Ethnicity, Health and Primary Care

Edited by Joe Kai . Oxford University Press , 2003 , PB £19.95, 230 pp. ISBN 0-19-851573-1 There is a substantial body of literature documenting that ethnic minorities have poorer health outcomes than white people. While socioeconomic differences contribute to ethnic disparities in health outcomes, there is also mounting evidence that patients from ethnic minority groups receive inferior health care than white people. Countries including the United Kingdom and the United States have prioritized eliminating health inequalities nationally; however, it is far from clear how health providers should address these disparities in their day-to-day clinical practices. Ethnicity, Health and Primary Care, edited by Joe Kai, is a practical guide for clinicians addressing this specific issue: how to effectively treat ethnically and culturally diverse patients. While the book is written for British clinicians, the lessons are readily applicable to practice setting around the world. Kai and colleagues opt not to provide a ‘compendium’ of health issues by ethnic group, which they argue would be overwhelming given the extraordinary diversity in Britain and might serve to encourage stereotyping. Rather, the authors assert that to best serve patients, clinicians should have general skills to respond to patients’ individual needs. For minority patients this means clinicians must be sensitive to differences in culture, language and socioeconomic status. Furthermore their practice settings must be welcoming to all and have resources such as interpreters and advocates to facilitate cross-cultural communication. Consistent with this perspective, seven chapters of the book detail generic principles of effective patient care, including patient profiling, interpreting and translation, and working with advocates. These topics generally require management level interventions rather than change at the individual clinician level. While these topics are undeniably important for creating an effective clinical environment for diverse patients, they triggered a concern for me. As physicians are notoriously dismissive of training on non-clinical topics, I feared that by initially focusing on management level issues, clinicians may be turned off or feel released from responsibility for the ethnic inequality in health care. Kai does focus specifically on the clinicians’ role in responding to patient ethnicity in the last chapter in the section. In it he encourages clinicians to reflect on their prejudice, and uses quotes quite effectively to demonstrate how health professionals’ behavior may be racist or construed as racist (e.g. ‘The doctor put his gloves on to examine me– it was as if I had a contagious disease because I was a refugee and African’). Surprisingly, however, he does not go the next step to cite the empirical evidence showing that minority patients receive inferior medical treatment relative than white patients. Given the skepticism of many regarding racism in society, I see this literature as the strongest argument to convince clinicians that they play an important role in creating (and thus remedying) ethnic health disparities. The final 10 chapters each focus on a specific clinical issue that has particular relevance to minority patients. The topics fall into three categories: diseases that minority populations experience at disproportionately high rates, such as diabetes and hypertension; general health topics that require cultural sensitivity, such as mental health and sexual health; and populations of special interest, such as the elderly and refugees. This is the more practical section of the book, and consequently, to me the more interesting section. The chapters taken together provide evidence that ethnicity cannot be ignored in medical care, as it not only influences disease prevalence and severity, but the type of pharmacological treatment and self-management approach. The book, in sum, is a practical and timely guide for improving the quality of care for ethnically diverse patients. Its two pronged approach of outlining general principles of effective care and highlighting important clinical care issues related to minority patients is ambitious. It attempts to impact both individual clinicians as well as clinic-level policy. However, given the documented ethnic inequalities in Britain and elsewhere around the world, ambitious change is what is necessary

Cultural diversity · Environmental health · Ethnic group · Family medicine · Health care · Health equity · Political science · Population · Public health · Socioeconomic status · Global Health Workforce Issues · Medicine · Nursing · Obesity and Health Practices · Primary Care and Health Outcomes · Psychology · Gerontology