EDUCATION MATTERS

Tackling health inequalities: learning from our forebears Janet Scammell

© 2014 MA Healthcare Ltd

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s a student, you probably studied some nursing history and felt inspired by stories of our nursing greats such as Florence Nightingale, Edith Cavell and Mary Seacole. Mary was unusual in that she rose to prominence despite some significant social disadvantages—being female, from a minority ethnic background and of limited financial means. Mary was born in Jamaica in 1805 and became a ‘doctress’, a role somewhat akin to today’s nurse practitioners. She learned her skills from her mother and by working with doctors in her local hospital. She used these skills to serve her community, as well as migrant workers and then soldiers in the Crimean War. Mary’s work was self-funded; indeed, she left the Crimea with significant personal debts. Her selfless attitude to use her skills to care for the sick was her prime motivation. Times have changed, but such histories can help to ground us in the roots of our profession and its core values of care and compassion for all, regardless of social status. Health is shaped by many factors that affect us over the course of our lives, such as lifestyle, education, housing, wealth and discrimination. For those of us living in the UK, we are privileged to benefit from universal education and health systems, free at the point of access, funded by central government through taxes. On the face of it, therefore, inequalities should not exist in the UK. However, despite improvements, considerable evidence (Marmot, 2010) indicates that health outcomes—that is, the incidence of morbidity and mortality— differ across a range of social groupings, such as gender, ethnicity, social class and geography. For example, health inequalities vary between and within ethnic groups. People from black and minority ethnic (BME) communities generally have worse health outcomes than the general population (Marmot, 2010). The picture is complex, but the overall message is clear. The link between health inequalities and ethnicity is a significant concern for the NHS today. The UK has one of the most ethnically diverse populations in Europe. In the 2011 census (Office for National Statistics (ONS),

British Journal of Nursing, 2014, Vol 23, No 22

2012), the majority ethnic group was reported to be white British (86%), with the remaining 14% comprising white or BME groups. As such, it is important that pre- and post-qualification education prepares the nursing workforce to work with diversity to ensure that the health needs of all the population are addressed in order to tackle health inequalities. Equally important, perhaps, is nurturing a diverse health and social-care workforce, one that is reflective of the UK population profile.Where diversity is valued, this is shown to have a positive impact on patient care (NHS Employers, 2014a). However, a recent report by Kline (2014) indicates that despite a number of central leadership initiatives, the ethnicity and gender diversity of London NHS Trust Boards, as well as national NHS bodies at a senior level, remains very poor. This under-representation of ethnic and gender diversity in key leadership positions, Kline argues, may adversely affect the provision of services to meet the diverse population needs across London and deny ‘the NHS the potential contribution a diverse leadership could make’ (Kline, 2014: 4). More than ever, initiatives need to be embedded in mainstream working to address inequalities in health care and the wider healthcare workforce. Education clearly plays a part, but developing an attitude of ‘zero tolerance’ to discrimination, and valuing diversity and difference, are also important. Like many university nursing departments, we encourage our students to sign up to become champions for the ‘Personal, fair and diverse (PFD) NHS campaign’ (NHS Employers, 2014a). This exciting initiative was launched in 2012 and seeks to celebrate diversity in all its forms to ensure we create and maintain an inclusive healthcare service. Designed for NHS staff working at all levels, the idea is to nurture a culture where everyone feels that they count, where fairness is ‘built-in’, and where everyone is treated with respect. One facet of this is the view that talent should be spotted and encouraged to flourish. This aspiration links with another initiative designed to address health inequalities: the Mary Seacole Awards (MSA) (NHS Employers,

2014b). Named in honour of this great advocate both for nursing and those in need of health care, these yearly awards, funded by Health Education England (HEE), are awarded to nurses in England to undertake projects to enhance health outcomes for BME communities. As a member of the MSA Steering Group, I had great pleasure attending the recent award ceremony, where past awardees presented their projects and the new awardees were announced. Last year’s projects ranged from working to safeguard children and their families from BME backgrounds to investigating the lived experience of dementia for individuals of black ethnicity. The 2014–15 projects will consider similarly varied topics, from infant feeding within EU migrant families to student nurses’ experiences of intercultural encounters. Further details can be found at http://www. nhsemployers.org/maryseacole, including how to apply for the next round of awards. Mary Seacole was a role model for nurses today. Despite suffering inequalities herself, she embodied what health care should be about. This is summed up very appropriately in the subtitle of the NHS constitution: ‘the NHS belongs to us all’ (Department of Health, 2013). BJN  Department of Health (2013) The NHS constitution: the NHS belongs to us all. http://tinyurl.com/c9qmsac (accessed 1 December 2014) Kline R (2014) The ‘snowy white peaks’ of the NHS’: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England. http:// tinyurl.com/lnpz6pg (accessed 1 December 2014) Marmot M (2010) Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post-2010. http://tinyurl. com/cffvo7o (accessed 4 December 2014) NHS Employers (2014a) Creating a personal, fair and diverse NHS: join our campaign. http://tinyurl.com/ lypxbcw (accessed 4 December 2014) NHS Employers (2014b) The Mary Seacole Awards. http://www.nhsemployers.org/maryseacole (accessed 1 December 2014) Office for National Statistics (2012) Ethnicity and National Identity in England and Wales 2011. http://tinyurl.com/ pgw8uot (accessed 4 December 2014)

Janet Scammell Associate Professor (Nursing) Bournemouth University

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