Religious and Cultural Barriers in Health Care Systems

The COVID-19 Pandemic and our way out of it – vaccination – has brought into sharp focus just how an individual’s concerns and reaction to treatment are shaped by their culture, ethnicity, religion, socioeconomic status and the sources of information they have access to.

All these factors have the potential of positively impacting an individual’s health, wellbeing and treatment but can also make them more vulnerable.

We don’t need to look far to see the impact of this in action. From the outset, the evidence was clear Black, Asian and minority ethnic groups had and still have higher rates of infection, serious disease, and deaths from COVID-19 and yet we hear reports everyday that the uptake of vaccines in these communities is low.

Examples of the concerns raised about the vaccines by these communities range from whether the vaccines are permissible for Muslims (a major concern being whether receiving a vaccine was interfering in God’s will) through to whether the vaccines are halal, or if they affect fertility or have an impact on our DNA. For some, the answers to these questions provided the clarity they needed and resulted in them accepting vaccination but for others, the responses provided were not enough and has led to an ever stronger reluctance not to be vaccinated.

What has become apparent is that the outward concerns about the vaccines are masking something much deeper. Scratching beneath the surface, what we have found is that the concerns from these communities are not necessarily about the vaccines themselves but a long-standing mistrust of public services. A mistrust fuelled by a history of marginalisation, structural racism and systematic discrimination going back decades.

In addition to all this within these communities, the amount of misinformation fuelled by an outspoken minority of anti-vaxxers cannot be understated. These groups capitalise on these examples of previous bad practice towards Black and Asian Minority Ethnic communities to feed an existing suspicion that these communities will be less favourably treated. Their campaigns, which began at the start of the pandemic, have led many from these communities not to get involved in research and to question the notion of having a vaccine.

It is therefore vital that as health care professionals we are aware of both the wider context of communities that patients are a part of, as well as the background of the patients themselves to understand what motivates patients to refuse or receive treatment and the information that they have access to which may be influencing their decisions. It is also important to think about how health messages are conveyed and by whom.

Here are a few simple points to consider (this is not an exhaustive list). These have been divided up into organisational and individual staff level but it is important to note that neither are mutually exclusive.

Organisational Level

The Pandemic has highlighted the need for public organisations like the NHS to actively engage with the communities to become culturally competent and learn how to serve their communities better.

Here are some ways in which organisations can achieve this:

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Individual Staff Level

If you require a text version of the above image, this is available as a PDF.

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Particularly when trying to counteract any inaccurate information, try to avoid saying that something is a fact – use instead ‘the evidence suggests’ – this way you are helping patients weigh up benefits and risks and are facilitating them to make informed choices based on accurate, evidenced and balanced information.

If you would like to look into this topic further, please take a look at the CCDH website and the Antivax playbook report.