Tackling health inequalities: learning from our forebears.

Abstract

British Journal of Nursing, 2014, Vol 23, No 22 1201 © 2 01 4 M A H ea lth ca re L td As 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), Janet Scammell