VOCABULARY OF DISCRIMINATION (MEDICAL SETTING …



VOCABULARY OF DISCRIMINATION (MEDICAL SETTING EXAMPLES)

Assimilation Ignoring the diversity (heterogeneity) of ethnic minority groups i.e. assuming that all British black-African populations have the same cultural/religious background and therefore similar disease experience and health care needs

Assuming that all elderly people are minimally active and therefore not considering offering additional treatments that support active lifestyles and social interactions such as by-pass heart surgery, reconstructive surgery after breast amputations and advanced physiotherapy rehabilitation to mobilise the elderly patients

Invisibility Health services are less likely to appropriately address the health needs of Gypsy/Traveling communities, homeless people, children in foster care, ethnic minority groups, prisoners, intravenous drug users, patients with mental health problems. These groups are less likely to be involved in patient satisfactory surveys and patient involvement programmes when services for thse groups are planned

Primary care: those people who need care most are less likely to present to the health service, e.g. men with early signs of bowel cancer from deprived areas

Exclusion Groups such as: Gypsy/Travelling communities, homeless people, children in foster care, ethnic minority groups, prisoners, intravenous drug users, patients with mental health problems are less likely to be involved in / targeted in population wide health improvement initiatives and health promotion strategies. E.g. programmes to increase physical exercise are less likely to focus on disabled people or older people

Health care information (leaflets, consent forms) may not be available in the required format for blind and deaf people

Screening services: ethnic minority groups are less likely to take up cervical and breast screening, due to lack of understanding of its importance (e.g. language or literacy barriers to understand invitation letter / additional information leaflet)

Deprived population may have limited access to particular health services when additional travel is required due to travel costs

Sanitation A preference for using the term ‘deprivation’ rather than ‘poverty’ in analysis of health outcomes and health programme initiatives

A preference for using the terms like ‘inclusion’ and ‘diversity’ rather instead of ‘anti-discrimination’ or ‘anti-oppressive’ practice

Normativism Organisational meetings e.g. team meetings are automatically not planned for Christian holidays, without giving due consideration to other faiths/beliefs

There is an expectation that service users will fit in the 9am-5pm opening time of a health service. E.g. sexual health services and screening services would benefit from more flexible opening times

Bias Drugs are mainly tested on young white males; however once they are fully licensed they are prescribed for the whole population including the elderly, females and ethnic minority groups. (Side-) Effects and dosage may be different for these groups, however.

Most health care providers are located in the well off areas, rather than in the areas of ‘greatest need’ (‘inverse care law’ by Tudor Hart)

Patient satisfaction surveys are more likely to be filled in by those who attend the service, while those who don’t access the service for a specific reasons are not involved in the feedback process

Research papers reporting positive results of small studies are more likely to be published than those reporting negative results (‘publication bias’)

Blaming the victim Smokers who develop respiratory disease or cancer, may be blamed for their disease

Patients with alcohol abuse who develop liver disease and require liver transplant may be blamed for their condition

Obese patients may be blamed for their overweight and numerous associated conditions, such as diabetes, cancer, infertility etc.

Patronising Health care professionals may patronise patients who are physically disabled, including deaf and blind people, by talking to their carers rather to them

Young children may not respected as individuals with their own views in medical treatment decisions

Stereotyping Muslim women do not wish to be attended by a male clinician

All those people who do not speak the English language well are not highly educated

Ethnic minority groups are more likely to be materially deprived that the indigenous population

Women are more likely to be expected to take on caring responsibility for elderly parents, rather then the men

Gay men and women are promiscuous and have multiple sexual partners

Tokenism Involving patients and communities in health service design (e.g. sexual health clinics) only at the later stages, where major decisions have been already made and only little can be changed if suggested by the lay representatives

Inviting a patient representative to a decision making panel on a health service development (e.g. colon cancer screening programme), but not giving him/her the right to vote, only using this representation for lay advice without implementing it

Exploitation Running clinical trails in vulnerable populations e.g. cancer patients without giving them a full informed consent or suggesting that the trail treatment is better than the conventional treatment to recruit patients more easily to the trail

Involving communities in research projects, giving the impression that they may benefit form the research, which may be misleading if this is not the intention of the research aims

Innuendo Suggestion that older women undergoing a breast amputation for breast cancer would not benefit from reconstructive breast surgery as part of their treatment

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