Breaking barriers: Tackling health inequalities in Black African and Caribbean Communities

For Black African and Caribbean communities, health inequalities are a persistent and deeply rooted reality, shaped by long-standing injustices in the healthcare system and underrepresentation in both policy and practice. 

These disparities manifest in poorer health outcomes compared to other ethnic groups. Black African and Caribbean populations are much more likely to be impacted by conditions like diabetes, chronic kidney disease and cardiovascular disease, with a direct link to lower access to timely, culturally appropriate care.

Inequalities within the health system mean that Black African and Caribbean communities will experience increased time spent in ill health, be at greater risk of long-term health conditions and, most sadly of all, have a lower life expectancy. The 10 year health plan for England highlights the need to tackle inequalities around access and narrow the gap for those experiencing worse outcomes in their care.

In north east London, these inequalities are starkly visible in the vaccine uptake data. Low vaccine uptake among Black African and Caribbean communities across north east London highlights issues that require deeper understanding.

Listening to lived experience

Despite targeted campaigns, Black African and Caribbean residents continue to have lower levels of vaccine confidence and engagement with health services. But behind the statistics lie stories of real people, with real lived experience whose stories are helping to shed light on why these issues continue.

One recent initiative set out to prioritise listening to those very stories. In Havering, a workshop led by grassroots organisation From Me to You (FM2U) recently took place.

Residents of all ages were welcomed to St George’s Wellbeing Hub where a safe and inclusive space had been made for open, honest dialogue. Listening was in fact the main purpose of the workshop and participants were invited to share their experiences with local health services.

What emerged were the experiences of real, local people and the barriers they had witnessed to gaining access to important healthcare. They shared their experiences of language barriers they had encountered, as well as digital exclusion. What also became evident was a lack of availability of culturally sensitive services; those that acknowledge, respect, and adapt to the diverse cultural backgrounds and beliefs of an individual when providing care.

Historical medical mistrust when it comes to vaccines was a key theme highlighted by participants, linked to long-standing structural and institutional racism in healthcare.

Those present shared their concerns around vaccine misinformation, perceptions of political undertones in messaging and transparency about possible side effects. Language barriers also played a key part in low confidence levels, with people not having all the information provided to them in a clear way so that they can feel equipped to make important decisions about their health.

One attendee said, they hoped in the future, “the NHS has a more person-centred approach when it comes to delivering vaccines to the African and Caribbean and Asian communities, that is more aware of the community’s belief systems, which might not support them taking vaccines.  Looking at the way it’s promoted, and the language used.”

Trust is built, not assumed

The workshop’s success lay in its collaborative, community-led approach. FM2U partnered with trusted local organisations such as Havering BME Forum, TARACC, and Ageless Teenagers to ensure the event was grounded in existing relationships within the community.

This model of co-production, where community groups actively work together to shape solutions, is so important in rebuilding trust and delivering care that is truly equitable for all and it’s success was evident in some of the feedback.

One attendee said, “It was important for community leaders to join the discussion. We were able to encourage the community in general to participate. The space felt safe to talk and it’s important to have our views heard. It showed unity and consensus across the issues that were discussed.”

This approach reflects NHS North East London’s broader focus on engaging communities and recognising social determinants of health. For our Bright Start in Life vaccination campaign, we listened to Black African and Caribbean parents share their experiences and concerns around vaccines and used their feedback to create more transparent and culturally relevant materials.

Similarly, the importance of listening to people’s lived experience is also what lies behind the success of the award-winning Tree of Life Programme in Hackney, helping African, Caribbean, and mixed heritage young people to explore their heritage and talk about difficult experiences in a safe environment to improve mental health in a more culturally attuned way.

Insight to action

The insights gathered from the Havering workshop are already informing local health messaging, including future vaccination campaign rollout. The findings are being shared with key strategic groups and partners and plans are underway to co-develop an action plan with Havering BME Forum, to ensure the valuable insight shared at the workshop is listened to and acted upon. Those that attended the workshop will be involved in reviewing and refining this plan so that they maintain community ownership.

We understand that addressing these long-standing disparities requires more than one-off events or awareness campaigns. These injustices need to be addressed as part of a wider, sustained effort to tackle the barriers that continue to impact the lives of Black African and Caribbean communities, as we work towards a fairer healthcare system for everyone.

Sam Ogunkoya, Engagement and Community Communications Lead, NHS North East London