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Health outcomes for people from BAME communities

Colin Garner Coronavirus COVID-19, Learn more

Current events, such as the COVID-19 pandemic and the killing of George Floyd in America, have shone a much-needed spotlight on some of the issues that disproportionately affect health outcomes for people from BAME communities. Research has consistently shown that people from black, Asian and minority ethnic backgrounds experience worse health outcomes than Caucasian people do – in a wide range of contexts.

One such context is within the world of antibiotic-resistant bacterial infections. Antibiotic Research UK provides research into potential treatments and supports those affected by such infections. But, we also educate the public on the issues surrounding antibiotic resistance.

Why are health outcomes worse for people from BAME communities?

Research to answer this question is ongoing. One theory centres on the fact that, in high-income countries, socioeconomic status and ethnicity are often highly correlated. Poor socioeconomic status also correlates with health outcome disadvantages. While we cannot infer cause and effect from such correlations, it can guide future research. It means that the following issues could contribute to the issue affecting poorer and BAME communities:

  • Less access to high-quality healthcare.
  • Poorer education around health and hygiene, particularly when it comes to much-misunderstood issues such as antibiotic-resistant infections.
  • Lower quality and more crowded living and working environments.

In relation to antibiotic resistance, evidence from studies suggests that  MRSA, resistant E Coli urinary tract infections and community acquired blood stream infections disproportionately affect people living in more deprived areas.

Why is it so important to understand the impact of antibiotic-resistant infections in different communities?

Death from antibiotic-resistant infections are on the rise. As our existing antibiotics become less effective and without any promising new drugs in development, there are predictions that we could be losing 10 million people a year  to antibiotic-resistant infections within the next 30 years. With the increase in the use of antibiotics as a result of COVID-19 – though they do not treat coronavirus infections, they are useful against other infections that arise through some hospital procedures that COVID-19 patients undergo, such as the use of ventilators – this impact could be increased.

While ‘10 million’ is a global figure, the impact will not be evenly distributed. If we can better understand how and why some communities are more affected by antibiotic-resistant infections than others, we can help to protect those communities.

However, it can be difficult to truly measure the impact of things like ethnicity, for a number of reasons. The way in which ethnicity is recorded varies in terms of approach to gathering and categorising the data. Some studies will have a limited ‘multiple choice’ question for this, others will allow participants to self-report their ethnicity. Some (usually older) studies may not even gather this data at all.

It must be considered that ‘ethnicity’ does not define any specific characteristic about a person, such as genetics. Rather, it might mean that people of one background share some traits. These can be similarities in diet, travel, medical opinions, and religious practices. It could even consider the way that people within the group are treated by healthcare professionals. Those shared characteristics, however, will not be shared by all. So, the findings of research into the health outcomes of people from BAME communities, for example, can show trends. Rarely can it show probable causes. It is important to identify these trends, though, in order to allow a more effective response to these issues.

How can we mitigate against this elevated level of risk to BAME communities?

While much more, well-funded research is required – and indeed, some is ongoing – there are steps that we can all take to help protect everyone. We can, and must, support at-risk communities such as those from BAME backgrounds now. Once there is high-quality data from completed studies, we will be able to make more informed decisions about how specifically to tackle this risk.

The key non-medical intervention to prevent a global health catastrophe related to antibiotic-resistant infections is to educate ourselves about the risk, and about some of the common behaviours that contribute to the problem.

Over-prescribing of antibiotics is a key driver of antibiotic resistance

If you have mild symptoms of, for example, a chest infection, and are otherwise in good health, give your body’s immune system time to clear to infection itself. This can take up to three weeks.

The misuse of antibiotics also contributes to the risk

If you have a cold or the flu, do not ask for antibiotics from your GP, as they do not work against viral infections. If you have a bacterial infection and a doctor prescribes antibiotics, take them as instructed. You must complete the course. Do not stop taking them as soon as your symptoms go away. Never share your medicines, save them for later use or dispose of them in the bin or the water system. If you have completed the course of treatment as instructed and have any medicine left over, or you find old medicines in your house, return them to a pharmacy for safe disposal.

Under no circumstances should you take antibiotics unless they have been prescribed by a doctor. We have heard stories of passengers bringing antibiotics illegally into the UK from other countries where antibiotics can be purchased over the counter. This practice increases the risk of getting a drug-resistant infection not only to the person taking the antibiotics but to those around them.

Good hygiene helps protect you and your family

Good hygiene, such as proper hand washing and the use of hand sanitisers, can significantly reduce the risk of illness  within your household and in the wider community. Sneeze and cough into tissues and dispose of them immediately after use. This precaution can also reduce the risk of passing on an infectious illness.

You can find out more using the Antibiotic Research UK web pages covering topics such as:

Communicating with communities

Another much-investigated reason for poor health outcomes in some BAME communities is the lack of effective engagement with them.

A one-size fits all approach does not get complex messages across. There are very diverse audiences within BAME communities to reach. For example, second-generation South Asians may read English better than their parents but they may not be the decision makers in the household.

Anecdotally, people from BAME backgrounds have told us that since antibiotics have been scarce in their countries of origin until recently. So, when they available, people buy antibiotics for when they might next require them. As they often have private health services, countries of origin also apply a ‘no one leaves without medication’ approach.

Antibiotic Research UK is working with partner groups to best communicate with BAME groups. We work with organisations such as NHS Oldham Clinical Commissioning Group, sharing their expertise in this area.

To join with us, please message peter.gibson@antibioticresearch.org.uk

Further reading

If you would like to know more about antibiotic-resistant infections, you can visit the Antibiotic Research UK website. The links below include more research on the topics explored in this article.

  1. Burden of present-on-admission infections and health care-associated infections, by race and ethnicity
  2. Racial, ethnic, and socioeconomic disparities in pituitary surgery outcomes
  3. Race and socioeconomic disparities in national stoma reversal rates
  4. Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-Resistant Staphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data
  5. Living conditions are associated with increased antibiotic resistance in community isolates of Escherichia coli
  6. Key demographic characteristics of patients with bacteriuria due to extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in a multiethnic community, in North West London