Historically, Black, Asian, and minoritised ethnic communities have been excluded or mistreated by healthcare systems. From globally-significant atrocities of the past — such as the Tuskegee syphilis study to more contemporary failings including inequalities in healthcare outcomes related to Covid-19 and maternal mortality rates — many minoritised ethnic people have good reason to be distrustful of the health and care establishment.
Designing health and care treatments, services and systems which address the underlying factors causing racial health inequalities requires effective collaboration with the people impacted by those inequalities, built on trust.
As such, transformation approaches which genuinely share power between professionals and people with lived experience are vital, placing marginalised voices at the core of driving positive change. These approaches must go beyond traditional “Patient and Public Involvement and Engagement” (PPIE), where engagement tends to be limited to consultation on existing plans or minority representation on steering groups.
Co-production of solutions is sometimes referred to as the ‘gold standard’ for developing and implementing new mechanisms to improve healthcare services. This is a process that involves service providers and community members working together in equal partnership to design, shape, and deliver services for the target community.
Within the context of the Race Equity Maturity Index (REMI), co-production is also an important tool for more mature organisations to use for Creating and Championing anti-racist projects and programmes with Black, Asian and minoritised ethnic people and communities.
Building trust for effective engagement
In January, LARCH’s latest learning and engagement webinar, “Hearing Community Voices: Effective Engagement to Reduce Health Inequality” addressed the importance of building trust within communities in the process of co-production.
Lucy Morgan from the Health Policy Partnership established the concept of trust within the context of co-production as “someone’s willingness to put themselves in a situation where they are dependent on someone else, or where they can accept help from someone else, with the belief that that person will have their best interest”.
She introduced four pillars as a guide to build back trust from traditionally underrepresented groups to increase health equity:
- Understanding
- Inclusion
- Communication
- Data generation
Figure 1: How can health systems earn trust?
Source: Earning trust: a foundation for health equity
Making the most of knowledge intermediaries
Both Rini Jones, Senior Policy and Delivery Manager at the NHS Race and Health Observatory, and Safia Marcano from the London Association of Directors of Public Health, highlighted the importance of acknowledging and addressing the lack of trust in healthcare institutions as a primary step.
Acknowledging historical injustices against communities is crucial for creating safe and appropriate spaces for engagement. Rini emphasised the importance of “knowledge intermediaries” – a group of working professionals that belong to the community and help bridge the gap between their community and professional organisations. They play a crucial role in co-production as they can act as cultural and linguistic mediators.
Safia echoed a similar sentiment in her presentation, pointing to shared language and agreed terminologies being essential for creating understanding between communities and healthcare institutions. Through building mutual understanding, healthcare initiatives can ensure they are community-led and appropriately tailored to the lived experiences of those in the community.
Connecting with people through choosing the right channels
The importance of engaging with communities through trusted voices was echoed by Riyadh Karim, Assistant Director of Community Engagement Vaccine and Screening Equity in London for NHS England. He used the example of his colleagues at the London Bangladeshi Health Partnership taking on television talk show interviews on Bangladeshi channels. While some might assume the best way to reach an audience would be through a national channel, they knew from their experience of engaging with the community that “Bangladeshis prefer to listen and access the plethora of Bangladeshi channels beaming out of London”. In recognition of that, they mobilise opportunities for GPs, NHS leaders, and other community engagement specialists to have discussions in these spaces. In short: a “trusted voice, within the trusted channels with trusted leaders”.
Becoming a part of communities to build engagement
Keymn Whervin, Health and Social Care Strategic Co-production, Co chair of the WM-ADASS Co-production Advisory Group and Lived Experience Expert, elaborated on the importance of holistic approaches to co-production. She mentioned community spaces can be an empowering way to engage the community in co-production. For example, for Britain’s Black community, barbershops have been identified as community hubs to support men’s mental health. By leveraging these spaces, service providers can build relationships and co-design solutions that are responsive to community needs. Keymn acknowledges a holistic approach can take a long time, but in the long run it can be more valuable in ensuring meaningful engagement rather than tokenistic participation.
Building trust in co-production to address health inequalities among Black, Asian and minoritised ethnic communities in London requires a nuanced approach. While there is no one-size fits all approach to building trust, efforts to build understanding of communities, and intentional collaboration with those communities, underpins the driving force behind each of them.
By prioritising building trust with communities for co-production, the healthcare sector can move towards a more equitable future.
To find out more, explore our resources on co-production for anti-racist transformation.
