Discriminatory Care And South Asian Patients With Chronic Gastrointestinal Diseases

The research in this dissertation has shown widespread and prolonged discrimination in provision of healthcare to South Asian patients with chronic gastrointestinal diseases. The data, which forms the basis for the analysis, were collected using different techniques, in different places and at different times. The consistency of the findings reinforces their reliability. In the initial study, a cohort of newly diagnosed patients with ulcerative colitis was assessed over a 10-year period. South Asian patients were less likely to see a consultant, underwent less investigations and were more likely to be discharged. Subsequent studies showed South Asian patients with Crohn’s disease were less likely to receive expensive biologic therapies. These studies reviewed treatment registers and data generated from Freedom of Information requests. In the case of achalasia, the first study of its incidence in the South Asian community showed it to be of comparable frequency to White British people. The first meta-analysis of cancer frequency demonstrated the risk to increase progressively with time, although no specific information for the South Asian community could be extracted. However, a review of treatment modalities demonstrated South Asians with achalasia were significantly more likely to receive novel treatments given by practitioners on the early part of their learning curve. Despite objective evidence for substandard care given to South Asian patients, trusts and associated monitoring bodies, where this happened, denied the reality of the findings and reported no appropriate adjustments. National bodies with statutory responsibility for ensuring equitable care could provide no examples of actions which they had taken to remedy such situations. A review of legal options through which poorer care for South Asian patients could be addressed failed to identify any effective remedies and proposed that the only effective option available was through the tort of negligence. Potential methods of improving this situation are discussed.