wrote.

Widespread Inequities in Care and Outcomes

The National Health Service (NHS)was founded on principles of equity, but disparities remain pervasive. Black, Asian, and other ethnic minority patients  were found to experience poorer outcomes across numerous health conditions, including COVID-19, maternal and neonatal health, mental illness, and chronic disease management. For instance, ethnic minority patients accounted for 34.5% of critically ill in the U.K. up to April 2020, despite representing just 14% of the population. Sex and gender disparities are similarly stark. British women live longer than men on average, but they do so in poorer health. Conditions disproportionately affecting women—such as endometriosis, autoimmune diseases, and mental health disorders—are under-researched and underfunded. The U.K. also has the largest female health gap among G20 countries and the 12th largest globally, according to the report. Intersecting disadvantages further worsen health outcomes. A Black woman with disabilities living in poverty, for example, faces greater compounded health risks than the additive effect of each factor alone.

Harm Beyond the Clinic: Workforce Inequity and Economic Costs

Ethnic minority healthcare workers—who make up nearly 25% of the NHS workforce—report significantly worse workplace experiences than their white colleagues. These include bullying, harassment, , and feeling undervalued, particularly among migrant workers. Similarly, female staff, who comprise more than 75% of the NHS workforce, experience high levels of discrimination and sexual harassment, especially in surgical environments. This culture of discrimination has economic consequences. Health inequities cost the U.K. economy up to £33 billion annually in lost productivity and impose at least £5.5 billion in direct healthcare costs. Workplace bullying and harassment alone are estimated to cost £2.28 billion.

Call for Structural Reform and Leadership Accountability

The researchers argue that NHS leaders must acknowledge the pervasiveness of racism and sexism in the health service and be held accountable for eliminating them. Key recommendations include:

• Establishing a sixth Care Quality Commission criterion focused on "staff wellbeing", including racism and sexism.
• Expanding statutory responsibility and reach of the Race and Health Observatory.
• Mandating equitable research practices through funding bodies such as the National Institute for Health and Care Research.
• Implementing the 2022 Messenger report’s leadership diversity recommendations in full.
• Requiring NHS organizations to collect disaggregated data on race, sex, and gender.
• The report also calls for equity impact assessments at all levels of NHS planning and governance and recommends that the NHS create national equity metrics to guide progress.
  
  

Training, Research, and Clinical Practice Must Catch Up

Improving outcomes also requires addressing gaps in clinical training and research. Medical devices calibrated for white patients, such as pulse oximeters, have demonstrated reduced accuracy in patients with darker skin. Diagnostic tools like the Apgar score have similarly yielded unreliable results among neonates of color.The report recommends mandatory in-person training for NHS staff—co-designed with patients—on race, ethnicity, sex, and gender bias. The NHS should also prioritize research that disaggregates findings by sex and ethnicity and ensure diverse representation in research teams and patient cohorts. Additionally, clinical guidelines must reflect how health conditions and treatments affect patients differently based on sex and race. Recent efforts, such as the Women’s Health Strategy in England, are steps in the right direction but remain underfunded and narrow in scope.

“The Time for Action Is Now”

The researchers conclude that implementing multilevel interventions is not just a moral obligation but a strategic investment that leads to better patient care outcomes and better retention rates for staff.  Without swift action, inequities could continue to undermine the NHS’s credibility and performance.“Inaction represents an unacceptable choice that increases harms to patients and costs in terms of increased staff absences, sickness, resignations, and reduced productivity,” the researchers wrote. “The evidence and policy options are abundantly clear.”

Disclosures: Several authors are affiliated with the Race and Health Observatory. Funding for contributors includes support from the Wellcome Trust.

Source: BMJ