There is clear evidence that BME individuals and groups experience barriers to accessing health care services which may in turn affect their health outcomes. For example, Airey and Evans (1999) reporting a national survey of NHS patients seen in general practice found that: • Almost half of Asian women reported being unable to see a female GP either always or sometimes (c. f. 25 per cent white women and 35 per cent black Caribbean or African women) (p. 192);
• Seeing a GP of a person’s own ethnic group is most important for those who do not speak English (among Chinese people, 17 per cent of English speakers thought it important, compared with 41 per cent of non-English speakers) (p. 193); • White patients were more likely to say they were seen by their GP soon enough (81 per cent against 63 per cent for ethnic minorities) (p. 106); • 32 per cent of Bangladeshi and 33 per cent of Chinese patients said GP consultation was too short (c. f. 25 per cent white and 21 per cent black Caribbean) (p. 118); and • 19 per cent of minority ethnic patients have wanted to complain in the past months but have not done so (c. f. 11 per cent of white patients) (p. 226).
Explanations of Social Inequalities in Health Although social differences in the provision of medical care in the United States are pointed to as an explanation of existing social inequalities in health in that country, in the United Kingdom they are a less likely explanation because of universal access under the National Health Service.
One way medical care’s contribution to health has been assessed is by separating causes of death into two categories: those thought to be amenable to medical intervention and those thought not to be amenable (i. e. , where medical care is judged to make no difference to the mortality rate). In the United Kingdom, the improvement in mortality over time is largely the result of the decline in causes of death judged to be nonamenable to medical care.
The improvement in mortality has been greater for higher than for lower social classes because there has been a greater decline in the causes of death among the higher classes (Marmot, Michale G. , 1994). Just as medical care plays a limited role in generating social inequalities in health; it also plays a limited role in generating international inequalities in health. For example, Japan, like the United Kingdom, spends a relatively small proportion of its GNP on medical care.
Unlike the United Kingdom, however, Japan experienced a decline in mortality for both amenable and nonamenable causes of death (Marmot, Michale G. , 1994). A second possible explanation for social inequalities in health is health selection, the idea that health may determine social position rather than the reverse. For example, people with schizophrenia tend to be downwardly mobile. However, there is no evidence to support health selection as an explanation of broader social inequalities in health (Marmot, Michale G. , 1994).