Ethnicity and health: Equity of access to health care between ethnic groups

The London Health Observatory report on Ethnic Disparities in Health and Health Care includes some information on equity of access to health care. Research in this area, whether academic or service-based (e.g. health equity audit), generally requires (a) data on need and (b) data on provision and/or uptake. Establishing whether a service is equitable will generally involve comparing need and provision/uptake in different population groups. For further information on health equity audit methodology see Health Equity Audit Made Simple.

A range of data is available on need (e.g. disease prevalence) and also on the provision and uptake of services (e.g. NHS patient databases). However, substantial challenges face researchers looking to identify, measure and interpret equity/inequity of access between ethnic groups. For example:

	There are substantial gaps in the ethnic monitoring data in key NHS databases. This is described in more detail in the section: Deficiencies in ethnic monitoring data.
	It may sometimes be necessary to adjust for the confounding effect of socioeconomic status. Most NHS patient databases such as “Hospital Episode Statistics” do not contain information on the socioeconomic position of individual patients (area-level deprivation measures are sometimes used as a crude proxy for individual-level measures).
	Studies need to be large enough in terms of patient numbers to permit adjustment for the different confounding factors.
	Account may need to be taken of different patient preferences for treatment which may vary unevenly between ethnic groups.

Consequently, few studies have been successful in assessing whether services are truely equitable between ethnic groups – often the available information is simply in the form of comparative statistics on rates of access, sometimes standardised by age and sex. This said, such information can be used to identify apparent differences in access that might then be amenable to further investigation using more sophisticated methods.

Appendix 3, based on information extracted from the London Health Observatory report, includes information on equity of access to health care relating to:

The London Health Observatory report does not specifically address issues of equity of services for asylum seekers. For a brief discussion of the health care issues affecting asylum seekers refer to Asylum seekers in dispersal – health care issues (Home Office Online Report 13/03).