Chiropractic Care for Minority Groups: Bridging the gap
By BCA Board Member, Philippa Oakley
One could be forgiven for thinking that as we all have spines, chiropractic care shouldn’t need to vary based on a patient’s characteristics, or belonging to any minority groups. And yet, we’d be wrong. It’s well-established that individuals from minority groups have specific health needs and considerations, ranging from barriers to accessing healthcare to increased risk of developing specific conditions. [1]
Within the context of this article, we’ll think of key minority groups such as racial and ethnic minorities, LGBTQ+ individuals, religious minorities, and people with disabilities. It’s important to note that this isn’t an exhaustive list, and there are various other marginalised communities, both voluntary and involuntary, who each have their unique challenges and needs.
In the UK, as in many parts of the world, health inequalities persist among minority groups [2]. These disparities manifest in various ways, including access to healthcare services, quality of care received, and health outcomes.
When it comes to back pain, perhaps the leading reason why people seek help from a chiropractor, these health inequalities can have profound implications on both people’s outcomes from care and overall health, which has been identified within ARMA’s recently published “Musculoskeletal Health Inequalities and Deprivation” report. [3]
Let’s unpack this further
Racial and ethnic minorities in the UK often experience socioeconomic disadvantages, which can impact their access to healthcare services, including chiropractic care [4]. LGBTQ+ individuals may face discrimination or lack of understanding from healthcare providers, leading to barriers in seeking appropriate treatment [5]. Religious minorities may have cultural beliefs or practices that influence their health behaviours and treatment preferences [6], and people with disabilities may face systemic inequalities, in addition to physical and structural barriers when accessing healthcare [7].
It’s undisputed that we are all working to deliver the best care we can to our patients, but what do we do when the “same great care” isn’t enough for those already at a disadvantage? When providing individualised, holistic packages of care, are we taking sufficient steps beyond the ‘one size fits all’ approach? For example, black people tend to report greater myofascial and joint pain in comparison to white people. This knowledge would likely influence all of our treatment plans and affect our anticipated outcomes for those patients [8].
So, why should chiropractors be conscious of the healthcare needs of minority groups?
Everyone deserves access to the high-quality care chiropractors can provide, regardless of their background or identity. New research from the GCC shows that 71% of our patients believe EDI is important to the chiropractic profession [9]. If it’s important to our patients, it should be important to us. Chiropractors can play a vital role in reducing health disparities, promoting health equity, and delivering the exceptional level of person-centred care that BCA chiropractors excel at.
A recent systematic review of social determinants of health in low back pain showed important associations between gender, race, ethnicity, education, occupation, and socioeconomic status, and important facets of low back pain. As such, we can consider individuals from minority groups as some of those most in need of the care we can provide but also least likely to be able to afford it [10]. As a clinic owner myself, I know the sensitive balance that must be struck between the rising costs of running a clinic, and pro bono or reduced fee appointments.
Chiropractic Awareness Week 2024 centred around building connections and nurturing a community, providing an opportunity for all of us to forge stronger relationships with people from all walks of life. We saw chiropractors hosting workshops, providing drop-in screening sessions, and releasing all manner of informative marketing materials, demonstrating that inclusive healthcare doesn’t have to be limited to the confines of traditional hands-on care; we can increase access to the wealth of knowledge and resource that we are so willing to share, at minimal cost to us.
There are a few more steps we could take as a profession
Firstly, developing an understanding and awareness of the many factors that can influence health beliefs, behaviours and outcomes can help us identify what we can do to minimise barriers and open up our clinics to all. This could be through physical changes to our clinics, inclusive marketing practices, community outreach events or directly liaising with representatives from those groups.
Secondly, building trust and rapport with patients from minority groups is essential. I would like to see us exploring strategies that we, as a profession, can implement to reach out to these individuals and deliver knowledge, advice and education to bridge the gap between us and those who are perhaps most in need of the support and expertise we can provide.
Acknowledging and addressing the health inequalities faced by minority groups is not only a matter of providing better care but also of upholding the principles of fairness, respect, and compassion in our delivery of the evidence-based, person-centred care we take such pride in.
References:
[1] Gov.uk. n.d. Health disparities and health inequalities: Applying all our health. [online] Available at: https://www.gov.uk/government/publications/health-disparities-and-health-inequalities-applying-all-our-health/health-disparities-and-health-inequalities-applying-all-our-health [Accessed 9 May 2024].
[2] The King’s Fund. (2023). Health of people from ethnic minority groups in England. Retrieved from https://www.kingsfund.org.uk/insight-and-analysis/long-reads/health-people-ethnic-minority-groups-england
[3] Arthritis and Musculoskeletal Alliance. (2024). Musculoskeletal Health Inequalities and Deprivation report. Retrieved from https://arma.uk.net/wp-content/uploads/2024/03/Musculoskeletal-Health-Inequalities-and-Deprivation-report_v07.pdf
[4] Public Health Wales. (n.d.). Inequalities in access to healthcare services: Agile scoping report. [online] Available at: https://phw.nhs.wales/news/scoping-review-reveals-factors-behind-inequality-in-access-to-healthcare/inequalities-in-access-to-healthcare-services-agile-scoping-report/ [Accessed 9 May 2024].
[5] Stonewall. (2018). LGBT in Britain: Health Report. Available at: https://www.stonewall.org.uk/system/files/lgbt_in_britain_health.pdf (Accessed: May 9, 2024).
[6] Office for National Statistics. (2020). Religion and health in England and Wales. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/religion/articles/religionandhealthinenglandandwales/february2020 (Accessed: May 9, 2024).
[7] King’s College London. (2022). LeDeR 2022 Report. Available at: https://www.kcl.ac.uk/ioppn/assets/fans-dept/leder-2022-v2.0.pdf (Accessed: May 9, 2024).
[8] Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Manag. 2012 May;2(3):219-230. doi: 10.2217/pmt.12.7. PMID: 23687518; PMCID: PMC3654683.
[9] General Chiropractic Council. (2024). EDI attitudes patient report 2024. Retrieved from https://www.gcc-uk.org/assets/downloads/EDI_Attitudes_Patient_Report_2024.pdf
[10] Health Foundation. (2024). Inequalities in who is in poverty. Retrieved from https://www.health.org.uk/evidence-hub/money-and-resources/poverty/inequalities-in-who-is-in-poverty
